P3.04-002 Reducing the Amount of Resection after Induction Photodynamic and Chemotherapy in Inoperable Non-Small Cell Lung Cancer: Topic: Miscellaneous I

Abstract

Involvement of the main bronchus in non-small cell lung cancer (NSCLC) often determines functional inoperability. Induction chemotherapy and endobronchial photodynamic therapy (PDT) were done with the purpose of performing lobectomy (bilobectomy) instead of pneumonectomy. Prospective study included patients with central NSCLC with the involvement of the main bronchus or trachea who were initially considered as intolerant to pneumonectomy. After an induction from two to six courses of chemotherapy and endobronchial PDT (chlorine E6 as a photosensitizer, light wavelength of 662 nm) patients were re-examined and lobectomy was offered to patients with positive response. From 2008 to 2015 48 patients with NSCLC were considered as intolerant to pneumonectomy due to low level of FEV1 (an average, 49±18% predicted, from 21% to 67%), data of perfusion scintigraphy, level of DLCO, level of Vo2 max and contralateral side lobectomy performed earlier. After preoperative treatment 38 patients (79%) underwent lobectomy instead of pneumonectomy. Initial tumor was localized the right main bronchus in 13 patients (34%), left main bronchus — in 18 (47%), tracheal bifurcation — in 7 patients (18%). Stages were: IIA – 2 patients, IIB – 2 patients, IIIA – 15 patients, IIIB – 19 patients. cN0 disease was diagnosed in 12 patients (32%), cN1 – in 9 (24%), cN2 – in 17 patients (44%). In all cases tumor disappeared from the main bronchus after preoperative treatment. 11 conventional lobectomies, 15 wedge, 9 sleeve lobectomies and 3 bilobectomies were done. In all cases bronchial cutting was done in initially affected zone. Pathological examination revealed 34 of 38 patients operated completely (R0-89%), 4 – microscopically incompletely (positive bronchial resection margin, R1-11%), pN+ was diagnosed in 12 patients (32%). No postoperative mortality and major complications were noted. During follow-up (from 6 to 72 months) one local recurrence was developed (3%); three- and five-year survival rates were 88% and 55%. Preoperative treatment including chemotherapy and PDT led to less extensive resections (lobectomy instead of pneumonectomy) reducing surgical risks.