Сombined endoscopic photodynamic therapy for stenosing cancer in the only lung lobe

Abstract

A clinical case of stenosing cancer in the only lung lobe treated with endoscopic photodynamic therapy (PDT) in combination with argon-plasma coagulation (APC) is presented. Material and methods . A patient with central cancer of the left lung (pT2N0M0, st 1b) had a radical extended pneumonectomy on the left. In 28 months, central metachronous endobronchial cancer of the right main bronchus (cT1N0M0 stIA) developed. Histological examination revealed G2 squamous cell carcinoma. Because of bronchial stenosis in the only lung lobe, the patient was treated with endoscopic PDT followed by APC at the site of the tumor. Lakhta-Milon laser (Russia) with wavelength 662 nm, optical fibers having a microlens and a cylindrical diffuser 1.0 cm long were used for the treatment. Radiation power 500 mW, energy density 70 J/cm 2 . Three hours before PDT, the patient was injected intravenously and dropwise 100 mg of Photoditazine dissolved in 100 ml of physiological solution (ratio 1.2 mg per 1 kg of body weight). Irradiation was made from 3 positions: a flexible light guide with a microlens irradiated the upper lobe spur; then the tumor was irradiated with a light guide having a cylindrical diffuser via residual bronchial lumens. APC of the tumor was performed electrosurgically with device APC ERBE VIO 300D. ForcedCoag mode, power 80 W, argon flow rate 1 liter per minute. Results . One day after the first PDT session, dyspnea became gradually less; on day 6 the patient had the second PDT session by the same technique. After it, his condition improved, vital signs stabilized: shortness of breath and expiratory stridor decreased; respiratory rate – 22 per/min; heart rate – 94 beats/min; sat. O 2 = 86%. Later, despite multiple courses of chemotherapy, the tumor was growing which required regular PDT-APC recanalization at 2–6-week intervals. Such a combined endoscopic treatment maintained a satisfactory quality of life in the patient for 1.5 years. Conclusion . PDT combined with APC can be used as an independent effective technique in antitumor therapy in patients with stenosing lung cancer when other surgical and chemoradial options are ineffective. It also significantly prolongs the life of patients.