A new method of treatment for some patients with lung or esophageal cancer is available. The treatment is called photodynamic therapy (PDT) and is used mostly in patients where a lung malignancy is comprising an airway or an esophageal malignancy is compromising a patient’s nutritional status.

The steps in treatment with PDT:

• The patient will be evaluated in the Thoracic and General Surgical Oncology Clinic to decide whether or not this treatment is best for the patient.
• The patient will go through a number of pre-operative steps, including education about the treatment, history and physical, etc.
• The patient will receive an injection of porfimer sodium, or Photofrin®, a photosensitive drug that is absorbed by malignant cells. This injection is done on an outpatient basis.
• Approximately 48 hours after injection, the patient is taken to the operating room where a laser is used to kill the tumor by activating Photofrin®. A second laser application can be given 96-120 hours after injection if needed.
• The dead malignant cells may be removed by endoscopy or bronchoscopy or, in the case of esophageal cancer, may be expelled through the gastrointestinal system.
• The patient stays in the hospital approximately three or four days, depending on the patient’s condition, etc.
• At discharge from the hospital, patient care managers oversee the patient’s care for the first two weeks.
• Up to three courses of PDT can be administered, each application separated by at least 30 days. In addition, patients need to wait about 2-4 weeks after receiving PDT to have any radiotherapy and wait about 4 weeks after radiotherapy to receive PDT.

Why is PDT helpful?

PDT is most helpful because in esophageal cancer patients, it is difficult for the patient to swallow. Therefore, patients with esophageal cancer often have a difficult time eating and keeping their strength for the battle against the cancer. In lung cancer patients, tumors can obstruct the airway, restricting breathing for patients. PDT can be useful in obliterating the tumor and helping the patient breathe more easily.

What are the risks or contraindications of PDT or Photofrin®

PDT’s greatest adverse effect is that Photofrin® is highly photosensitive for approximately 30 to 90 days after injection. Great care has to be taken to protect the patient from light for this period of time. Skin cells also absorb Photofrin®, making a patient greatly sensitive to light from both inside and outside. Patients must wear protective clothing, such as long sleeves, sunglasses, etc. when going outside and must avoid bright light inside. Therefore, great steps are made to ensure patient care and education.

Other adverse effects include, but are not limited to, dyspnea, pain, hemoptysis, coughing, fever, nausea and edema.

In addition, PDT therapy would not be appropriate in patients with an existing tracheoesophageal or broncho-esophageal fistula or in patients with tumors eroding into a major blood vessel. Photofrin® would not be appropriate in patients who are allergic to porphyrins.

Screening of patients for PDT is done very carefully. Patients who have had a previous high dose of radiotherapy, have poor lung function, have multifocal multilobar disease or an overall poor medical condition may not be suitable for treatment by PDT. In addition, patients who are at high risk for developing a serious health condition, such as esophageal fistula, are sometimes referred to another therapy because of the risks involved with PDT. Some patients who have tumors in risky areas, such as tumors of the carina, may also not qualify for PDT.