R. Allison et al., Photodynamic therapy for chest wall progression from breast carcinoma is an underutilized treatment modality, CANCER, 91(1), 2001, pp. 1-8
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 ranged
from 0.57 to 9 cm. Photodynamic therapy consisted of outpatient intravenou
s infusion of 0.8 mg/kg of Photofrin, followed 48 hours later by 630 nm lig
ht treatment of 135-170 J/cm(2) delivered by a KTP:YAG laser coupled to dye
unit. Two patients underwent a second PDT procedure due to new lesion form
ation. All patients were observed for a minimum of 6 months, and none was l
ost 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.