Photodynamic Therapy for Endobronchial Obstruction is Safely Performed with Flexible Bronchoscopy

Objective: To determine the safety and efficacy of photodynamic therapy (PDT) in patients with endobronchial tumors using the flexible bronchoscope for light application and debridement bronchoscopy without general anesthesia or the rigid bronchoscope. Method: Thirty-seven consecutive cases with inoperable cancer, either primary or metastatic to the lung, were treated with PDT. PDT was performed using Photofrin® infusion at 2 mg/kg followed by illumination after 48-72 hours. 630 nm laser light was delivered with a cylindrical light diffusing fiber passed through a flexible bronchoscope. Pulmonary hygiene flexible bronchoscopy was performed 48 hours later and as needed to remove necrotic debris. Repeat illumination was done as needed to a maximum of three treatments. Results: There were 32 complete or partial responders and five treatment failures. There was no treatment-related mortality. Major post-operative complications included respiratory failure requiring shortterm intubation in one patient. All illumination and debridement bronchoscopies were performed with the flexible bronchoscope and conscious sedation only Conclusions: PDT is effective for palliation of inoperable advanced lung cancer. PDT and hygiene bronchoscopy can be performed safely and effectively with the flexible bronchoscope alone. General anesthesia and rigid bronchoscopy are not mandatory for effective PDT.