Qualitative improvement of the surgical treatment of cancer using laser equipment--surgical technic after photodynamic therapy

Nineteen patients with lung cancer were treated by combined preoperative photodynamic therapy (PDT) and surgery. Preoperative photodynamic therapy was performed for the purpose of either reducing the extent of resection or increasing operability. Clinically, nine patients had stage I disease, one had stage II, eight had stage III and one had stage IV. There were two cases of tracheal superficial invasion from primary lesions, three cases of intrabronchial polypoid tumor or superficial invasion of the carina by primary lesions, eleven cases of polypoid tumor or superficial invasion of the main bronchus, and three cases of double primary lesions. Argon dye laser was used in this study. Preoperative PDT was performed 48 to 72 hours after intravenous injection of hematoporphyrin derivative (HpD). Therapeutic conditions were 60 to 600 joules/cm2 for the superficial invasive areas and an additional 200 to 800 m W for 8 to 15 minutes for polypoid lesions. Surgical resection was performed 1 to 9 weeks after PDT. The initial purpose of PDT was achieved in 15 of the 19 patients treated. In five of six originally inoperable cases, conversion to an operable status was achieved. Thirteen patients were originally candidates for pneumonectomy, and it became possible to reduce the extent of resection to lobectomy in ten of them. This study suggests that PDT may have an important role in combination with surgery and other modalities in advanced lung cancers.