Photodynamic therapy, Nd-YAG laser and electrocautery for treating early-stage intraluminal cancer: which to choose?

The degree of healing and damage of the bronchial wall after photodynamic t herapy. Nd-YAG laser and electrocautery for intraluminal early-stage cancer have been analysed. Review of the bronchoscopy reports and follow-up histo logy specimens of twenty-nine patients treated bronchoscopically with curat ive intent for their intraluminal tumor have been performed. Seventeen pati ents had been treated with bronchoscopic electrocautery (BE) only, six with photodynamic therapy (PDT) and six with Nd-YAG laser. Bronchial wall scarr ing seen during follow-up bronchoscopy was scored and subepithelial fibrosi s were histologically evaluated using Alcian blue staining, Azan staining a nd polarised light. After BE, prominent airway scarring was seen in five pa tients (29%), with significant stenosis (> 50% lumen) in one of these: case s. Prominent scarring and significant stenosis were found in four (67%), af ter PDT. In five (83%) after Nd-YAG laser prominent scarring was found, one patient had significant stenosis. In three cases, two after BE and one aft er PDT, subepithelial tissue in the follow-up biopsies was insufficient for proper histologic examination. In the remaining biopsy specimen only one ( 7%) showed a moderate or excessive amount of fibroblasts after BE, whereas for PDT and Nd-YAG this was found in three (60%) and four patients (67%), r espectively. Excessive matrix was found in none of the biopsies after BE, i n two (40%) after PDT and in three (50%) after Nd-YAG laser. Compact collag en formations were seen in two (12%) biopsies after BE, in two (40 and 33%) after PDT and Nd-YAG, respectively. Compared to electrocautery, more airwa y scarring and more subepithelial fibrosis were seen after treatment with P DT and Nd-YAG laser. These findings, especially regarding PDT, is in contra st to the assumption that PDT is selective and may be important in the choi ce of treatment for patients with early stage cancer. (C) 2001 Elsevier Sci ence Ireland Ltd. All rights reserved.