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E. Kassis



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-028 - Photodynamic Therapy for Airway Malignancies: A 15-year single institution experience (ID 1701)

      09:30 - 09:30  |  Author(s): E. Kassis

      • Abstract

      Background
      Photodynamic therapy (PDT) is a unique combination of photosensitizing drug and laser light for drug activation which results in tissue destruction by direct cellular damage and small vessel thrombosis. We have utilized PDT to manage airway malignancies since 1998. This large, single institution case series will describe technical considerations of airway PDT,incorporation of PDT into multi modality therapy, patient selection, patient management and clinical outcomes.

      Methods
      All patients receiving PDT were entered into an IRB approved outcomes registry. Data was abstracted from the medical record and the cancer registry. Photofrin was used as the photosensitizer at a dose of 2 mg/kg IV . Light dosimetry ranged from 100 - 200 J. Light was delivered at 630 nm. All patients were treated under general anesthesia for light application and airway debridement. Autofluorescent bronchoscopy was used to delineate extent of endobronchial disease.

      Results
      Between 1998 and 2013, we have performed PDT on 910 patients; 519 procedures (57%) have involved the tracheobronchial tree. The average age was 62 years with a range of 18 -92 years.The cell types managed by PDT included NSCLC, SCLC, carcinoid, and metastases to the airway. Indications for tracheobronchial PDT included symptom management/ palliation (63%), induction therapy (27%), and definitive therapy with curative intent (10%). Dyspnea and post obstructive pneumonia from airway obstruction were the most common symptoms. Photosensitivity rate was < 2%. There were no perforations of the tracheobronchial tree. There was a single stricture in this cohort; this occurred in a patient who had been previously resected.

      Conclusion
      PDT for primary or metastatic lesions to the tracheobronchial tree is safe. Early and advanced lesions can be treated. PDT can be used prior to surgical resection and may increase resectability by reducing endoluminal disease. PDT may be used after radiation therapy with good efficacy. PDT can be utilized during multiple courses of treatment to palliate obstructing or bleeding lesions. Photosensitivity is an infrequent complication. Our experience demonstates the utility of PDT across all stages of NSCLC when there is a visible endoluminal component. In order to more specifically define the utility of PDT in NSCLC, we have established a prospective multi center registry to delineate indications, contraindications and the role of PDT in treatment algorhythms for airway malignancies.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-006 - Robotic Assisted Lobectomy: A platform for increasing minimally invasive pulmonary resections (ID 284)

      09:30 - 09:30  |  Author(s): E. Kassis

      • Abstract

      Background
      Minimally invasive pulmonary resection has been accepted as a technique for performing lobectomy since the mid 1990s; however, despite a number of effectiveness studies, the percentage of VATS lobectomies remains low. By some estimates, VATS lobectomy accounts for only 8 to 20 % of all lobectomy cases. We evaluated the development of a robotic assisted lobectomy program and short term outcomes. We assessed the impact of this platform on the rate of minimally invasive resections.

      Methods
      All patients undergoing robotic lobectomy were consented and entered into an IRB approved outcomes registry at the time of initial surgical consent. Multiple variables including length of operation, hospital stay, duration of chest tubes, complications, and mortality were evaluated. Medical records of patients undergoing robotic-assisted lobectomy between September 2011 and May 2013 were reviewed. Case logs for the years 2010 through 20123 were tallied to provide aggregate data on pulmonary resection.

      Results
      Histology for these patients included adenocarcinoma (45), squamous cell (20), benign disease (13), carcinoid (7), metastases from other primary (7). Stages of NSCLC were: I (56%), II (16%), IIIa (14%) and IV (6%). Ten of 87 patients with NSCLC had induction therapy (9 chemo/rad, 1 chemo). Conversion to thoracotomy occurred in 10% overall, but was performed in 3 of 10 induction patients. LOS (6d v 5d) and operative time (275 min v 221min) were longer in the induction group. When analyzed by quartile, average duration of robotic assisted lobectomy decreased from 280 min to 170 min. LOS decreased by 2 days over the initial 100 cases. Mortality rate was 1%. The minimally invasive case percentage prior to robotic assisted resection was 24%. During the first year of robotic assisted surgery, this minimally invasive value increased to 78%. In the second year of robotic assisted lobectomy, 86% of resections were performed with minimaly invasive approach.

      Conclusion
      In 2011, we added a robotic assisted surgery program into a multi-surgeon comprehensive thoracic oncology service. As expected, procedure times and need to convert to thoracotomy decreased as experience was acquired despite the increasing complexity of procedures. Robotic assisted resection has applicability to all stages of NSCLC including patients receiving induction therapy. Most importantly, robotic assisted surgery provided a platform for significantly increasing the rate of minimally invasive lobectomy in our institution.