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Photodynamic Therapy (PDT) Center
Microinvasive (early) endobronchial non-small cell lung cancer - Other endobronchial lung tumors
- Advanced, partially or totally obstructing cancer of the esophagus
- Other lung tumors, including mesothelioma
- Early-stage esophageal cancer with Barrett's esophagus
- Skin cancers
- Breast cancer
- Colorectal tumors
- Gynecologic malignancies
- Head and neck cancer
How Photofrin®-PDT works:
A non-toxic drug called Photofrin® (porfimer sodium) is injected intravenously. Both normal and malignant cells absorb the drug. However, two to three days later Photofrin® concentrates in the cancer cells and is reduced in the normal cells that are near many cancers. Non-thermal (without heat) red light, which is generated by a laser, is applied to the tumor. This light activates the Photofrin®, causing an almost immediate destruction of the tumor cells.
Photofrin® is a photosensitizing drug, and it is retained for some time by skin. Because of this, patients are required to avoid direct sunlight for a period of 4-6 weeks after injection. Patients are advised to avoid very bright artificial lights (like a dentist's lamp or physician's examining light) or strong residential direct indoor lighting (like spotlights and floodlights) for this period of time. When outdoors, sunglasses, dark-colored clothing, long-sleeved shirts, hat, gloves and long pants must be worn to protect the skin. Patients are also cautioned to avoid cone- or helmet-type hairdryers for one month after Photofrin® injection because extreme heat could activate the drug retained in the scalp. These light, or heat, exposures produce a photosensitivity-type reaction resulting in redness and swelling of the skin.
Microinvasive (early) endobronchial non-small cell lung cancer
The FDA has approved Photofrin® - PDT for the treatment of microinvasive (early) endobronchial non-small cell lung cancer in patients for whom surgery and radiotherapy are not indicated. The cancer must be located in an airway and be reachable using a bronchoscope (a flexible instrument used to visualize the airways). Photofrin® is injected intravenously and the tumor is exposed to red light two days later during a bronchoscopy. This procedure may be done under local or general anesthesia. Two days later a "clean-up" bronchoscopy, where dead tumor cells and debris are removed, is performed under local or general anesthesia.
For more information about PDT and lung tumors contact the PDT Center, Todd Demmy, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL .
Endobronchial lung tumors
Photofrin® - PDT has been approved by the FDA for certain early and late stage lung tumors. Tumors must be accessible via a bronchoscope. The drug-activating red light is delivered by way of fiberoptics that are threaded through the bronchoscope. This is done under local or general anesthesia, two days after Photofrin® injection. Three days after light treatment a "clean-up" bronchoscopy is performed under local or general anesthesia. Dead tumor cells and debris are removed to open the airway to its fullest extent.
For more information about PDT and lung tumors contact the PDT Center, Todd Demmy, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.
Advanced, partially or totally obstructing, cancer of the esophagus
Photofrin®-PDT has been approved by the FDA for palliative use in patients with advanced cancer of the esophagus, where the esophagus is totally or partially obstructed and the lesions are not suitable for treatment with thermal laser therapy. The patient will receive an intravenous injection of Photofrin®. Two to three days later the patient will undergo an endoscopy to visualize the tumor and at the same time deliver the drug-activating red light. The side-effects of this therapy may include chest pain and burning, difficulty swallowing and possible stricture of the esophagus.
For more information about PDT and cancer of the esophagus, contact the PDT Center, Todd Demmy, MD; Hector Nava, MD; Chumy Nwogu, MD, or Judy Smith, MD; at 1-800-ROSWELL.
Other lung tumors, including mesothelioma
It is possible to treat certain cancers within the lung or on the lining (pleura) of the lung using PDT. PDT is done following removal of the tumor while the patient is still in surgery. The drug-activating red light for PDT is directed into the lung cavity. Treatment time is determined by the size of the lung cavity and may last from 1-3 hours.
