[Photodynamic therapy for bronchogenic carcinoma]

Laser endoscopic surgery has now achieved a status as effective therapeutic modality for lung cancer. Especially increasing attention has been focused on photodynamic therapy (PDT) using Photofrin and excimer dye laser. PDT obtained government approval in October 1994 and finally obtained national insurance reimbursement status in April 1996. Over the past decade, 248 patients (296 lesions) with central type lung cancers have been treated in our hospital. Overall complete remission was obtained in 42.5% of the 125 lesions, partial remission in 56.8% and no remission was obtained in 1.0%. Indications of PDT are follows, 1. Early stage lung cancer as a curative purpose: among 104 early stage lesions CR was obtained in 87 (83.7%) and 61 cases were disease free at 2 to 178 months. 2. Advanced lesions for opening of bronchi: overall, "effective" opening of bronchi was achieved in 61 out of 81 lesions (75%) for the PDT group, as opposed to 143 of 177 (81%) for the Nd-YAG laser therapy group. 3. Preoperative laser irradiation for the propose of increasing operability and reducing the extent of resection area: the initial purpose of PDT, i.e., either reduction of extent of resection of conversion of inoperable disease to operable status, was achieved in 21 out of 21 patients treated. 4. Multiple primary lung cancer. The success from clinical trials using PDT for treatment of cancers offers encouragement for its future use. More stable, definitive and more successful results will be obtained if new dyes which distribute more equally in the tumor tissue and deeper tissue penetration by longer wavelength beams are used.