What is the key question?

• What is the effectiveness of photodynamic therapy (PDT) in patients with Stage III or IV non-small cell lung cancer (NSCLC) and central airway obstruction (CAO)?

What is the bottom line?

• PDT and other ablative therapies (cryotherapy, argon plasma coagulation, and laser) have been effectively applied as a monotherapy or part of a multimodal approach for the palliation of NSCLC patients who are not surgical candidates. However, it remains unclear whether any particular endobronchial treatment modality that is used impacts clinically relevant outcomes.
• In this retrospective cohort study, authors reviewed the SEER-Medicare database from year 2000 to 2011 and compared 3 groups of patients with stage III/IV NSCLC: patients with CAO treated with “PDT and radiation therapy” with or without chemotherapy (n=39), patients with CAO treated with “non-PDT ablation and radiation therapy” with or without chemotherapy (n=558), and patients treated with “radiation and chemotherapy” alone (n=43,186).
• The PDT group had a hazard for all-cause and cause-specific mortality comparable to that of the “radiation and chemotherapy” group unlike the non-PDT ablation group where the hazard for all-cause and cause-specific mortality were higher. The PDT group had longer time-to-subsequent treatment compared to non-PDT ablation group but that was not statistically significant.
• Some of the key limitations of the study were the selection bias and the lack of information on whether the “radiation and chemotherapy” group did or did not have CAO.

Why read on?

• This is the first study that used a large administrative data and demonstrated that PDT, as part of multimodality therapeutic approach, is a meaningful anti-cancer treatment modality for patients with stage III or IV NSCLC with airway obstruction with a potential for improved outcomes when compared with non-PDT ablation techniques.