Photodynamic Therapy for Lung Cancer



Fig. 29.1
(a) There is mild thickening and redness on the mucosa of the left upper lobe bronchus (arrow). This was diagnosed as squamous cell carcinoma after biopsy. (b) On autofluorescence imaging during bronchoscopy, fluorescence (arrow) is seen on the same site





 

  • 2.


    Entire tumor can be observed.

     

  • 3.


    A tumor that is located on the central side of a subsegmental bronchus.

     

  • 4.


    The patient does not have porphyria.

     






      29.1.2 Preparation






      • Laser equipment for photodynamic therapy (PDT).


      • Laser probes: Be sure to provide a dedicated probe for the laser equipment (Fig. 29.2a, b).

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        Fig. 29.2
        (a) Irradiation probe for photodynamic therapy. (b) Direct probe. (c) Side elevation probe. (d) Sequential type electronic scope. (e) Screen is white out during laser irradiation


      • Bronchoscope or simultaneous type electronic scope through which probe insertion is possible (Fig. 29.2c, d).


      • When a bronchoscope is used, a dedicated filter to be attached to the eyepiece is required.


      • Photosensitizer

      Necessary preparations for light shielding of patients (sunglasses, hat, large mask, clothes to avoid exposure of the skin, and gloves)


      29.1.3 Procedure





      1. 1.


        Check whether the laser device is working properly prior to administering the photosensitizer.

         

      2. 2.


        The photosensitizer is administered intravenously prior to laser irradiation. If talaporfin sodium will be used, injection of the drug should be 4–6 h prior to laser irradiation and the dose is 40 mg/m2 (Fig. 29.3).

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        Fig. 29.3
        Actual talaporfin sodium administration

         

      3. 3.


        Immediately before intravenous injection, the patient is shielded below 500 lx and is asked to wear sunglasses.

         

      4. 4.


        The patient is kept away from sunlight exposure until the start of treatment.

         

      5. 5.


        During local anesthesia, start the laser equipment and perform an output test.

        The following is the procedure if you use the PD laser®:


        1. (a)


          Switch on the PD laser® then put the power switch on the back (Fig. 29.4).

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          Fig. 29.4
          The front panel of PD laser®

           

        2. (b)


          Wait until warm-up is complete (Fig. 29.5).

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          Fig. 29.5
          Display during warm-up

           

        3. (c)


          When the output test mode is ready, mount the laser probe to the laser equipment body.

           

        4. (d)


          For the output test, insert the laser probe to the adapter while pressing the white button (stopper) of the adapter (Fig. 29.6).

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          Fig. 29.6
          Laser probe that is installed on the output test adapter

           

        5. (e)


          Put the adapter with the inserted laser probe to the PD laser® body (Fig. 29.7).

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          Fig. 29.7
          Put the laser probe to the laser device for the output test

           

        6. (f)


          Press the probe selection button on the laser body to select the mode appropriate for the mounted probe (Fig. 29.8).

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          Fig. 29.8
          Selection of laser probe

           

        7. (g)


          Press the START/STOP button to start the output measurement (Fig. 29.9).

          A340824_1_En_29_Fig9_HTML.jpg


          Fig. 29.9
          Measurement of laser output at the tip of the probe

           

        8. (h)


          Make sure that the output is sufficient. If the output is low, replace the probe with a new one (Fig. 29.10).

          A340824_1_En_29_Fig10_HTML.jpg


          Fig. 29.10
          Check the laser output

           

        9. (i)


          Do the output test for each probe to be used.

           

        10. (j)

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      Sep 25, 2017 | Posted by in RESPIRATORY | Comments Off on Photodynamic Therapy for Lung Cancer

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