Photodynamic Therapy in Early Lung Cancer: A Report of Two Cases
A 70-year-old Korean man presented with squamous carcinoma\nin situ at, a previously treated, left main anastomotic pneumonectomy site. A left pneumonectomy was performed for squamous lung cancer 20 months previously; at that time the surgical margin was positive for squamous cell carcinoma. The patient was treated with concurrent chemoradiotherapy with six cycles of weekly paclitaxel (45 mg/m2) plus cisplatin (20 mg/m2) during radiotherapy with 5,040 cGy, and received four cycles of consolidation chemotherapy by paclitaxel plus cisplatin every three weeks. Follow-up bronchoscopic findings, after 20 months, showed that the mucosa in the anastomotic site had progressed with hypervascular infiltrative change; a biopsy revealed progression of cancerous changes. Bronchoscopic PDT was performed under local anesthesia with conscious sedation (Midazolam 2 mg intravenous injection). Before the PDT procedure, the photosensitizer (Photogem®: Lomonosov Institute of Fine Chemical, Russia) was injected intravenously at a dose of 2.0 mg/kg body weight. After an injection of Photogem, the patients were instructed to avoid direct sunlight exposure for at least two weeks. The laser beam was transmitted via a quarz fiber (400 mm) inserted through the instrumentation channel of a fiberoptic bronchoscope. A light using Diode laser (Biolitec Inc., Germany, wavelength; 633 nm) was delivered to the anastomotic site at 200 J/cm2 with a 3 cm diffuser and 100 J/cm2 with a 2 cm diffuser for 500 seconds, respectively. Fourty-eight hours after the procedure, bronchial toilet was performed. Necrotic changes at the PDT treated site were noted. There were no immediate complications. We performed a follow up bronchoscopic biopsy after three and 12 months. The histology at the PDT site regressed to focal squamous metaplasia and inflammatory conversion (). Clinical and histological findings were consistent with complete remission; there was no evidence of recurrence during 30 months of follow-up.