Photodynamic therapy for central type early-stage lung cancer: Long-term outcomes, repeatability, and the impact of metachronous malignancies.

BACKGROUND: Achieving durable local control of central airway malignancies while preserving pulmonary function is clinically important, particularly in patients at risk for repeated lesions due to field cancerization. OBJECTIVE: To evaluate long-term outcomes of photodynamic therapy (PDT) for early and central airway lesions, with emphasis on lesion morphology and the impact of metachronous malignancies. METHODS: We retrospectively reviewed 23 patients treated with PDT at a single center between April 2012 and December 2024, comprising 36 treatment sessions. Lesions were categorized bronchoscopically as superficial, thickened, or nodular. Response was classified as complete response (CR), partial response (PR), or no data (ND). Survival was defined as days from the initial PDT session to death or last follow-up. RESULTS: Superficial lesions achieved high CR rates with PDT alone or repeat sessions. Thickened and nodular lesions often required hybrid approaches (e.g., radiation, snaring, cryotherapy/ablation) yet could still achieve durable control. The longest observed survival was 4,239 days. Overall survival was favorable after the initial PDT, with estimated OS of 93.8% at 3 years, and 84.4% at 5 years; median OS was not reached. In long-term survivors, mortality was frequently driven by competing risks, particularly second primary lung cancers. CONCLUSIONS: PDT is a robust, repeatable, lung-sparing modality for local airway control with favorable long-term survival. Morphology-informed selection of irradiation strategy and timely integration of multimodal therapy may optimize outcomes, while lifelong surveillance remains necessary due to the high incidence of metachronous malignancies.