Recent Advances in Photodynamic Therapy; An Expanding Role in Non-small Cell Lung Cancer

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Other Title
  • 肺癌に対する光線力学的治療―光線力学的治療の進歩と非小細胞肺癌に対する適応拡大―
  • An Expanding Role in Non-small Cell Lung Cancer
  • ―光線力学的治療の進歩と非小細胞肺癌に対する適応拡大―

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Description

Endoscopic laser treatment has been recognized as a lung-sparing local therapeutic modality that can achieve remarkable responses. In particular, photodynamic therapy (PDT) is able to obtain selective tumor necrosis safely and without unacceptable effects on surrounding tissue. PDT is a specific term that refers to the interaction of light with a photosensitizing agent in the presence of molecular oxygen, resulting in an oxygen-dependent photochemical process. The photosensitizing agent (e.g. Photofrin) absorbs photons of the appropriate wavelength (e.g. 630 nm), becomes an excited triplet species of the photosensitizer, and then transfers its energy to ground-state triplet oxygen to produce excited-state singlet oxygen. Singlet oxygen is a cytotoxic agent that produces cell death through interaction with cellular components. In Japan, PDT for the treatment of early hilar non-small cell lung cancer (stage 0 and I) was restricted to patients for whom the usual treatments for lung cancer were not appropriate, preservation of lung function was required, and in whom the distal tumor margin was clearly visible. We started fundamental studies of PDT in 1978, then applied it to clinical use. In 1980, the first PDT in the world for a patient with early hilar lung cancer was performed via bronchoscopy in our institute. By the end of 2003, the number of centrally located early stage lung cancer lesions treated curatively by PDT reached 221 lesions, and complete response (CR) rate was achieved in 84.6% (187 out of 221 lesions). According to retrospective analysis, curative treatment of early hilar lung carcinoma is possible using PDT alone when the tumor size is below 1 cm and the distant margin of the lesion is visible. Furthermore, the endoscopic evaluation before treatment seems to be a crucial factor in PDT. This paper reviews the experience of our institution; pre-treatment evaluation (autofluorescence diagnosis, EBUS), the art of PDT and results of clinical application. The expanding role of PDT in advanced lung cancer (e.g. palliative PDT, pre-operative PDT) is also discussed.

Journal

  • Haigan

    Haigan 45 (6), 687-692, 2005

    The Japan Lung Cancer Society

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