For more information about PDT and lung tumors contact contact the PDT Center, Todd Demmy, MD; or Chumy Nwogu, MD, at 1-800-ROSWELL.
Early-stage esophageal cancer in conjunction with Barrett's esophagus
To be eligible for this therapy the patient must have high-grade dysplasia in conjunction with Barrett's esophagus. Photofrin® is injected two days before red-light treatment. The light is delivered through a specially designed endoscope.
For more information about PDT and cancer of the esophagus, contact the PDT Center, Hector Nava, MD; Todd Demmy, MD; Chumy Nwogu, MD, or Judy Smith, MD; at 1-800-ROSWELL.
Skin cancers
Skin cancers are treated using PDT in conjunction with the Dermatology Department at RPCI. Basal cell carcinoma, the most common type of skin cancer, as well as squamous cell carcinoma, Bowen's disease and nevoid basal cell carcinoma syndrome (NBCC) may be effectively treated using PDT. The drug-activating red light is directed onto the skin cancer two to three days following Photofrin® injection. After PDT the treated skin may become red, swollen and uncomfortable and may eventually form a scab. The scab usually falls off after two to three weeks. For larger skin cancers a second treatment may be required to completely destroy the tumor. Also underway is a study to treat solar keratosis, which is the most common premalignant lesion in light-skinned people. A drug called ALA is used in this application.
For more information about PDT and skin cancer, contact the PDT Center or Allan R. Oseroff, MD, at 1-800-ROSWELL.
Breast cancer
Local recurrences in the skin and chest wall following mastectomy are difficult to treat. Some such cases may be treatable with PDT. However, the nature of these recurrences limits the utility of PDT in this situation, and the prior treatment of the area with radiation makes effects on the normal tissue more severe. Other therapies, including additional radiation with or without hyperthermia, may be more appropriate. The PDT Center and Breast Program Staff will review individual cases for suitability of PDT, and discuss options with a patient's physician.
For more information about PDT and breast cancer recurrences, contact the PDT Center, Michele Cooper, RN, CCRC at 1-800-ROSWELL.
Colorectal tumors
In most cases PDT is combined with surgery in an attempt to kill any microscopic tumor cells that may remain after surgical removal of the tumor. PDT may be performed at the time of surgery, or after surgery to a perineal tumor.
For more information about PDT and colorectal cancer, contact the PDT Center; John Gibbs, MD or Judy Smith, MD, at 1-800-ROSWELL.
Gynecologic malignancies
Gynecologic tumors often occur in areas that are easily accessible to the activating light used in PDT. PDT may be an effective treatment in certain cases that involve tumors of the vagina, vulva and cervix. In recurrent tumors this therapy has resulted in some long-lasting results. Treatment takes place two days after Photofrin® injection and usually lasts ½ to 1 hour. Local pain is to be expected in the treatment field for several days following therapy, but this pain can be treated with analgesics.
For more information about PDT and gynecologic tumors, contact the PDT Center or Sashikant Lele, MD, at 1-800-ROSWELL.
Other PDT drugs in use at RPCI:
ALA (5-aminolevulinic acid) is a topical agent currently being investigated for treatment of superficial skin tumors and patch- and plaque-stage CTCL (mycosis fungoides). It is applied directly to the skin and has been found safe and effective, and avoids the long-lasting generalized photosensitivity associated with Photofrin® - PDT.
Photochlor® or HPPH (2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a) is utilized in the treatment of obstructive esophageal tumors, early stage esophageal cancer, skin cancer, and locally recurring Breast cancer on the chest wall following mastectomy and appears to avoid the long-lasting photosensitivity of Photofrin®.
Please direct general and disease-specific questions to:
PDT Nurse
(716) 845-4427
email: pdtctr@roswellpark.org
Mailing Address:
PDT Center
Roswell Park Cancer Institute
Elm & Carlton Streets
Buffalo, NY 14263 USA
