P-216REDUCING THE EXTENT OF RESECTION IN NON-SMALL CELL LUNG CANСER WITH THE USE OF PHOTODYNAMIC THERAPY

Abstract

About one-third of NSCLC patients have unresectable locally advanced tumour or limited pulmonary function. Preoperative and intraoperative photodynamic therapy (PDT) was performed for the purpose of reducing the extent of resection in this type of patients. Twenty-two patients with central stage II-III non-small cell lung cancer (NSCLC) (main bronchus/distal trachea involvement) who completed the treatment plan were prospectively analyzed. They were not initially eligible for surgery: 12 patients did not tolerate pneumonectomy, 10 patients had tracheal invasion from primary lesion (mostly left). Treatment plan included preoperative endobronchial PDT plus chemotherapy followed by tumour resection and intraoperative PDT. Once a macroscopic complete resection was achieved, the intraoperative PDT of the open bronchial stump and mediastinum was performed, the stump was then manually sutured. The second generation photosensitizer agent chlorine E6 and 662 nm laser light was used for PDT. Endoscopic response was noted in 21 (95%) patients after neoadjuvant treatment. Twelve patients were originally candidates for pneumonectomy, and it became possible to reduce the extent of resection to lobectomy or bilobectomy in all of them. In 10 patients with initial trachea tumour it disappeared from the trachea lumen in 9. These 9 patients underwent pneumonectomy, remaining one–carinal pneumonectomy. One patient died postoperatively. Microscopic examination revealed malignant cells of bronchial stump in 3 patients (R1-14%), N0 in 6 (27%), N1 in 14 (64%) and N2 in 2 (9%). Main follow-up period was 31 months (6 to 55 months), no local recurrence was diagnosed. One- and 3-year survivals were 95% and 91%, respectively. This study suggests that PDT may have an important role in combination with operation in NSCLC and makes it possible to reduce the extent of resection. All authors have declared no conflicts of interest.