A Case of Massive Hemoptysis as a Catastrophic Complication After Photodynamic Therapy for Recurred Tracheal Malignancy

Abstract

SESSION TITLE: Cardiothoracic Surgery SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Photodynamic therapy is a useful treatment method for tracheal malignancy. However, it sometimes provokes disasterous complications such as dyspnea or hemoptysis. We experienced a case of fatal hemoptysis after photodynamic therapy for tracheal cancer and hereby reported. CASE PRESENTATION: A 37-year old woman was admitted to a hospital for the treatment of her recurred tracheal cancer. She received surgical resection followed by concurrent chemoradiation therapy for her large cell neuroendocrince carcinoma in trachea 3 years before. Photofrin was administrated intravenously at a dose of 2mg/kg. One day after, endoscopic tumor ablation was performed with a light diffusion catheter using a 630mm wavelength light sorce. The patient was given 120J for one session, with duration of 400 seconds. The patient was discharged without complications 5 days after the treatment initially. However, she visited emergency room complaining dyspnea. Bronchoscopic examination showed purulent sputum and ulcerative lesion in treatment lesion. After tolileting sputum and antibiotics administration, the symptom was relieved. At 10th day of hospital stay, she appealed severe dyspnea again and endoscopic toileting was performed. Although no specific signs or symptoms have been appeared for the next 3 days, a massive hemoptysis was suddenly developed. Despite the immediate intensive care, the patient expired on the 13th day of hospitalization. DISCUSSION: Photodynamic therapy has been proved to be feasible and safe for the treatment of airway cancers. However, a patient who had been performed photodynamic therapy and revealed symptoms such as dyspnea should be carefully observed to prevent the tragic results whch might be caused by complications. CONCLUSIONS: PDT is a useful modality for lung cancer in tracheobronchial trees. It could be applied for palliative purpose to reduce symptoms caused by tumor obstruction, or hemoptysis. PDT could be an excellent substitution of surgery for patients with severe comorbidities, or patients who refuse surgery. Risks for fatal complications should be evaluated before the practice. Reference #1: Minnich DJ., Bryant AS., Dooley A., Cerfolio RJ., Photodynamic laser therapy for lesion in the airway., Ann Thorac Surg., 2010 Jun;89(6):1744. Reference #2: Wood DE. Management of malignant tracheobronchial obstruction. Surg Clin North Am. 2002 Jun;82(3):621-42. Reference #3: Guibert N., Mhanna L., Droneau S., Plat G, Didier A., Mazieres J., Hermant C., J Thorac Dis., 2016 Nov;8(11):3343. DISCLOSURE: The following authors have nothing to disclose: Eunjue Yi, Jae Ho Chung, Sungho Lee, Kwang Taik Kim No Product/Research Disclosure Information