Porfimer

INTRODUCTION

Indications

Part of photodynamic therapy (PDT) for Esophageal cancer that has completely or partially obstructed the esophagus and cannot be treated with Nd:YAG laser therapy, Reduction of obstruction and palliation of symptoms in patients with completely or partially obstructive endobronchial non–small-cell lung cancer, Microinvasive endobronchial non–small-cell lung cancer when surgery or radiation are not options, High-grade dysplasia due to Barrett's esophagus in patients who are unable to have esophagectomy.

Action

Porfimer is retained by the tumor, which is then treated with a laser light. When porfimer absorbs the light, a photochemical reaction occurs, causing cellular damage. Thromboxane A is also produced, causing additional local tumor necrosis. Therapeutic Effects: Shrinkage of esophageal or endobronchial tumors.

Adverse Reactions/Side Effects

CNS: insomnia, anxiety, confusion, weakness. Resp: RESPIRATORY INSUFFICIENCY, dyspnea, mucositis reaction, pharyngitis, pleural effusion, pneumonia, cough, tracheoesophageal fistula. CV: HEART FAILURE, atrial fibrillation, chest pain, edema, hypertension, hypotension, tachycardia. GI: ESOPHAGEAL RUPTURE, GI BLEEDING, abdominal pain, constipation, nausea, vomiting, anorexia, diarrhea, dyspepsia, eructation, esophageal tumor bleeding, esophageal stricture. Derm: photosensitivity. F and E: dehydration. Hemat: anemia. Misc: fever, pain, moniliasis, urinary tract infection, weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor respiration, and report signs of respiratory insufficiency, pleural effusion, or pneumonia. Signs include shortness of breath, dyspnea, rapid/shallow breathing, chest pain, fever, and cyanosis. Monitor pulse oximetry and perform pulmonary function tests (See Appendces I, J, K) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

• Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

• Be alert for signs of esophageal rupture, including chest and abdominal pain, nausea, vomiting blood, rapid breathing, and shock. Request emergency care if these signs occur.

• Assess signs of heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, ...