Endobronchial photodynamic therapy in the management of airway disease in adults
- Joseph LoCicero, III, MD, FCCP
Joseph LoCicero, III, MD, FCCP
- Professor of Surgery Emeritus
- SUNY Downstate
- Septimiu Murgu, MD
Septimiu Murgu, MD
- Associate Professor
- University of Chicago
Photodynamic therapy (PDT) is a non-thermal ablative technique. Cells in tissue, which previously received a photosensitizing chemical, die when exposed to a specific light wavelength.
Since the early 1900s, it has been used to treat cancers of the esophagus, stomach, bladder, skin, oropharynx, and biliary tree. The same principles of PDT can be applied using bronchoscopes to treat airway disease, primarily endobronchial non-small cell lung cancer (NSCLC).
The principles and procedure, as well as the indications, contraindications, and complications of bronchoscopic PDT, are reviewed in this topic. Other bronchoscopic techniques used to manage airway disease and the use of PDT for the treatment of other types of cancers are described separately. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults" and "Endobronchial electrocautery" and "Bronchoscopic argon plasma coagulation in the management of airway disease in adults" and "Airway stents" and "Flexible bronchoscopy balloon dilation" and "Endobronchial brachytherapy" and "Barrett's esophagus: Treatment with photodynamic therapy" and "Treatment of actinic keratosis", section on 'Photodynamic therapy' and "Treatment and prognosis of basal cell carcinoma at low risk of recurrence", section on 'Photodynamic therapy' and "Treatment and prognosis of cutaneous squamous cell carcinoma", section on 'Photodynamic therapy' and "Ampullary carcinoma: Treatment and prognosis", section on 'Minimally-invasive nonsurgical therapies' and "Early gastric cancer: Treatment, natural history, and prognosis", section on 'Other endoscopic modalities' and "Bronchoscopic cryotechniques in adults" and "Treatment options for locally advanced cholangiocarcinoma", section on 'Photodynamic therapy'.)
PRINCIPLES OF PHOTODYNAMIC THERAPY
Phototoxic reaction — The phototoxic reaction depends upon the cellular uptake of a photosensitizing agent, which is usually administered intravenously (see 'Photosensitizing agent administration' below). Photosensitized tissue is subsequently exposed to light (usually 48 hours later) (see 'Bronchoscopic phototherapy' below). The light induces a type II photo-oxidative intracellular reaction, in which molecular oxygen is transformed to singlet reactive oxygen species (ROS) [1,2]. The presence of excessive amounts of intracellular ROS results in cell death and, consequently, tissue necrosis.
Tumor cells and the neovascular endothelium of tumors preferentially retain the photosensitizer such that the cytotoxic reaction is somewhat selective for neoplastic cells . Capillary damage and tumor necrosis begin within hours after illumination; however, the maximal clinical effect of tissue destruction takes a few days to be appreciated.
- Dougherty TJ. Hematoporphyrin derivative for detection and treatment of cancer. J Surg Oncol 1980; 15:209.
- Edell ES, Cortese DA. Photodynamic therapy. Its use in the management of bronchogenic carcinoma. Clin Chest Med 1995; 16:455.
- Gomer CJ, Dougherty TJ. Determination of [3H]- and [14C]hematoporphyrin derivative distribution in malignant and normal tissue. Cancer Res 1979; 39:146.
- Dougherty TJ, Marcus SL. Photodynamic therapy. Eur J Cancer 1992; 28A:1734.
- Miyazu Y, Miyazawa T, Kurimoto N, et al. Endobronchial ultrasonography in the assessment of centrally located early-stage lung cancer before photodynamic therapy. Am J Respir Crit Care Med 2002; 165:832.
- Diaz-Jiménez JP, Martínez-Ballarín JE, Llunell A, et al. Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction. Eur Respir J 1999; 14:800.
- Minnich DJ, Bryant AS, Dooley A, Cerfolio RJ. Photodynamic laser therapy for lesions in the airway. Ann Thorac Surg 2010; 89:1744.
- McCaughan JS Jr. Survival after photodynamic therapy to non-pulmonary metastatic endobronchial tumors. Lasers Surg Med 1999; 24:194.
- Moghissi K. Role of bronchoscopic photodynamic therapy in lung cancer management. Curr Opin Pulm Med 2004; 10:256.
- McCaughan JS Jr. Photodynamic therapy of endobronchial and esophageal tumors: an overview. J Clin Laser Med Surg 1996; 14:223.
- Kato H, Okunaka T, Shimatani H. Photodynamic therapy for early stage bronchogenic carcinoma. J Clin Laser Med Surg 1996; 14:235.
- Cortese DA, Edell ES, Kinsey JH. Photodynamic therapy for early stage squamous cell carcinoma of the lung. Mayo Clin Proc 1997; 72:595.
- Moghissi K, Dixon K, Stringer M, et al. The place of bronchoscopic photodynamic therapy in advanced unresectable lung cancer: experience of 100 cases. Eur J Cardiothorac Surg 1999; 15:1.
- McCaughan JS Jr, Williams TE. Photodynamic therapy for endobronchial malignant disease: a prospective fourteen-year study. J Thorac Cardiovasc Surg 1997; 114:940.
