Surgical Procedures & Innovations Photodynamic Therapy

Photodynamic Therapy (PDT) is a unique method for treating cancers growing in the trachea and bronchial air passages. This treatment consists of injection of a photosensitizer (Photofrin®) followed by illumination of the cancer through a fiberoptic bronchoscope.

Both primary lung cancers and metastatic cancers (those that have migrated from other primary sites in the body) growing within the tracheal or bronchial air passages respond to photodynamic therapy. However, to be successfully treated with PDT, the cancer must be large enough to be visualized by bronchoscopy. Cancers growing outside the tracheobronchial air passages or cancers growing beyond the reach of a bronchoscope are not suitable for PDT.

Photodynamic therapy is a curative treatment for small primary non-small cell lung cancers (NSCLCs) growing in the tracheobronchial airways in patients who are not able to undergo surgery or radiotherapy. PDT is also available for palliative (non-curative, but symptom reducing) treatment of obstructing tracheobronchial cancers growing in the large airways, causing pneumonia, shortness of breath, or coughing of blood.

Evaluation for photodynamic treatment involves an initial medical history, physical examination, review of chest X-rays and CT scans, and diagnostic bronchoscopy.

How Does PDT Work?

If the initial evaluation reveals a cancer amenable to photodynamic therapy, an intravenous injection of Photofrin is given. This photosensitizing agent is selectively retained in cancer cells. Within 40 to 50 hours after the injection, a bronchoscopy is performed, illuminating the cancer with red laser light through the bronchoscope. The light can penetrate one centimeter deep into the treated area.

The low-power red laser light used for this procedure is non-burning and does not damage surrounding normal tissue. The red light combined with the Photofrin‚ retained in the cancer cells, causes a locally toxic photochemical reaction. This photochemical reaction kills the exposed cancer cells. Two days after the light treatment, bronchoscopy is repeated to remove the dead cancerous tissue and associated mucus and debris in the air passages.

The Photofrin injection causes skin photosensitivity for four to eight weeks afterwards. This photosensitivity can lead to severe sunburn on exposure to sunlight, or even unusually bright indoor light. Therefore, all treated patients must completely avoid sunlight for four to eight weeks following treatment. Normal indoor light exposure during this time is not harmful.

For further information on the photodynamic therapy program for lung cancer at NewYork-Presbyterian/Columbia, call 212.326.8415.