77P - Bronchoscopic photodynamic therapy for treatment of microscopic residual disease post resection in non-small cell lung cancer

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Non-Small-Cell Lung Cancer, Locally Advanced
Lung and other Thoracic Tumours
Surgery and/or Radiotherapy of Cancer
Presenter Abhishek Biswas
Citation Annals of Oncology (2017) 28 (suppl_2): ii24-ii27. 10.1093/annonc/mdx092
Authors A. Biswas1, A. Khokar2, S. Fernandez-Bussy1, M.A. Jantz1, H.J. Mehta1
  • 1Division Of Pulmonary And Critical Care Medicine, University of Florida, 32610 - Gainesville/US
  • 2University of Florida, Gainesville/US

Abstract

Background

The goal of lung cancer surgery is a complete tumor resection (R0 resection) with tumor-free resection margins. However, 4-5% of lung cancer resections have evidence of microscopic residual disease which is associated with worse prognosis as compared to complete resection. Definitive management for such patients is re-operation and resection of residual tumor. However, a significant percent of patients may not be able to tolerate another surgery and for those patient’s definitive management is not well studied. We treated these patients with stage I cancer and mucosal residual disease with bronchoscopic PDT (photoynamic therapy) and report our experience here.

Methods

We conducted a retrospective analysis of patients who underwent definitive surgery for early stage lung cancer. All patients with R1 resection, stage I disease with mucosal residual tumor and or carcinoma in situ along the stump site were treated with bronchoscopic photodynamic therapy and were studied. Patient characteristics, histology, type and site of surgery, pattern of recurrence, recurrence status, and survival data were evaluated. Adverse events were recorded.

Results

A total of 11 patients (Table) with mucosal R1 resection were treated with PDT along the stump site between 2007 and 2013. The breakdown according to the pattern of residual disease was as follows: CIS in 3 and MRD in 8 patients. One patient (9%) had local recurrence 1 year after treatment and was treated with radiation along the stump site. Four patients (36%) had no evidence of recurrence to date after a median follow up of 4 years and other 6 patients had evidence of regional (16%) or distant (45%) and were treated appropriately for the same. Local control rate was 91%. The median overall survival and progression free survival in our cohort of patients were 45 and 26 months respectively. One patient developed pneumonia and one patient has evidence of photosensitivity reaction.rnTable: 77Prn

rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn rnrn
Patient #AgeSexOperationHistologyType of residual diseaseSite of treatmentPattern of recurrencePFS monthsOverall survival monthsAlive
153MLobectomyAdeno caMRDLLLregional4966Y
280FLobectomySCCaCISLULn/an/a45N
380FSegmentectomyAdeno caMRDRMLDistant1011N
457MLobectomySCCaCISRLLn/an/a70Y
566MLobectomySCCaMRDLLLDistant2832N
640MLobectomyAdeno caMRDRULregional3659N
766FLobectomyAdeno caMRDRLLn/an/a86Y
867FLobectomySCCaMRDRMLDistant2634N
976MSleeve lobectomySCCaMRDLLLn/an/a39N
1072FSegmentectomySCCaCISRULLocal2473Y
1174FLobectomySCCaMRDLULDistant2125N
rn

Conclusions

Conclusion: Bronchoscopic photodynamic therapy (PDT) is a nonthermal ablative technique that can be used to treat central airway disease in adults. In conclusion, based on our findings, PDT is a safe and effective alternative therapy for patients with mucosal residual disease post R1 resection. Although this was a retrospective evaluation with a small sample, our data suggest that selected NSCLC patients after R1 resection may benefit from bronchoscopic PDT.

Clinical trial identification

This is not a clinical trial.

Legal entity responsible for the study

University of Florida

Funding

None

Disclosure

All authors have declared no conflicts of interest.