title: Photodynamic therapy in the management of endobronchial metastatic lesions from renal cell carcinoma.
abstract: OBJECTIVE
  Bronchoscopic procedures to ablate endobronchial lesions (EBL) from renal cell carcinoma (RCC) are frequently complicated by hemorrhage because of the vascular nature of the metastases. After ablation, recurrence of symptoms from the EBLs is common. Photodynamic therapy (PDT), because of its mode of action, may be a safer and a more effective alternative in the nonemergent management of EBL from RCC.
  
  
  METHODS
  Medical records of patients undergoing PDT at the authors' institutions between December 2005 and December 2008 were reviewed and patients undergoing treatment for EBLs from RCC were identified. Procedure-related complications, 30-day mortality, and efficacy of PDT measured by recurrence in symptoms and the need for additional interventions on the treated EBLs were reviewed.
  
  
  RESULTS
  Eleven patients underwent a total of 13 treatments with PDT. Hemoptysis, with or without symptomatic airway obstruction, was the most common presenting symptom. The most common location for the EBLs was the lobar or segmental bronchi. Six patients had undergone other interventions (rigid bronchoscopy, mechanical debridement, or argon plasma coagulation) before treatment with PDT, with recurrence in symptoms. No immediate complications were seen with PDT and none of the patients had recurrence of symptoms or required airway interventions during the 30-day follow-up. Four patients died at a median of 4 months (range: 3 to 6 mo) after PDT and all deaths were due to progression of cancer and none of the deaths were due to airway complications.
  
  
  CONCLUSIONS
  PDT is a safe and effective option for the management of hemoptysis or airway obstruction caused by EBLs from RCC.
authors.affiliation: *Division of Pulmonary, Critical Care and Occupational Medicine, University of Utah School of Medicine, Salt Lake City, UT †Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Chakravarthy
authors.initials: C
authors.lastname: Reddy
authors.forename: Gaetane
authors.initials: G
authors.lastname: Michaud
authors.forename: Adnan
authors.initials: A
authors.lastname: Majid
authors.forename: Felix
authors.initials: F
authors.lastname: Herth
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst