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Eur J Cardiothorac Surg 1999;15:1-6
© 1999 Elsevier Science NL

The place of bronchoscopic photodynamic therapy in advanced unresectable lung cancer: experience of 100 cases¹

^a The Yorkshire Laser Centre, Goole and District Hospital, Woodland Avenue, Goole, East Yorkshire, UK
^b Department of Applied Physics, The University of Hull, Hull, UK
^c Centre for Photobiology and Photodynamic Therapy, The University of Leeds, Leeds, UK

Received 25 August 1998; received in revised form 19 October 1998; accepted 20 October 1998.

^* Corresponding author. Tel./fax: +44-1724-290-456.

Objectives: The objectives of the study were: (1) to evaluate effectiveness of photodynamic therapy (PDT) for symptom palliation in patients with inoperable lung cancer; (2) to determine survival benefit in a subset of patients. Methods: One hundred patients, 68 male, 32 female, aged 44–81 years (mean 62.5) with advanced inoperable bronchogenic cancer and endobronchial luminal obstruction were prospectively studied. Eighty-two percent had previous chemo/radiotherapy. The pre-treatment protocol consisted of: clinical, radiological and bronchoscopic examination, pulmonary function testing, assessment of WHO performance status and clinical staging. Treatment protocol was: intravenous injection of 2 mg/kg body weight of photofrin/polyhaematoporphyrin and interstitial illumination using 630 nm laser light 24–72 h later. Follow-up was at 6–8 weeks for 1 year. Then every 3–6 months if applicable. Repeat PDT as necessary. Results: All patients were stage IIIa–IV. The histology of the tumour was: non small cell in 90 and small cell in 10. There was no treatment related mortality. Mean endoluminal obstruction fell from 85.8% to 17.5%, mean forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) improvement was 430 ml and 280 ml, respectively. Ninety patients died from 6 weeks to 37 months, mean and median survival: 9 months and 5 months, respectively. Ten patients are alive from 13 to 72 months, mean 36 months, median 29 months. Overall 2-year survival was 19%. Multivariant analysis indicated that age, sex, histology and stage of disease did not influence survival significantly but performance status did. Patients with WHO<2 had mean and median survival of 17.8 and 14 months versus WHO>2, 6.9 mean and 4 months median survival (log-rank P<0.0001). Conclusions: (1) PDT is effective in palliation of inoperable advanced lung cancer. (2) Subset of patients with a better performance status have added survival benefit.

Key Words: Photodynamic therapy • Lung cancer

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