Photodynamic therapy for the treatment of metachronous central lung cancer: a case report

Background. Treatment of metachronous lung cancer is challenging, because bronchopulmonary polyneoplasia develops in 4% and 10% of patients within 5 years after the initial diagnosis. Due to the low functional reserves of patients undergoing radical lung resection, the options for repeat lung resection are significantly limited. In this case, alternative endobronchial therapies like photodynamic therapy (PDT) appear promising. the purpose of the study was to present a case of successful use of PDT in the treatment of metachronous central lung cancer, which resulted in a complete tumor regression and a 6-year relapse-free period. Case presentation. Patient Ya., born in 1953, first visited Cancer Research Institute of Tomsk National Research Medical Center in 2017. The histological examination revealed central squamous cell carcinoma in the right upper lobe bronchus of the lung, stage I, cT1N0M0. After correction of severe concomitant pathology, the patient underwent radical surgery (July, 2017): right upper lobectomy, wedge resection of the intermediate and main bronchi with the creation of a 2/3 interbronchial anastomosis, and mediastinal lymph node dissection. No evidence of disease progression was found until July 2019, when a follow-up examination revealed metachronous central (squamous cell) carcinoma in the left upper lobe bronchus of the left lung, stage I, cT1N0M0. Considering significant comorbidities and low respiratory function of the patient, the case was considered functionally inoperable. Given the early stage of metachronous central left lung cancer, photodynamic therapy (PDT) was chosen. The patient underwent endobronchial PDT sessions (July, 2019) using the technique developed at Tomsk Cancer Research Institute. No signs of relapse or disease progression were found within 6 years of follow-up. Conclusion. Endobronchial photodynamic therapy is the treatment of choice for metachronous central lung cancer in patients with high comorbidity and low respiratory function. PDT has been shown to provide a long relapse-free period, with satisfactory quality of life and social and occupational rehabilitation.