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
- Assistant 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.
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- 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