Definitive surgery and intraoperative photodynamic therapy for locally advanced non–small cell lung cancer: A case report

Backgound: Locally advanced lung cancer (T3 or T4) has no straightforward guidelines are available to manage it. Although surgery has traditionally been regarded as the mainstay of treatment and the only curative modality, it has limited relevance in patients with locally advanced non–small cell lung cancer (NSCLC). Photodynamic therapy (PDT) is a clinically approved cancer therapy; it is an established treatment modality with curative intent for early stage and superficial endobronchial lesions. However, the efficacy of PDT in advanced lung cancer is controversial and it primarily has been used in palliative care.Case presentation: This case report describes a 70-year-old male who had a right upper lung cancer and endobronchial lesion that extended into the distal trachea. A biopsy specimen was obtained upon bronchoscopy, and the result confirmed squamous cell carcinoma. We performed a definitive sleeve lobectomy and intraoperative PDT. Gross total resection of the tumor was achieved, but the presence of microscopic residual tumors was inevitable. Complete anatomical resection of the primary tumor by pneumonectomy was not possible due to poor lung function and endobronchial extension to the distal trachea. We decided to apply intraoperative PDT to the lumen and outer wall of the bronchi and distal trachea for local tumor control. The patient is alive with no evidence of disease after 13 months of follow-up. Conclusions: This is the first report to describe the feasibility and efficacy of intraoperative PDT as part of multimodal therapy for locally advanced NSCLC.