Preoperative endobronchial photodynamic therapy improves resectability in initially irresectable (inoperable) locally advanced non small cell lung cancer

Objectives: This report describes the result of prospective randomized trial to assess effectiveness and safety of neoadjuvant photodynamic therapy (PDT) and chemotherapy as well as possibility for further surgery for locally advanced NSCLC. Methods: Patients with stage IIIA and IIIB central NSCLC (main bronchus/distal trachea involvement) who were not initially eligible for surgery but might be considered as surgery candidates after neoadjuvant therapy were enrolled in the study. They were randomized to either neoadjuvant chemotherapy and endobronchial PDT or chemotherapy alone followed by surgical resection. PDT was done with photosensitizer agent chlorine E6 and 662 nm laser light before each of the three courses of chemotherapy. Results: From January 2008 to December 2011, 42 patients were assigned to PDT arm (n = 21) and No-PDT arm (n = 21). Groups were similar with respect to age, sex, tumor stage, and histology. No PDT major complications were observed. After neoadjuvant treatment partial response revealed in 19 pts (90%) in PDT arm and 16 pts (76%) in No-PDT arm (p = 0.460), these patients underwent thoracotomy. After thoracotomy tumor was unresectable in 3 pts of No-PDT arm (19%). There were 14 pneumonectomies and 5 lobectomies in PDT arm vs. 10 pneumonectomies and 3 lobectomies in No-PDT arm. Completeness of resection was significantly higher in PDT arm (R0-89%, R1-11%) vs. No-PDT arm (R0-54%, R1-46%), p = 0.038. Conclusions: The study demonstrated that neoadjuvant PDT along with chemotherapy is effective, safe and it makes possible to convert to surgery candidates and to improve resection completeness in stage III central NSCLC patients. (C) 2014 Elsevier B.V. All rights reserved.