Photodynamic therapy (PDT) of lung cancer: experience of the Tokyo Medical University

Endoscopic low (Photodynamic therapy (PDT)) or high (vaporization) power laser treatment has been recognized as a lung-sparing local therapeutic modality that can achieve remarkable responses. This paper reviews the experience of our institution since 1978 in the treatment of lung cancer using laser. Endoscopic ablation of tracheobronchial malignancies is mainly intended to reduce respiratory distress and improve quality of life. Effective results were obtained in 143 (81%) of the 177 lesions. PDT is extremely attractive and has been used for the various purposes. In the curative PDT for centrally located early stage lung cancer, complete response (CR) rate was achieved in 86.4% (165 out of 191 lesions). Overall 5-year survival rate was 57.6% and the lung cancer specific 5-year survival rate was 92.5%. With regard to palliative PDT to opening obstructed bronchi in advanced cases, more than 50% opening of the obstruction was accomplished in 75%. Preoperative PDT was performed in 32 patients with lung cancer for the purpose of either reducing the extent of resection or increasing operability. The initial purpose of PDT was achieved in 27 of 32 patients treated. Conversion to an operable condition was achieved in 4 of 5 originally inoperable cases. In 23 of 27 patients who were originally candidates for pneumonectomy, it became possible to reduce the extent of resection to lobectomy or sleeve lobectomy. PDT could be used to treat peripheral tiny lung cancers safely and without unacceptable effects on surrounding tissue. The authors believe that PDT has a great potential and will achieve further development in the future.