BRONCHOSCOPIC PHOTODYNAMIC THERAPY COMPARED TO CRYODEBRIDMENT FOR MALIGNANT CENTRAL AIRWAY OBSTRUCTION: A SINGLE-CENTER COMPARATIVE STUDY

Abstract

SESSION TITLE: Rapid: Diagnostic and Therapeutic Interventions in Lung Cancer SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Malignant central airway obstruction (MCAO) is a significant cause of morbidity and mortality among patients with primary and metastatic malignancies. While many ablative techniques have been developed for airway recanalization, there is a paucity of comparative data on their relative efficacy. In particular, the potential increased benefit of ablation techniques with delayed effects such as photodynamic therapy (PDT) is not well established. We performed a single center retrospective review of the safety and efficacy of PDT in comparison to immediate airway recanalization using cryodebridement (CD). METHODS: Retrospective review of 101 patients treated with either bronchoscopic PDT (n=22) or CD (n=79) as the primary therapeutic method for MCAO between January 2000 and December 2018. Multiple clinical outcomes such as airway patency, symptoms and need for further interventions after each procedure were analyzed in a large volume academic interventional pulmonary program. RESULTS: 22 patients (Mean age 72.9 years and 63.6% male) were treated with PDT and 79 patients (Mean ager 66.2 and 48.10% male) with CD. The most frequent cause of airway obstruction was lung squamous cell carcinoma for the PDT group (36.4%) as well as for the patients treated with CD (35.4%). Most obstructions were located at the lobar bronchus for both groups (72.7% PDT vs. 53.2% CD). The most common presenting symptom was dyspnea (72.7% PDT vs. 58.2% CD) and hemoptysis (45.45% vs. 25.32). Endobronchial lesions (rather than mixed lesions) were treated more commonly with PDT compared to CD (68.2% vs. 13.9%, P-value 50%) was more frequently treated with CD (93.7% vs. 81.8%, p0.05). Improvement of symptoms within eight weeks after the procedure was reported in 68.2% of patients treated with PDT and 48.10% with CD, (p=0.53). Radiologic improvement on chest CT scan at eight weeks post-procedure was reported in 36.4% with PDT compared with 26.6% with CD (p=0.9). Further interventions were required in 22.7% of patients with PDT and 20.3% CD (p>0.05). No complications were found in patients treated with PDT; However, 12.7% (n=10) of patients in the CD group had at least one complication such as respiratory failure, hemodynamic instability, and bleeding. CONCLUSIONS: PDT and CD are safe and effective for the management of MCAO. CLINICAL IMPLICATIONS: We found no clinically significant difference in improvement of symptoms, airway patency and need for repeat following initial therapy, although complications such as bleeding and respiratory failure were more frequently reported in the CD group. DISCLOSURES: No relevant relationships by Jason Beattie, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 03/15/2019 by Alex Chee, source=Web Response, value=Consulting fee No relevant relationships by Hanine Inaty, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Juan Pablo Uribe, source=Web Response