- Maziak DE, Markman BR, MacKay JA, et al. Photodynamic therapy in nonsmall cell lung cancer: a systematic review. Ann Thorac Surg 2004; 77:1484.
- Hugh-Jones P, Gardner WN. Laser photodynamic therapy for inoperable bronchogenic squamous carcinoma. Q J Med 1987; 64:565.
- Simone CB 2nd, Friedberg JS, Glatstein E, et al. Photodynamic therapy for the treatment of non-small cell lung cancer. J Thorac Dis 2012; 4:63.
- 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.
- Santos RS, Raftopoulos Y, Keenan RJ, et al. Bronchoscopic palliation of primary lung cancer: single or multimodality therapy? Surg Endosc 2004; 18:931.
- DeArmond DT, Mahtabifard A, Fuller CB, McKenna RJ Jr. Photodynamic therapy followed by thoracoscopic sleeve lobectomy for locally advanced lung cancer. Ann Thorac Surg 2008; 85:e24.
- Lee JE, Park HS, Jung SS, et al. A case of small cell lung cancer treated with chemoradiotherapy followed by photodynamic therapy. Thorax 2009; 64:637.
- Akopov A, Rusanov A, Gerasin A, et al. Preoperative endobronchial photodynamic therapy improves resectability in initially irresectable (inoperable) locally advanced non small cell lung cancer. Photodiagnosis Photodyn Ther 2014; 11:259.
- Jheon S, Kim T, Kim JK. Photodynamic therapy as an adjunct to surgery or other treatments for squamous cell lung cancers. Laser Ther 2011; 20:107.
- Cai XJ, Li WM, Zhang LY, et al. Photodynamic therapy for intractable bronchial lung cancer. Photodiagnosis Photodyn Ther 2013; 10:672.
- McCaughan JS Jr, Hawley PC, LaRosa JC, et al. Photodynamic therapy to control life-threatening hemorrhage from hereditary hemorrhagic telangiectasia. Lasers Surg Med 1996; 19:492.
- Lieder A, Khan MK, Lippert BM. Photodynamic therapy for recurrent respiratory papillomatosis. Cochrane Database Syst Rev 2014; :CD009810.
- Endo C, Miyamoto A, Sakurada A, et al. Results of long-term follow-up of photodynamic therapy for roentgenographically occult bronchogenic squamous cell carcinoma. Chest 2009; 136:369.
- Usuda J, Ichinose S, Ishizumi T, et al. Management of multiple primary lung cancer in patients with centrally located early cancer lesions. J Thorac Oncol 2010; 5:62.
- Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study. Lung Cancer 2003; 39:49.
- Furukawa K, Kato H, Konaka C, et al. Locally recurrent central-type early stage lung cancer < 1.0 cm in diameter after complete remission by photodynamic therapy. Chest 2005; 128:3269.
- 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.
- Furuse K, Fukuoka M, Kato H, et al. A prospective phase II study on photodynamic therapy with photofrin II for centrally located early-stage lung cancer. The Japan Lung Cancer Photodynamic Therapy Study Group. J Clin Oncol 1993; 11:1852.
- Kato H, Usuda J, Okunaka T, et al. Basic and clinical research on photodynamic therapy at Tokyo Medical University Hospital. Lasers Surg Med 2006; 38:371.
- Allison R, Moghissi K, Downie G, Dixon K. Photodynamic therapy (PDT) for lung cancer. Photodiagnosis Photodyn Ther 2011; 8:231.
- Chen KC, Hsieh YS, Tseng YF, et al. Pleural Photodynamic Therapy and Surgery in Lung Cancer and Thymoma Patients with Pleural Spread. PLoS One 2015; 10:e0133230.
- Simone CB 2nd, Cengel KA. Photodynamic therapy for lung cancer and malignant pleural mesothelioma. Semin Oncol 2014; 41:820.
- Friedberg JS, Mick R, Stevenson JP, et al. Phase II trial of pleural photodynamic therapy and surgery for patients with non-small-cell lung cancer with pleural spread. J Clin Oncol 2004; 22:2192.
- Okunaka T, Kato H, Tsutsui H, et al. Photodynamic therapy for peripheral lung cancer. Lung Cancer 2004; 43:77.
- Vrouenraets MB, Visser GW, Snow GB, van Dongen GA. Basic principles, applications in oncology and improved selectivity of photodynamic therapy. Anticancer Res 2003; 23:505.
- Capella MA, Capella LS. A light in multidrug resistance: photodynamic treatment of multidrug-resistant tumors. J Biomed Sci 2003; 10:361.
- Colt HG, Murgu SD, Korst RJ, et al. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e437S.
- PRINCIPLES OF PHOTODYNAMIC THERAPY
- Phototoxic reaction
- Light source
- INDICATIONS AND EFFICACY
- Airway obstruction
- - Malignant
- Tumor or patient characteristics
- Comparison with other ablative procedures
- - Benign
- Radiographic occult lung cancer
- Stump recurrence
- Patients with extrinsic compression
- Patients with life-threatening symptoms
- Patients with lesions adjacent to a major blood vessel
- Contraindications to bronchoscopy
- Photosensitizing agent administration
- Bronchoscopic phototherapy
- Photodynamic therapy specific
- Bronchoscopy specific
- Repeat bronchoscopy
- Photosensitivity precautions
- SUMMARY AND RECOMMENDATIONS