Case report
Efficacy of photodynamic therapy combined with a guide sheath method concomitant with chemotherapy in a small-cell lung cancer patient with central endobronchial stenosis

https://doi.org/10.1016/j.pdpdt.2016.08.008Get rights and content

Highlights

  • A case of small-cell lung cancer treated with a combination of chemotherapy and PDT.

  • PDT effectively treated airway stenosis in small-cell lung cancer.

  • PDT combined with a guide sheath is a safe and useful method.

Introduction

Photodynamic therapy (PDT) is useful as palliative treatment in advanced lung cancer with central airway stenosis. Diaz-Jimenez et al. reported that PDT is a valid method of palliation in non-small-cell lung cancer (NSCLC) with respiratory tract stenosis [1]. Alternatively, PDT is often combined with other treatment as part of multimodal therapy. Akopov et al. reported that neoadjuvant PDT with chemotherapy was safe and effective for locally advanced NSCLC [2] and Kimura et al. reported about palliative PDT combined with chemotherapy for intractable advanced lung cancer [3]. However, most reports of PDT for lung cancer have described the treatment for NSCLC but not for small-cell lung cancer (SCLC). As reports of PDT for SCLC, Moghissi et al. reported that 10 of 100 patients with advanced SCLC underwent PDT and appear to have benefited from PDT equivalent to patients with NSCLC [4]. Lee et al. reported a case of complete response in LD-SCLC treated with PDT and chemoradiotherapy [5]. Also, Kato reported 292 cases of PDT in which 11 SCLC lesions were included [6].

We herein present a SCLC case with central endobronchial stenosis in which PDT improved WHO performance status (PS) by alleviating airway stenosis and enabled him to continue to receive chemotherapy. Ingenuity of our new PDT procedure is that to the best of our knowledge, this report is the first one describing PDT concomitantly performed with chemotherapy.

Section snippets

Case

A 78-year-old male ex-smoker with COPD presented with chest x-ray abnormality on regular follow-up. Chest CT revealed an irregularly shaped mass in the right hilar region and bilateral mediastinum lymphadenopathy. He was diagnosed as LD-SCLC (cT4N3M0 Stage IIIb) and platinum-doublet chemotherapy was administered without definitive thoracic radiotherapy. Thoracic radiotherapy was high risk for him because of his advanced age, impaired pulmonary function, and an episode of interstitial changes

Discussion

In this case, we acknowledged two important clinical issues.

First, PDT is effective even for SCLC. In our case, patency of the right main bronchus did not deteriorate for 4 months until disease progression caused death. Efficacy of PDT for SCLC was similar as previous reports also in our case. If PDT had not been effective in this case, airway stenting could have been considered as an alternative proposal. This assumption comes from the reasoning that, if airway stents were placed initially to

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