Three patients who had recurrence after complete response underwent surgical resection, and no evidence of nodal metastasis was found. Photodynamic therapy begins with intravenous administration of hematoporphyrin derivative 2 to 3 days before laser irradiation is planned. For argon laser application, the patient is given a general anesthetic or topical anesthetic sufficient to prevent coughing. The appearance of the irradiated area is unchanged immediately after treatment, but within 6 to 48 hours, edema, swelling, and necrosis occur. Significant coughing, wheezing, and dyspnea may develop.
Most patients expectorate necrotic tissue within several days of treatment.
The most common complication of photodynamic therapy is burns related to extreme light sensitivity. Direct sunlight must be avoided for 6 to 8 weeks after a treatment session. The extent of photodynamic therapy's role in lung cancer is still being defined. Although central superficial tumors represent a small percentage of bronchogenic carcinomas, in this highly select group of tumors, photodynamic therapy may be an effective alternative to surgical resection. It may also provide effective local control of disease in patients who are not surgical candidates.