Photoradiation therapy with hematoporphyrin derivative in early and stage 1 lung cancer

Photoradiation therapy with hematoporphyrin derivative was used in 13 cases of early-stage and eight cases of stage 1 central-type lung cancer. The lesions were photoradiated superficially or interstitially by an argon dye laser with a power of 80 to 600 mW for 10 to 40 minutes at 48 hours or more after intravenous injection of 2.5 to 5.0 mg of hematoporphyrin derivative (Photofrin) per kilogram of body weight. Eight of the 13 early-stage cases were treated with photoradiation only, due to poor pulmonary function or refusal of surgery. Macroscopically complete tumor remission was obtained in all eight cases, and the patients are free of disease at 13 to 41 months after photoradiation therapy, except two patients who died at 16 and 31 months after therapy, due to chronic obstructive pulmonary disease and cerebral infarction, respectively. Five cases were resected following photoradiation therapy. Complete remission was demonstrated histologically in two and significant remission in three, and all are free of disease at 7 to 30 months after surgery. The histologic type was squamous cell carcinoma in all cases. In eight stage 1 cases (seven squamous cell carcinomas and one large cell carcinoma), surgery was performed in three after photoradiation therapy, and the remaining five cases were not resected, due to poor pulmonary function or refusal of surgery. Apparent complete remission was obtained in two of the nonresected cases (one died of cerebral infarction at 27 months, while recurrence occurred 15 months after photoradiation therapy in the other) and significant remission in six. In three nonresected cases with significant remission, two patients died of pneumonia unrelated to the photoradiation treatment at 11 and 4 months, respectively, after such treatment. The reason why only significant remission was obtained in early and stage-1 cases was due to the penetration of the argon dye laser beam being limited due to the location of the tumor or the degree of intrabronchial or extrabronchial growth in eight cases. In one other case the power of the argon dye laser beam was insufficient due to technical difficulties. Indications for photoradiation therapy were discussed in relation to the histologic findings in the specimens following such therapy. Procedures were performed under local anesthesia in all cases. Our results indicate that with present methods, photoradiation therapy is effective in cases of superficial invasion or intramural invasion, but curative effects can hardly be expected in cases growing beyond the normal muscular or cartilaginous layer.(ABSTRACT TRUNCATED AT 400 WORDS)