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Breast Cancer With Chest Wall Progression: Treatment With Photodynamic Therapy

From the Photodynamic Therapy Program, Leo Jenkins Cancer Center, Departments of Surgery (REC), Radiation Oncology (RRA, CS), and Medicine (GHD), The Brody School of Medicine, East Carolina University, Greenville, North Carolina.

Correspondence: Address correspondence and reprint requests to: Rosa E. Cuenca, MD, Department of Surgery, 600 Moye Blvd., PCMH TA-202, Greenville, NC 27858; Fax: 252-744-5775; E-mail: cuencar{at}mail.ecu.edu

Background: Chest wall progression of breast carcinoma affects up to 5% of breast cancer patients and is a major source of their pain. Treatment options are limited or may not be offered to these patients. Low-dose Photofrin-induced photodynamic therapy (PDT) offers an excellent clinical response with minimal morbidity. We report our continued experience with PDT in this setting.

Methods: Fourteen patients with more than 500 truncal metastases were treated with PDT. All received off-label Photofrin (.8 mg/kg) IV and light treatment at 630 nm from a diode laser with a microlens at a fluence of 1800 mW and a total light dose of 150 to 200 J/cm² at 48 hours. One patient required re-treatment because of extensive disease.

Results: Follow-up was at least 6 months, and several extended to >24 months. All patients demonstrated tumor necrosis, with 9 of 14 complete responses, including with lesions >2 cm in thickness. Disease progression occurred outside of the treatment field. Several patients had initial regression of untreated lesions. Wound care, especially with disease in the deep tissues, was an issue.

Conclusions: Low-dose Photofrin-induced PDT offers patients with chest wall progression a treatment option with an excellent clinical response. To date, the response is prolonged and offers good local control. Surgical oncologists have an active role in this treatment option.

Key Words: Breast carcinoma • Chest wall recurrence • Photodynamic therapy • Photofrin

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