PDT Indications

Indications and Usage

Photdynamic therapy with PHOTOFRIN is indicated for:

palliation of patients with completely obstructing esophageal cancer, or of patients with partially obstructing esophageal cancer who, in the opinion of their physician, cannot be satisfactorily treated with Nd:YAG laser therapy.
reduction of obstruction and palliation of symptoms in patients with completely or partially obstructing endobronchial nonsmall cell lung cancer (NSCLC) treatement of microinvasive endobronchial NSCLC in patients for whom surgery and radiotherapy are not indicated.

Contraindications

PHOTOFRIN is contraindicated in patients:

with porphyria or in patients with known allergies to porphyrins
with an exisiting tracheoesophageal or bronchoesophageal fistula
with tumors eroding into a major blood vessel

Warnings

Following injection with PHOTOFRIN precautions must be taken to avoid exposure of skin and eyes to direct sunlight or bright indoor light.

Esophageal Cancer

If the esophageal tumor is eroding into the trachea or bronchial tree, the likelihood of tracheoesophageal or bronchoesophageal fistula resulting from treatment is sufficiently high that PDT is not recommended.

Patients with esophageal varices should be treated with extreme caution. Light should not be given directly to the variceal area because of the high risk of bleeding.

Endobronchial Cancer

Patients should be assessed for the possibility that a tumor may be eroding into a pulmonary blood vessel. Patients at high risk for fatal hemoptysis include those with large, centrally located tumors, those with cavitating tumors or those with extensive tumor extrinsis to the bronchus.

If the endobronchial tumor invades deeply into the bronchial wall, the possibility exits for fistula formation upon resolution of tumor.

PDT should be used with extreme caution for endobronchial tumors in locations where treatment induced inflammation could obstruct the main airway, e.g, long or circumferential tumors of the trachea, tumors of the carina that involve both mainstem bronchi circumferentially, or circumferential tumors in the mainstem bronchus in patients with prior pneumonectomy.

Comments to: KKee@partners.org