Chest
Volume 102, Issue 5, November 1992, Pages 1319-1322
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Clinical Investigations
Photodynamic Therapy in the Management of Early Superficial Squamous Cell Carcinoma as an Alternative to Surgical Resection

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Photodynamic therapy has been used since 1980 at our institution for the management of cancer of the tracheobronchial tree. We identified 13 patients (14 cancers) who were thought to be surgical candidates but who elected to have photodynamic therapy. Thirteen cancers (93 percent) had a complete response to hematoporphyrin-derivative phototherapy. Ten cancers (71 percent) showed a complete response after single treatment, and three (21 percent) required a second course of therapy to achieve a complete response. Ten (77 percent) of 13 cancers have shown no local recurrence. Three patients with persistent cancer underwent surgical resection and were found not to have nodal involvement. We concluded that photodynamic therapy is an alternative to surgical resection in the management of early superficial squamous cell carcinoma.

Section snippets

Selection of Patients

All patients in our study had biopsy specimen-proven squamous cell carcinoma involving the tracheobronchial tree. Conventional chest roentgenograms were obtained for all patients and computed tomography of the chest was performed for most of them. These studies showed no evidence of cancer spread. Each patient was thought to be a surgical candidate, as determined by pulmonary function testing and general cardiac assessment. Informed consent was obtained from each patient prior to therapy.

Hematoporphyrin Derivative

We

RESULTS

Thirteen patients (14 cancers) were treated with HpD-PT and the results were analyzed (Table 1). The results were categorized according to the therapeutic response after HpD-PT, the subsequent behavior of the tumor, long-term results, and the status of each patient as of October 1991.

DISCUSSION

Photodynamic therapy has been used for management of bronchogenic carcinoma at our institution for the last ten years. Initially, the treatment modality was confined to patients who were thought not to be surgical candidates because of underlying cardiopulmonary dysfunction. The effectiveness of HpD-PT is known to be limited because the maximal therapeutic depth of penetration by activating light is no more than 2 cm. Therefore, we believe that for the management of bronchogenic carcinoma, the

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Manuscript received December 3; revision accepted February 10.

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