Photodynamic therapeutic ablation for peripheral pulmonary malignancy via electromagnetic navigation bronchoscopy localization in a hybrid operating room (OR): a pioneering study

Abstract

Background: With the aid of electromagnetic navigation bronchoscopy (ENB), it has become possible to approach peripheral lung tumors from the airway. Meanwhile, local ablation using photodynamic therapy (PDT) has shown increasing promise in the realm of lung cancer treatment. The purpose of this study was to explore an alternative ablation method using PDT with SuperDimension ENB localization in a hybrid operating theater.

Methods: Our study includes patients with primary or metastatic lung cancer who underwent PDT via ENB in the hybrid operating room (OR) of National Taiwan University Hospital between January 2016 and January 2017. ENB with the SuperDimension Navigation System (7th edition) was performed before PDT ablation to localize the target lesions. PDT ablation was performed with the assistance of intraoperative Dyna-computed tomography (Dyna-CT). Tumor response was evaluated by CT 3 months after the procedure.

Results: Three patients underwent lung interstitial PDT via the aid of ENB during the study period. The mean size of the nodules was 21.3 mm. The mean navigation time was 14.3 minutes. In all cases, the target pulmonary nodule was ablated by PDT successfully. No major procedure-related complications occurred. One patient suffered from skin hypersensitivity one month after the procedure. The follow-up CT showed significant tumor shrinkage for all the patients. They were all discharged without incident a few days after the procedure as scheduled.

Conclusions: PDT with SuperDimension ENB guidance in the hybrid OR is a novel and feasible approach to control peripheral lung malignancy.

Keywords: Peripheral-type lung malignancy; SuperDimension; electromagnetic navigation bronchoscopy (ENB); photodynamic therapy (PDT).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Using a locatable electromagnetic guide and an extended working catheter, the nodule was localized with the SuperDimension 7th edition electromagnetic guide and the navigational console.

Figure 2

PDT after ENB localization in the hybrid OR. (A) Insertion of the PDT irradiation probe through the working channel to the targeted lesion; (B) setting up of the Dyna-computed tomography scanner in the hybrid OR to check the position of the working catheter and probe; (C) the PDT irradiation probe. PDT, photodynamic therapy; OR, operating room.

Figure 3

Dyna-computed tomography image showing the position of the ENB-guided PDT irradiation. ENB, electromagnetic navigation bronchoscopy; PDT, photodynamic therapy.

Figure 4

The pre-PDT axial CT (A) and the post-PDT axial CT 3 months later (B). The tumor volume shrinkage was more than 50% (PR). PR, partial remission; PDT, photodynamic therapy; CT, computed tomography.