Airway stent placement for palliation of malignant airway obstruction symptoms is an accepted intervention in the care of lung cancer patients. A common complication of stent placement is granulation tissue reaction that can occlude stents. Removal of stents for this indication can require rigid bronchoscopy and hours of manipulation with ablative technologies. PDT is currently used as part of multimodality therapy for airway management in lung cancer.
A 68 year old African-American female limited stage small cell lung cancer survivor received a left main stem wall-stent followed by chemotherapy and radiation in 1995. She presented nine years later with hemoptysis and 3 years of progressive dyspnea on exertion. Bronchoscopy revealed 90% stenosis over 4 cm in the left main bronchus with granulation tissue overgrowth. A chest CT scan demonstrated volume loss in the left lung. Biopsy showed no recurrence of malignancy. The stenosis was treated with PDT with a complete tissue response; follow-up CT scan demonstrated increased volume. Mitomycin C at the stent site was applied to prevent recurrence of granulation tissue.
Nonsurgical lung cancer patients appear to be surviving longer in selected cases. Some are experiencing local complications of their aggressive therapies. Symptoms from granulation tissue airway obstruction can limit the quality of life of these patients. In our case PDT was used to evoke destruction with excellent clinical response and no complications. PDT provided an extensive rapid elimination of granulation tissue as an outpatient using a flexible bronchoscope. Mitomycin C prevented recurrent granulation tissue formation at 6 months follow up.
PDT followed by mitomycin is a reasonable alternative to restore and maintain airway patency in this clinical setting of nonmalignant hypervascularized endobronchial overgrowth.
Gabor Varju, None.