Light therapy opens airways

Another reason lung patients have hope

Spokane has attracted yet another physician to the area, one who offers an additional treatment option for people with lung cancer.

Gregory Loewen, DO, a pulmonologist from New York, has provided innovative care to five local patients since his arrival in the Northwest just a few months ago. He’s using photodynamic therapy—a procedure that’s been around for nearly 20 years, but has never been available in the Inland Northwest.

How it works

On a Monday, the patient, “Bob,” receives an injection of the medication that will kill the tumor in his lung. Because the drug makes a person extremely sensitive to sunlight, a nurse will give him sunglasses and gloves and make sure he has brought along a dark shirt and a wide brim hat, because sunscreen won’t be enough protection. Bob also receives verbal and written reminders that even just a little carelessness will result in sunburn and swelling.

On Wednesday, Bob comes to Sacred Heart’s operating room where he receives general anesthesia. Inserting a long, slender scope through Bob’s mouth, Dr. Loewen advances a light fiber into his lung. The light fiber is hooked up to a portable laser system, programmed to emit the proper dose of red light based on the size of the fiber and of the tumor. As it glows, the red light works into the tumor and activates the drug, releasing oxygen, which kills the tumor. After just 8-12 minutes, Dr. Loewen pulls the fiber out and Bob is monitored in the recovery room for a short time before returning home.

On Friday, Bob comes back to Sacred Heart, but this time to the outpatient endoscopy room where Dr. Loewen will insert a scope into the lung and remove the dead tissue from the bronchial passageway.

Within a week, Bob is breathing more easily and, for the first time in many months, able to do the activities he enjoys the most. Should the tumor grow back or another one develop, Bob can come back for additional photodynamic treatments.

His only side effect? Being incredibly sensitive to sunlight for a few weeks.

Breathing more easily

Sometimes, lung cancer is too deep inside the lung to be treated by photodynamic therapy (PDT). However, tumors found in the central main airways can be treated quite effectively.

“If I can see it with a bronchoscope, I can probably treat it with PDT,” says Dr. Loewen.

Frequently, a patient with a cancer blocking one of the main bronchial airways has already tried chemotherapy or radiation (or isn’t eligible for those), and photodynamic therapy can at least make the patient feel better and really slow the cancer down. If the cancer has caused the lung to collapse, the therapy can open up the airway and allow the lung to re-expand.

“A tumor the size of a marble is enough to plug up your entire airway, which can be terrifying,” Dr. Loewen explains. “If you don’t want surgery or radiation—or if surgery can’t be used—PDT is an alternative.”

In his opinion, it’s also the treatment of choice for micro-invasive cancer, or what doctors call “carcinoma in situ.” These are really early central lung cancers which are thin as a sheet of paper. When PDT is used in these situations, the usual cure rate is much higher than for any other form of lung cancer.

Those really early cancers account for less than 1 percent of all lung cancers. However uncommon, the pulmonologist has found two such patients in Spokane, just in the last few months.

“That’s what makes me the happiest—finding a cancer early enough to offer this,” he says.

Spreading the word

Dr. Loewen demonstrates how he holds the light completely still in order to maneuver the light fiber into perfect position.

Photodynamic therapy was first used experimentally in the 1980s, and the final approval by the Food and Drug Administration came in 1998 after extensive safety testing. It has been done frequently at the Mayo Clinic and at Roswell Park Cancer Institute in New York, where it was developed and where Dr. Loewen performed the procedure more than 60 times.

Still, it isn’t readily available to patients in many areas because few physicians have learned how to do the technique.

“I’m mystified, actually,” says Dr. Loewen. “I can’t understand why it hasn’t been more popular.” And that’s why he has already taught several physicians about the procedure and considers it his responsibility to show the insurance companies why it’s so useful.

That will be a crucial effort, considering a single dose of the drug used for photodynamic therapy costs several thousand dollars.

“Still … that’s about half the cost of one cycle of the usual chemotherapy for lung cancer. And it’s covered by Medicare/Medicaid and most private insurance providers when used in the right context,” he says.

As for the patients who have already tried PDT, the results have been profoundly positive. They have been given relief and more time to enjoy the things they love.

“Quality of life is really important,” Dr. Loewen shares. “When we can dramatically improve how patients feel, that really makes a difference.”

Dr. Loewen is an affiliate physician with Providence Cancer Center and serves as its Thoracic Section program director. As such, he will be creating new services and programs to ensure that Providence remains on the cutting edge of cancer care.

For more information, contact:

Providence Cancer Center
PO Box 2555
Spokane, WA 99220-2555

In Spokane: (509) 474-5490
Toll-free: (800) 228-6618

E-mail: hopebeginshere@psew.org

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