PDT is the most extensively studied endobronchial treatment for early lung cancer in patients who are not candidates for surgical resection. Potential advantages of this localized therapeutical modality relative to other techniques include tumor selectivity and complete healing of the bronchial mucosa after illumination. However, some observations suggest that complete healing is not always present, and we reviewed our own experience with this treatment.
In our experience, 21 patients with superficial squamous cell carcinoma were treated with PDT, using Photofrin II as sensitizer. In this series, we reviewed the cases of airway scarring and local stenosis induced by the treatment.
In 2 out of 21 patients treated with PDT, severe stenosis developed after PDT. In the first case, a carcinoma in situ (CIS) at the level of right bronchus 6 was treated with PDT and was associated with a 90% stenosis of the right lower lobe within 3 months that was treated with success by balloon dilatation under local anesthesia. The patient later developped a CIS at the level of the trachea that was treated with PDT. The second case was referred for the treatment of an early invasive cancer disclosed at the level of left bronchus 3 during a “clean up bronchoscopy” performed 2 weeks after right pneumonectomy for cancer. Fluorescence bronchoscopy disclosed a second early invasive cancer at the level of left bronchus 1. Both invasive lesions were treated with PDT (two illuminations) and complete stenosis of the two bronchi developed within a few months. Dilatation was technically impossible.
These cases suggest that, in contradiction with general thinking, PDT is not tumor selective and does not always lead to complete healing of the bronchial mucosa. In this series, this complication occured in about 10% of cases (2/21).
Since selectivity of PDT is challenged, this observation should promote comparative studies with alternative therapeutical modalities (e.g., electrocautery, cryotherapy) that are also cheaper.
P. Pierard, None.