What is the key question?

• What is the role of photodynamic therapy (PDT) in the treatment of residual endobronchial disease following anatomic lung resection in patients with non-small cell lung cancer (NSCLC)?

What is the bottom line?

• The incidence of microscopic residual tumor at the bronchial margin (R1 resection) is 4% to 5% of all anatomic lung resections. The National Comprehensive Cancer Network (NCCN) recommends repeat resection or radiotherapy (with or without chemotherapy depending on stage). However, a vast majority of these patients are not suitable for a reoperation because of high stage disease or limited cardiopulmonary capacity. Data on chemo-radiotherapy for bronchial R1 resection is limited.
• Authors conducted a retrospective review of all consecutive patients undergoing definitive surgery for lung cancer between the years 2007 and 2013 at the University of Florida and identified 15 patients with pathologic stage I disease and R1 resection who were not candidates for reoperation.
• All patients underwent bronchoscopic endobronchial biopsy along the stump site and were further classified as having carcinoma in situ or CIS (n=3), mucosal residual disease (MRD) if biopsy showed invasive cancer (n=8) and peribronchial residual disease (PRD) if biopsies were negative (n=4). Following discussion at the multidisciplinary tumor board, all CIS and MDR patients (n=11) underwent PDT 6 to 8 weeks after surgery.
• All of patients had bronchoscopic follow-up with biopsies at the treatment site at 6 months intervals for up to 2 years as well as radiographic follow up ruling out both macroscopic and microscopic residual disease at the treatment site.
• The PDT local control rate was 91% with 9% developing local recurrence at 1 year (treated with radiation), 36% with no evidence of recurrence to date after a median follow-up of 4 years, 16% with regional recurrence and 39% with distant recurrence. One patient developed pneumonia and another had a photosensitivity reaction.

Why read on?

• Bronchoscopic PDT is a safe and effective alternative option for a selected group of patients with NSCLC who have residual disease at the stump site.