Response and Pattern of Failure After Photodynamic Therapy for Intraluminal Stage I Lung Cancer

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Abstract
Photodynamic therapy (PDT) causes selective tumor damage and has been shown to be effective in the treatment of early-stage lung cancer. Thirty patients, with 39 intraluminal cancer lesions, who were considered to be high-risk surgical candidates, were treated with PDT. A complete response after PDT was found in 23 patients (28 lesions), in 20 patients (25 lesions) after the first treatment and in 3 patients after the second treatment. Thirteen complete responders (18 tumors) are still alive, with a median survival of 10 months (range, 2–95 months). Two patients developed subsequent primaries (4 and 40 months), seven had recurrences (2–19 months), and one developed nodal disease. Therefore, the overall long-term success rate of PDT in terms of local control was 46%. Two of the partial responders achieved a complete response after external irradiation; one is still in complete-response status after 52 months. Bronchoscopic evaluation showed that partial responders had tumors located distal to a segmental bronchial bifurcation or in bronchial stumps. Our data suggest that inadequate light delivery or an insufficient light dose may account for treatment failure in this category of patients. Improvement of light dosimetry and better assessment of tumor extension may increase the efficacy of PDT.

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