Aug. 6, 1999 A new laser treatment, offered at Rush-Presbyterian-St. Luke's Medical Center in Chicago, allows patients with cancerous tumors in their esophagus or lungs who could not breath or swallow to regain these functions almost immediately after recovering from a brief surgery.
Dr. William Warren, a cardiovascular-thoracic surgeon at Rush-Presbyterian-St. Luke's Medical Center, is one of the first surgeons in Illinois to use the innovative laser technique called photodynamic therapy (PDT). PDT works in a three-step process that takes several days, he explained.
First, patients with cancerous tumors in their esophagus or windpipe receive an injection in the arm with a dye called Photofrin, a photosensitizing drug. Over the next two days, the drug will largely be eliminated from most healthy tissue, but will selectively remain in cancer cells.
Next, physicians place a flexible scope into the patient's throat. Through the scope is passed a laser fiber. Once the laser is in position, the energy from the laser targets the light-sensitized tumor.
"Previously, lasers were very technique sensitive," Warren said. "Surgeons would have to be very precise when burning tumors to avoid damage to surrounding normal tissue."
However, surgeons can place the new laser adjacent to the tumor, where it activates the Photofrin retained by the tumor cells, effectively relieving the obstruction. The laser does not affect surrounding tissue, Warren said. Finally, the scope is placed to remove the dead cancerous tissue. After this 20-minute procedure, the tumor scabs over and function is restored. The entire process takes about five days and is generally accomplished on an outpatient basis.
According to the experience from the use of PDT at other institutions, the only side effect is temporary extreme photosensitivity, which means patients must avoid direct sunlight for between 30 and 60 days after the surgery.
"We recommend that these patients wear dark sunglasses, a wide-brimmed hat, turtleneck, long sleeves, gloves and long pants if they must go out during the day after the surgery to protect themselves against sunburn," Warren said. "Patients will not experience photosensitivity when exposed to ordinary indoor lighting from normal fluorescent or low wattage incandescent bulbs," he said.
Currently, PDT is FDA approved for use on tumors in the esophagus and lung cancers blocking the windpipe. Warren cautioned that, while PDT is not a cure for many patients whose cancer has spread, it can improve the quality of life significantly for those who are having trouble eating, swallowing or breathing. Other alternatives to ease swallowing or breathing include stent surgery, in which a device is implanted into the windpipe or esophagus to prop open the passageway. These can still be used in conjunction with PDT and conventional laser therapy.
Over a 20-year period, there have been significant increases in the number of deaths from several cancers involving the lungs, throat and esophagus. For example, according to the American Cancer Society, males have experienced a 24 percent increase in death from esophageal cancer, while there has been a 147 percent increase in the number of women who have died from lung cancer between 1974 and 1994.
"PDT may, in some cases, cure the cancer if it has been caught very early," he said. "In most patients, however, PDT will simply return to them the ability to breath and eat, which for many patients at this stage, is a Godsend."
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