Photodynamic therapy for chest wall progression from breast carcinoma is an underutilized treatment modality

BACKGROUND. Chest wall progression of breast carcinoma after failure of sal vage surgery, radiation, and chemohormonal therapy is a quagmire with limit ed therapeutic options. Because photodynamic therapy (PDT) offers excellent results in cutaneous lesions, PDT may play a role in this indication. Howe ver, to the authors' knowledge, published data for this subgroup of patient s using the only commercially available photosensitizing agent, Photofrin, often show high treatment morbidity, limiting PDT's usefulness. The authors report the feasibility of decreasing the photosensitizer drug dose as a me ans of exploiting photobleaching kinetics to improve the therapeutic ratio for these individuals. METHODS. One hundred two chest wall sites were treated with PDT after failu re of multimodality salvage therapy. In these 9 patients, lesion size range d from 0.57 to 9 cm. Photodynamic therapy consisted of outpatient intraveno us infusion of 0.8 mg/kg of Photofrin, followed 48 hours later by 630 nm li ght treatment of 135-170 J/cm(2) delivered by a KTP:YAG laser coupled to dy e unit. Two patients underwent a second PDT procedure due to new lesion for mation. All patients were observed for a minimum of 6 months, and none was lost to follow-up. RESULTS. Photodynamic therapy was well tolerated with no photosensitivity r eported. Despite all patients having failed surgery, full dose radiation an d multiagent chemohormonal therapy, chest wall lesions healed with no scarr ing. Only 1 (9 cm) lesion took longer than 3 months to granulate over. The authors were able to evaluate all treatment sites, and complete response, d efined as total lesion elimination, was noted in 89% of the lesions; reduct ion without regrowth occurred in 8% with no response in 3% of the lesions. CONCLUSIONS. Despite having prior treatment and fragile tissues, low dose P hotofrin-induced PDT offers excellent clinical response with minimal morbid ity. These results show that PDT should play an important role in the manag ement of chest wall failure from breast carcinoma. Cancer 2001;91:1-8. (C) 2001 American Cancer Society.