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(Chest. 1999;115:502-510.)
© 1999 American College of Chest Physicians

Fine-Needle Interstitial Photodynamic Therapy of the Lung Parenchyma*

Photosensitizer Distribution and Morphologic Effects of Treatment

David I. Fielding, MD; Giovanni A. Buonaccorsi, PhD; Alexander J. MacRobert, PhD; Andrew M. Hanby, FRCPath; Martin R. Hetzel, MD and Stephen G. Bown, MD

* From the National Medical Laser Centre (Drs. Fielding, Buonaccorsi, MacRobert, and Bown), Department of Surgery, University College London Medical School; Department of Thoracic Medicine (Drs. Fielding and Hetzel), University College London Hospitals; and Hedley Atkins/Imperial Cancer Research Fund Breast Pathology Laboratory (Dr. Hanby), Guy's Hospital, London, UK.

Study objective: To look at the effect of interstitial photodynamic therapy (PDT) in normal lung parenchyma to assess its potential for treating localized, peripheral lung tumors.

Design: Studies were performed on normal Wistar rats using the photosensitizer meso-tetrahydroxyphenyl chlorine. Drug distribution was measured by fluorescence microscopy on tissue sections. Light was delivered to the lungs via a single fiber inserted percutaneously under x-ray control and the PDT effect studied in animals killed at times up to 6 months later.

Results: Fluorescence studies showed that the drug was initially distributed throughout the lung, but was later predominantly in the vasculature, bronchi, and macrophages. PDT produced sharply defined zones of hemorrhagic necrosis up to 12 mm in diameter that healed with regeneration of bronchial epithelium and local fibrosis. Different histologic effects were seen between drug light intervals of 1 and 3 days. Treatment was well tolerated, there was a low incidence of pneumothorax, and as long as the fiber tip was within the lung parenchyma, there was no damage to adjacent tissues.

Conclusion: Interstitial PDT produces zones of necrosis in normal lung that heal safely by a percutaneous technique without affecting adjacent areas of untreated lung. If the lesion size can be increased by using multiple fibers, this could be a promising new technique for treating localized, peripheral lung cancers in patients who are unfit for surgery.

Key Words: image-guided therapy • non-small cell lung cancer • photodynamic therapy




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