Interventional Pulmonology, The Lung Center, Penn Highlands Healthcare, DuBois, PA.
Interventional Pulmonology, Medical College of Georgia School of Medicine, Augusta University, Augusta, GA.
J Bronchology Interv Pulmonol. 2023 Apr 1;30(2):135-143. doi: 10.1097/LBR.0000000000000889.
Newer navigational bronchoscopy technologies render peripheral lung lesions accessible for biopsy and potential treatment. We investigated whether photodynamic therapy (PDT) delivered via navigational bronchoscopy is feasible and safe for ablation of peripheral lung tumors.
Two studies evaluated PDT in patients with solid peripheral lung tumors followed by clinical follow-up (nonresection study, N=5) or lobectomy (resection study, N=10). Porfimer sodium injection was administered 40 to 50 hours before navigational bronchoscopy. Lesion location was confirmed by radial probe endobronchial ultrasonography. An optical fiber diffuser was placed within or adjacent to the tumor under fluoroscopic guidance; laser light (630 nm wavelength) was applied at 200 J/cm of diffuser length for 500 seconds. Tumor response was assessed by modified Response Evaluation Criteria in Solid Tumors at 3 and 6 months postprocedure (nonresection study) and pathologically (resection study).
There were no deaths, discontinuations for adverse events, or serious or grade ≥3 adverse events related to study treatments. Photosensitivity reactions occurred in 8 of 15 patients: 6 mild, 1 moderate, 1 severe (elevated porphyrins noted in blood after treatment). Among 5 patients with clinical follow-up, 1 had complete response, 3 had stable disease, and 1 had progressive disease at 6 months follow-up. Among 10 patients who underwent lobectomy, 1 had no evidence of tumor at resection (complete response), 3 had 40% to 50% tumor cell necrosis, 2 had 20% to 35%, and 4 had 5% to 10%.
PDT for nonthermal ablation of peripheral lung tumors was feasible and safe in this small study. Further study is warranted to evaluate efficacy and corroborate the safety profile.
较新的导航支气管镜技术使外周肺病变能够进行活检和潜在治疗。我们研究了经导航支气管镜给予光动力疗法（PDT）是否可行且安全，能否用于消融外周肺肿瘤。
两项研究评估了 PDT 治疗实性外周肺肿瘤患者的效果，这些患者接受了临床随访（非切除术研究，n=5）或肺叶切除术（切除术研究，n=10）。导航支气管镜检查前 40-50 小时给予血卟啉单甲醚注射液。通过径向探头支气管内超声确认病变位置。在荧光透视引导下将光纤扩散器置于肿瘤内或附近；将激光（630nm 波长）以 200J/cm 扩散器长度照射 500 秒。非切除术研究中在术后 3 个月和 6 个月通过改良实体瘤反应评价标准评估肿瘤反应，切除术研究中通过病理评估肿瘤反应。
无死亡、因不良事件停药或与研究治疗相关的严重或≥3 级不良事件。15 例患者中有 8 例出现光敏反应：6 例轻度，1 例中度，1 例重度（治疗后血液中卟啉升高）。5 例接受临床随访的患者中，1 例完全缓解，3 例病情稳定，1 例进展。10 例接受肺叶切除术的患者中，1 例切除标本未见肿瘤（完全缓解），3 例肿瘤细胞坏死 40%-50%，2 例 20%-35%，4 例 5%-10%。
在这项小型研究中，PDT 用于非热消融外周肺肿瘤是可行且安全的。需要进一步研究以评估疗效并证实安全性。
