Poster SessionP1.04-005 Efficacy of Photodynamic Therapy Combined with a Guide Sheath Method in Lung Cancer Patients with Endobronchial Stenosis: Topic: Pulmonology

Photodynamic therapy (PDT) using a second generation of photosensitizier, talaporfin sodium was useful for the curative or palliative treatment of lung cancer. However, it is required for interventional pulmonologist to perform accurate PD-laser irradiation in some lung cancer case. We hypothesized that all-direction type PD-laser probe covered with a guide sheath (GS) (GS-PDT) made it possible to secure its probe and fix its position in the endobronchial lesion, to enhance the effect of PDT by avoiding direct contact with the tumor lesion, thus preventing its probe from contact with blood. We evaluated the efficacy and safety of this irradiation technique for the lung cancer patients with endobronchial stenosis. Before the procedure, we evaluated the extent of tumor lesion by auto-fluorescence video-bronchoscope (BF TYPE-F260, Olympus, Japan). As a photosensitizer, talaporfin sodium (Laserphyrin, Meiji Pharma, Japan) was administered at 40mg/m2 intravenously 6 hours before irradiation. PDT was performed by using video-bronchoscope (EB-530T, FUJI MEDICAL, Japan) to visualize PD-laser light clearly by adjusting FICE（Flexible spectral Imaging Color Enhancement）mode. We irradiated 664nm laser light to the target bronchus with endobronchial stenosis utilizing an all-direction type laser probe covered with a GS (disposable K203 guide sheath kit, Olympus, Japan) at each dose of 100J/cm2 (150mW) for 11 minutes and 7 seconds under fluoroscopic guidance. After one month, we evaluated the endoscopic efficacy of this method. Between December 2014 and April 2015, we performed GS-PDT for three patients with pathologically diagnosed lung cancer, 1 squamous cell carcinoma, 1 adenocarcinoma and 1 small cell carcinoma. Stage IA squamous cell carcinoma patient with endobronchial stenosis underwent definitive therapy. Stage IA adenocarcinoma patient with endobronchial wall spread of tumor to proximal respiratory tract underwent a combination of induction chemo-radiotherapy followed by sleeve left upper lobectomy as for definitive therapy to reduce the extent of lung resection. Stage IIIA limited-stage small-cell lung cancer patient with the stenosis of right main and upper lobe bronchus underwent palliative therapy to improve oxygenation and to prevent obstructive pneumonia. One month after GS-PDT, we confirmed the endoscopic response (1 complete response, 2 partial responses). No PDT-related complications occurred. New GS-PDT method was safe and could be an effective technique to accurately irradiate the lung cancer patients with endobronchial stenosis.