PURPOSE: The purpose of this study was to assess patterns of failure in patients who underwent surgery and intraoperative photodynamic therapy (PDT) for non-small cell lung cancer NSCLC with pleural dissemination (Stage IIIB).
METHODS: 34 patients, with NSCLC and malignant pleural effusion and/or gross pleural carcinomatosis, were enrolled in a Phase II trial combining surgery and intraoperative PDT. 33/34 patients received preoperative chemotherapy. 30 patients underwent an anatomic lung resection, pleural stripping and intraoperative PDT. 4 patients went to surgery, but did not have stage IIIB disease and did not receive PDT (3 extrahemithoracic cancer, 1 no pleural cancer). 30 patients received PDT (27 “complete” and 3 “incomplete” resections). Patients are/were followed every 3 months with office visits/CT scans.
RESULTS: At this time the mean survival of all 30 stage IIIB patients is 27.4 months, with 4 patients alive with no evidence of disease (28-76 months). 28/30 patients were N2 and 2/30 were N1 (20 & 21 month survival). There were 2 postoperative mortalities. 21/26 deaths were cancer related with 6 isolated local recurrences, 3 local and distant recurrences, and 12 with local control but distant metastases: bone, brain, spine, abdomen, liver and contralateral lung.
CONCLUSION: Surgery combined with intraoperative PDT for these stage IIIB NSCLC patients appears to favorably impact both survival and local control. Our current mean survival rate of 27.4 months compares favorably with the 6-9 months of historical controls treated with the standard of care, chemotherapy alone. Surgery and chemotherapy, without intraoperative pleural adjuvant treatment, does not change this survival rate beyond chemotherapy alone. Of the patients who died from their cancer, 71% succumbed to distant metastatic disease in the usual distribution of NSCLC.
CLINICAL IMPLICATIONS: Surgery and intraoperative PDT may be an aggressive treatment option for stage IIIB NSCLC patients. This treatment resulted in good local control and mean survival rates significantly greater than expected, but the ultimate development of distant metastases speaks to the need for innovative systemic treatments for NSCLC.
DISCLOSURE: Joseph Friedberg, None.