Definitive surgery and intraoperative photodynamic therapy for locally advanced non-small cell lung cancer: a case report

• Published in: World journal of surgical oncology Vol. 20; no. 1; pp. 1 - 265
• Main Authors: Jung, Hee Suk, Kim, Hyun Jung
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 24.08.2022; BioMed Central; BMC
• Subjects: Airway management; Biopsy; Bronchi; Bronchoscopy; Bronchus; Cancer; Cancer therapies; Care and treatment; Case Report; Chemotherapy; Effectiveness; Lesions; Lung cancer; Lung cancer, Non-small cell; Lungs; Non-small cell lung carcinoma; Ostomy; Patient outcomes; Patients; Photochemotherapy; Photodynamic therapy; Pneumonectomy; Pulmonary arteries; Radiation therapy; Respiratory function; Small cell lung carcinoma; Squamous cell carcinoma; Surgery; Surgical outcomes; Surgical procedures; Tomography; Trachea; Tumors; Veins & arteries; South Korea
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-022-02729-5

Background There are no guidelines for straightforwardly managing advanced lung cancer (T3 or T4). Although surgery has traditionally been regarded as the mainstay treatment and the only curative modality, it has limited relevance for patients with locally advanced non-small cell lung cancer (NSCLC). Photodynamic therapy (PDT) is a clinically approved cancer therapy; it is an established treatment modality with curative intent for early-stage and superficial endobronchial lesions. However, the efficacy of PDT in advanced lung cancer is controversial, and it has primarily been used in palliative care. Case presentation This case report describes a 70-year-old male who had right upper lung cancer and an endobronchial lesion that extended into the distal trachea. A biopsy specimen was obtained upon bronchoscopy, and the result confirmed squamous cell carcinoma. We performed a definitive sleeve lobectomy and intraoperative PDT. Gross total resection of the tumor was achieved, but the presence of microscopic residual tumors was inevitable. Complete anatomical resection of the primary tumor by pneumonectomy was not possible due to poor lung function and endobronchial extension to the distal trachea. We decided to apply intraoperative PDT to the lumen and outer wall of the bronchi and distal trachea for local tumor control. The patient is alive with no evidence of disease after 13 months of follow-up. Conclusions This is the first report to describe the feasibility and efficacy of intraoperative PDT as part of multimodal therapy for locally advanced NSCLC. Keywords: Non-small cell lung carcinoma, Surgical procedures, Photochemotherapy