Long-term survival of patients treated with photodynamic therapy for carcinoma in situ and early non-small-cell lung carcinoma.
OBJECTIVE
The role of photodynamic therapy (PDT) in the treatment of small cancers has been established in several clinical studies. Here, we report on the efficacy of PDT for early inoperable or recurrent non-small-cell lung cancer (NSCLC).


METHODS
From June 1989 to November 2004, 40 patients with 50 NSCLC were treated with PDT. Twelve cases were inoperable for medical reasons and were staged as T1N0M0, and 28 had recurrent in situ carcinoma. Patients with residual disease after PDT received definitive radiotherapy and/or brachytherapy. Follow-up ranged from 6 to 167 months (median 43.59). Twenty of the 40 patients received i.v. injections of hematoporphyrin derivative (5 mg/kg), the other 20 had injections of porfimer sodium (Photofrin, 2 mg/kg). An argon dye laser (630 nm wavelength, 200-300 J/cm2) was used for light irradiation in 24 of the 40 patients, a diode laser (Diomed, 630 nm wavelength, 100-200 J/cm2) in the other 16.


RESULTS
PDT obtained a 72% complete response (CR) rate (36/50 treated lesions), that is 27 CR among the 37 Tis carcinomas and 9 among the 13 T1 cases. Kaplan-Meier curves showed a mean overall survival (OS) of 75.59 months (median 91.4 months). Two- and 5-year OS rates were 72.78% and 59.55%. The mean and median survival rates for patients with Tis stage were 86.5 and 120.4 months, respectively (standard error 9.50) and for patients with T1 disease they were 45.78 and 35.71 months, respectively; the difference was statistically significant (P = 0.03). No severe early or late PDT-related adverse events were recorded.


CONCLUSIONS
PDT is effective in early primary or recurrent NSCLC, resulting in a CR rate of 72%. The incorporation of PDT in standard clinical practice, in combination with radiotherapy, warrants further investigation.
Corti
Luigi
L
Department of Radiotherapy, IOV-IRCCS, Padua, Italy. luigi.corti@unipd.it
Toniolo
Lamberto
L
Boso
Caterina
C
Colaut
Flavio
F
Fiore
Davide
D
Muzzio
Pier-Carlo
PC
Koukourakis
Michael I
MI
Mazzarotto
Renzo
R
Pignataro
Michele
M
Loreggian
Lucio
L
Sotti
Guido
G
D000368:Aged; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017324:Hematoporphyrin Derivative / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate
D017319:Photosensitizing Agents; D017324:Hematoporphyrin Derivative; D017323:Dihematoporphyrin Ether