Photodynamic therapy (PDT) is a US Food and Drug Administration–approved method for managing both early- and advanced-stage endobronchial non–small-cell lung carcinoma. The possibility of eradicating metastatic endobronchial lesions with PDT was offered to patients presenting with a variety of histologies.
We retrospectively reviewed the treatment outcomes of primary and metastatic endobronchial tumors with the off-label and compassionate exemption use of PDT.
Between 1991 and 2002, we administered PDT to 13 patients with a variety of endobronchial histologies. PDT was used either as definitive therapy or in the adjuvant setting. The most common histology was carcinoid (38%). Initial response rate to PDT was seen in 8 of 13 (61%). Five patients were treated with PDT alone, while 46% of patients had various additional treatments including brachytherapy, laser therapy, lobectomy, chemotherapy, and/or radiation therapy. Complete, partial, and nonresponders were seen in 39%, 46%, and 15%, respectively. The overall mean percentage change in endoluminal occlusion after PDT was 84%. A long-term response rate (≥12 months) was seen in 5 patients (39%). The estimated 5-year survival is 73%.
Photodynamic therapy provides the option of a less morbid treatment of the management of endobronchial lesions. Patients with isolated endobronchial tumors can achieve effective treatment with PDT with or without combination therapy. The “off-label” use of PDT for the management of endobronchial tumors is a viable option that requires further investigation with prospective randomized clinical trials.