Breast cancer with chest wall progression: treatment with photodynamic therapy.
BACKGROUND
Chest wall progression of breast carcinoma affects up to 5% of breast cancer patients and is a major source of their pain. Treatment options are limited or may not be offered to these patients. Low-dose Photofrin-induced photodynamic therapy (PDT) offers an excellent clinical response with minimal morbidity. We report our continued experience with PDT in this setting.


METHODS
Fourteen patients with more than 500 truncal metastases were treated with PDT. All received off-label Photofrin (.8 mg/kg) i.v. and light treatment at 630 nm from a diode laser with a microlens at a fluence of 1800 mW and a total light dose of 150 to 200 J/cm2 at 48 hours. One patient required re-treatment because of extensive disease.


RESULTS
Follow-up was at least 6 months, and several extended to >24 months. All patients demonstrated tumor necrosis, with 9 of 14 complete responses, including with lesions >2 cm in thickness. Disease progression occurred outside of the treatment field. Several patients had initial regression of untreated lesions. Wound care, especially with disease in the deep tissues, was an issue.


CONCLUSIONS
Low-dose Photofrin-induced PDT offers patients with chest wall progression a treatment option with an excellent clinical response. To date, the response is prolonged and offers good local control. Surgical oncologists have an active role in this treatment option.
Photodynamic Therapy Program, Leo Jenkins Cancer Center, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA. cuencar@mail.ecu.edu
Rosa E
RE
Cuenca
Ron R
RR
Allison
Claudio
C
Sibata
Gordon H
GH
Downie
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D009362:Neoplasm Metastasis; D010778:Photochemotherapy; D035441:Thoracic Wall / Q000473:pathology*; D016896:Treatment Outcome; D014945:Wound Healing
D000970:Antineoplastic Agents; D017323:Dihematoporphyrin Ether