PURPOSE:Bronchoscopic procedures to ablate endobronchial lesions (EBL) from renal cell cancers (RCC) are frequently complicated by bleeding due to the vascular nature of the metastases and recurrences are common. Photodynamic therapy (PDT) because of it's mode of action, may be a safer and more effective alternative in the non-emergent management of EBL from RCC.
METHODS:Retrospective review of medical records of patients undergoing PDT for RCC related EBL from January 2006 through December 2007. Outcome measures were the procedure-related mortality, 30-day mortality and the efficacy measured by the need for additional interventions.
RESULTS:Eight patients were treated with PDT in a conventional dose and manner. The median age was 56 years (range: 26–72). The location of EBL was lobar or segmental in 7 patients (87.5%) and main stem bronchial in 1 (12.5%). Symptoms were hemoptysis in 4, hemoptyis and post-obstructive pneumonia in 3, and airway obstruction in 1 patient. EBL was diagnosed metachronously in 7 (87.5%) patients with the median duration of time between the diagnosis of the primary tumor and the EBL being 38 months (range: 11–81). Five patients had been treated with mechanical ablation with or without argon plasma coagulation (APC) of the EBL prior to requiring PDT for recurrence in symptoms. PDT was successful in controlling symptoms and relieving EB obstruction in all patients without any procedure related complications. Only one patient, who had a recurrence of hemoptysis 23 months later, required a second dose of PDT. There was no procedure-related mortality and 30-day mortality was 12.5% with one patient dying from the underlying cancer.
CONCLUSION:PDT is a safe and effective option for management of hemoptysis or airway obstruction from RCC related Endobronchial disease.
CLINICAL IMPLICATIONS:PDT is a safe and effective option for management of hemoptysis or airway obstruction from RCC related Endobronchial disease.
DISCLOSURE:Chakravarthy Reddy, No Financial Disclosure Information; No Product/Research Disclosure Information