Abstract
Photodynamic therapy is a nonsurgical therapeutic option for the management of endobronchial tumors. It involves intravenous injection of a photosensitizing drug, followed by direct application of a nonthermal laser. The laser provides the wavelength of light to activate the drug in the tumor. Once activated, the drug causes cell death through oxygen free radical generation, small vessel thrombosis, and a tumor-specific cytotoxic immunity. The necrotic debris should be removed by bronchoscopy to avoid airway obstruction.
Photodynamic therapy is currently indicated in patients with microinvasive endobronchial non-small cell lung cancer (NSCLC) and comorbidities that render them ineligible for surgical resections, where it is used with a curative intent and in patients with completely or partially obstructing endobronchial NSCLC who require debulking of the airway tumor for palliation of symptoms. Photodynamic therapy is also useful in debulking endobronchial metastatic lesions from nonpulmonary malignancies.
The major adverse reaction following PDT is skin photosensitivity that can be avoided with meticulous pre- and postprocedure patient education. Other adverse reactions include transient local inflammatory response, airway stenosis at the site of treatment, and, rarely, massive hemoptysis. The utility of PDT in the management of lung cancers is only expected to expand as newer photosensitizing drugs are developed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Dougherty TJ, Potter WR, Weishaupt KR. The structure of the active component of hematoporphyrin derivative. In: Doiron DR, Gomer CJ, editors. Porphyrin localization and treatment of tumors. New York: A.R. Liss. 1984; pp. 301–314.
Lipson RL, Blades EJ, Olsen AM. Hematoporphyrin derivative: a new aid for endoscopic detection of malignant disease. J Thorac Cardiovasc Surg. 1961;42:623–9.
Dougherty TJ, Kaufman JE, Goldfarb A, et al. Photoradiation therapy for the treatment of malignant tumors. Cancer Res. 1978;38:2628–35.
Hayata Y, Kato H, Konaka C, et al. Hematoporphyrin derivative and laser photoradiation in the treatment of lung cancer. Chest. 1982;81:269–71.
Lo Cicero J, Metzdorff M, Almgren C. Photodynamic therapy in the palliation of late stage obstructing non-small cell lung cancer. Chest. 1990;98:97–100.
Ackroyd R, Kelty C, Brown N, et al. The history of photodetection and photodynamic therapy. Photochem Photobiol. 2001;74(5):656–69.
Gomer CJ, Dougherty TJ. Determination of [3H]- and [14C] hematoporphyrin derivative distribution in malignant and normal tissue. Cancer Res. 1979;39:146–51.
Dougherty TJ, Gomer CJ, Henderson BW, et al. Photodynamic therapy. J Natl Cancer Inst. 1998;90:889–905.
Pass HI. Photodynamic therapy in oncology: mechanism and clinical use. J Natl Cancer Inst. 1993;8:443–56.
Wieshaupt KR, Gomer CJ, Dougherty TJ. Identification of singlet oxygen as cytotoxic agent in photoinactivation of a murine tumor. Cancer Res. 1976;36:2326–9.
Kessel D, Luo Y. Mitochondrial photodamage and PDT-induced apoptosis. J Photochem Photobiol. 1998;42:89–95.
Fingar VH. Vascular effects of photodynamic therapy. J Clin Laser Med Surg. 1996;14:323–8.
Korbelik M. Induction of tumor immunity by photodynamic therapy. J Clin Laser Med Surg. 1996;14:329–34.
Hayata H, Kato H, Konaka C, et al. Photoradiation therapy with haematoporphyrin derivative in early and stage I lung cancer. Chest. 1982;81:269–77.
Moghissi K, Dixon K. Update on the current indications, practice and results of photodynamic therapy (PDT) in early central lung cancer (ECLC). Photodiagnosis Photodyn Ther. 2008;5:10–8.
Kennedy TC, McWilliams A, Edell E, et al. Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd ed). Chest. 2007;132:221–33.
Koike T, Terashima M, Takizawa T, et al. Surgical results for centrally located early stage lung cancer. Ann Thorac Surg. 2000;70:1176–9.
Terzi A, Pelosi G, Falezza G, et al. Early hilar lung cancer clinical aspect and long term survival – identification of sub group IA patients with more favorable prognosis. Lung Cancer. 2000;27:119–24.
Ernst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med. 2004;169:1278–97.
Shah SK, Ost D. Photodynamic therapy: a case series demonstrating its role in patients receiving mechanical ventilation. Chest. 2000;118:1419–23.
Lam S, Grafton C, Coy P, et al. Combined photodynamic therapy (PDT) using photofrin and radiotherapy (XRT) versus radiotherapy alone in patients with inoperable obstructive non-small cell bronchogenic carcinoma. SPIE. 1991;1616:20–8.
Moghissi K, Dixon K, Hudson E, et al. Endoscopic laser therapy in malignant tracheobronchial obstruction using sequential Nd:YAG laser and photodynamic therapy. Thorax. 1997;52:281–3.
Freitag L, Ernst A, Thomas M, et al. Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma. Thorax. 2004;59:790–3.
McCaughan JS. Survival after photodynamic therapy to non-pulmonary metastatic endobronchial tumors. Lasers Surg Med. 1999;24:194–201.
Litle VR, Christie NA, Fernando HC, et al. Photodynamic therapy for endobronchial metastases from nonbronchogenic primaries. Ann Thorac Surg. 2003;76:370–5.
Reddy C, Michaud G, Majid A, et al. Photodynamic therapy in the management of endobronchial metastatic lesions from renal cell carcinoma. J Bronchol Inter Pulmonol. 2009;16:245–9.
PHOTOFRIN® (porfimer sodium) injection US Package Insert, August 2008.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Reddy, C. (2013). Photodynamic Therapy. In: Ernst, A., Herth, F. (eds) Principles and Practice of Interventional Pulmonology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4292-9_37
Download citation
DOI: https://doi.org/10.1007/978-1-4614-4292-9_37
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-4291-2
Online ISBN: 978-1-4614-4292-9
eBook Packages: MedicineMedicine (R0)