P3.16-041 Pleural Photodynamic Therapy and Surgery for Pleural Metastasis by Non-small Cell Lung Cancer

Abstract

Photodynamic therapy (PDT) is one of the established treatment modality for non-small cell lung cancer (NSCLC). Early-stage lung cancer and superficial endobronchial lesions less than 1 cm in thickness can be e ectively treated with external light sources. Thicker lesions and peripheral lesions may be amenable to interstitial PDT, where the light is delivered intra-tumorally. The primary adverse event, phototoxicity, is expected to be minimized with the introduction of new photosensitizers that have shown promising results in phase I and II clinical studies. Moreover, the addition of PDT to standard-of-care surgery and chemotherapy (or target therapy) can improve survival and outcomes in patients with pleural dissemination. Therefore, pleural PDT with surgery has shown promise in the treatment of non-small cell lung cancer with pleural spread. Between January 2007 and January 2017, we retrospectively reviewed the clinical characteristics, treatment course and outcome of 39 patients with pleural seeding by non-small cell lung cancer. The eligibility criteria are as follows: pathologic diagnosis of lung cancer or thymoma with pleural spread, medical feasibility for PDT and surgery. The exclusion criteria are as follows: younger than 18 years old, leukopenia, or thrombocytopenia; chronic renal insufficiency with serum creatinine >2.5 mg/dL; significantly impaired liver function; pregnancy or lactation. Patients underwent anatomic resections in whom it was possible to remove all gross tumor. After finishing the procedure, the parietal pleura were stripped from the bony hemithorax as radical parietal pleurectomy. Debulking of all gross tumor was performed in the mediastinum, too. For thymoma patients, the radical thymothy- mectomy was performed concurrent with radical pleural pleurectomy. The goal was to remove all detectable tumor in the operation field before proceeding to the photodynamic therapy. Thirty-nine patients enrolled in this study. There are 18 men and 21 women included in this study. The mean patient age was 52.6 ± 11.9 years. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 69.4% and 59.5%, respectively. There is one ARDS occurred immediately after the procedure. After medical treatment, the condition gradually improved. Other minor complications included prolonged air-leakage (five patients) and skin redness (six patients). The complications were successfully treated using medication. There was no procedure-related mortality. Photodynamic therapy and surgery for pleural dissemination in patients with non-small cell lung cancer is feasible and associated with a good soutcome.