PLEASE NOTE: Dr. Gary M. Hochheiser, Chief of Baystate Thoracic Surgery, now performs the photodynamic therapy procedure described in this article. Dr. Keith Mortman, who is quoted in the article, is not currently a member of the Baystate Medical Center staff.
The Baystate Regional Cancer Program is the only site in Western Massachusetts to offer a new treatment option for patients with esophageal and lung cancer: Photodynamic Therapy (PDT).
PDT is used to treat or relieve symptoms of esophageal cancer and non-small cell lung cancer. For patients with esophageal cancer, the therapy can relieve symptoms when the cancer obstructs the esophagus. In non-small cell lung cancer, it assists patients for whom curative treatments are not possible and relieves symptoms when the cancer obstructs the airways. PDT can also be used in combination with other cancer therapies, such as radiation, chemotherapy, or surgery.
“This is a novel approach to cancer care and a proven treatment option for certain patients with lung or esophageal cancer,” says Keith Mortman, MD, a cardiothoracic surgeon who joined the medical staff at Baystate Medical Center last year as part of Baystate Thoracic Surgery Associates. “Photodynamic therapy is the only treatment option that kills the cancerous tissue and the precancerous tissue, but not the normal tissue. We are excited to bring this technology to Western Massachusetts and the people who live here.”
Wilson Mertens, MD, medical director of the Baystate Regional Cancer Program, agrees. “Through the Baystate Regional Cancer Program, we are committed to providing referring physicians and their patients with the best available options for their care, the highest levels of expertise, and access to world-class facilities, leading clinical trials and state-of-the-art equipment. Incorporating PDT into our repertoire of treatment options helps us to fulfill this commitment.”
According to Dr. Mortman, the procedure uses a visible red laser light with a specific wavelength to destroy cancerous and precancerous cells and remove tumor obstructions. Prior to this minimally invasive outpatient procedure, the patient receives an injection of a photosensitizing agent called Photofrin (porfimer sodium). The agent is absorbed into all of the body’s cells, but remains in cancer cells longer than in normal cells.
Approximately 48 to 72 hours after injection, most of the agent has left normal cells. The surgeon uses an endoscope or bronchoscope to insert the laser and exposes the treatment area to the laser light. The photosensitizing agent and the light react to each other, which produces oxygen that destroys the cancerous cells, but does not affect surrounding healthy cells.
Patients are sedated and experience little to no discomfort during the procedure, which takes only minutes to perform. Typically two sessions of PDT are necessary to treat an affected area.
In addition to directly destroying cancer cells, PDT may also shrink or destroy tumors in two other ways. The photosensitizer often damages blood vessels to the tumor, causing the tumor to shrink. In addition, PDT may boost the patient’s immune system, making it stronger to fight the tumor cells.
Benefits of PDT
Prior to PDT, treatment for esophageal and lung cancer included chemotherapy, radiation, and surgery. PDT patients report fewer side effects after this newer procedure, such as less shortness of breath.
“Patients who undergo PDT typically respond better than patients treated with more traditional therapies, especially in terms of symptom control,” says Dr. Mortman. “One of the major improvements for patients with esophageal cancer is the ability to swallow food, which improves a patient’s quality of life considerably.”
There are some side effects to PDT, however. Dr. Mortman notes that the procedure makes patients sensitive to sunlight for about 30 days after they receive the drug. Other side effects include transient chest or abdominal pain and constipation.
“I tell my patients to avoid direct sunlight by running errands after dark for about a month after the procedure. Although it may be inconvenient, this is actually far less disruptive than some of the side effects associated with radiation, chemotherapy and surgery, which may include shortness of breath, nausea, hair loss, and fatigue.”
He adds that the makers of Photofrin provide special glasses, hats, and gloves for patients to wear to reduce their exposure to sunlight.
While PDT is primarily used to treat cancers of the esophagus and lungs, it is currently being studied for treating other types of cancer as well, including cervical, prostate, peritoneal, brain, and skin cancers.
According to Dr. Mortman, PDT may also be used to treat early-stage conditions, such as Barrett’s esophagus, as well as more advanced cancers that are not appropriate for other surgical procedures. He says that in these cases, “PDT may not always eradicate the cancer, but is an excellent way to palliate patients by removing tumors that prevent them from breathing and swallowing normally.”
The light needed to activate most photosensitizers cannot pass through more than about one-third of an inch of tissue, so PDT is currently used to treat tumors on or just under the skin or on the lining of internal organs or cavities. However, current research is focused on the development of photosensitizers that are more powerful, target specific cancer cells, and are activated by light that can penetrate tissue and treat deep or large tumors. Researchers are also investigating ways to improve equipment and the delivery of the activating light.
“Photodynamic therapy was developed about six years ago,” says Dr. Mortman, “but the technology is advancing as the procedure and its benefits become better known. I’m hoping we’ll soon be able to expand the types of cancer we can treat, and increase the number of lives we can improve.”
For more information on photodynamic therapy, or to refer a patient, please call Baystate Medical Practices — Baystate Thoracic Surgery at 413-794-8050.