PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in...
Transcript of PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in...
![Page 1: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/1.jpg)
PDT for Lung CancerCurrent status in clinical practice and 10 years in future
Harubumi Kato
Tokyo Medical University
International University of Health and Welfare
Niizashiki Central General Hospital
TMU, IUHW, NSCGH
![Page 2: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/2.jpg)
First experience of patient with Cis
Cis was detected by sputum cytology (1978)
Spur of r-mid. & lower lobe br.Cis
TMU, IUHW, NSCGH
![Page 3: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/3.jpg)
Worldwide increase of cancer patients
No improvement of death rate of cancer patients
Lung cancer patients Death
Europe 410,220 353,848
USA 214,226 167,545
Asia 1,045,695 936,051
Japan 94,855 75,119
(GLOBOCAN 2012)
TMU, IUHW, NSCGH
Eradication of Lung Cancer
Estimate 13,3500 in 2015 (Japan)
![Page 4: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/4.jpg)
厚生労働省統計表データベース国民医療費
兆円
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
0
5
10
15
20
25
30
35
1955 1960 1965 1970 1975 1980 1985 198919901991199219931994199519961997199819992000200120022003200420052006
National medical care expenses
Ratio of expenses per national income
Nat
ion
al m
edic
al c
are
exp
ense
s
Rat
io o
f ex
pen
ses
per
nat
ion
al i
nco
me
Annual trend of medical care expenses
-comparison to national income-
TMU, IUHW, NSCGH
![Page 5: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/5.jpg)
4.1(25.4%)
5.9(28.8%)
8.9(33.1%)
11.2(37.2%)
11.7(37.5%)
11.7(37.9%)
11.7(36.9%)
11.6(36.1%)
11.6(35.1%)
11.3(34.0%)
11.3(33.0%)
16.0
20.6
27.0
30.131.1 31.0 31.5 32.1 33.1 33.1
34.1
6.1 5.9
7.2
8.18.6 8.7 8.8 8.8
9.1 8.9 9.1
0
1
2
3
4
5
6
7
8
9
10
0
5
10
15
20
25
30
35
40
1985 1990 1995 2000 2001 2002 2003 2004 2005 2006 2007
Nat
iona
l m
edic
al e
xpen
ses
com
pariso
n t
o n
atio
nal
inc
om
e
National medical expenses (trillion yen)
National medical expenses/National income
Elderly medical expenses (trillion yen)
(trillion JPY)
総務省統計局『国勢調査報告』および国立社会保障・人口問題研究所『日本の将来推計人口』(平成18年12月推計)
(%)
Annual trend of medical care expenses
TMU, IUHW, NSCGH
![Page 6: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/6.jpg)
National medical care expenses 35.3 trillion yen
More than 70-year old 15.5 trillion yen
Per person
Less than 70 yo 160 thousand yen
More than 70 yo 776 thousand yen
More than 75 yo 882 thousand yen
August 26, 2010 MHLW
Medical Care Expenses of Elderly in 2009
TMU, IUHW, NSCGH
![Page 7: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/7.jpg)
Central type lung cancer
1. Curative treatment
Early stage primary squamous cell carcinoma
Single, Multiple
2. Palliative treatment
Advanced central type squamous cell carcinoma
Neo-adjuvant treatment for surgery
Combination with chemotheray and/or radiotherapy
QOL
TMU, IUHW, NSCGH
PDT, Current Status in Clinical Practice
![Page 8: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/8.jpg)
TMU, IUHW, NSCGH
What is Early Stage Lung Cancer (ESLC)?
Since 1975
Clinically curative lung cancer
Pathologically no invasive to vessels, lymph node and no metastasis
Location
Peripheral lung
Subsegmental bronchus - terminal alveolar bronchi
Less than 2cm
Central bronchus
Trachea – segmental bronchi
Endoscopically early stage squamous carcinoma
(1995, Japan Lung Cancer Society set a standard criteria)
WHO, UICC Staging: Stage 0, Tis
![Page 9: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/9.jpg)
TMU, IUHW, NSCGH
What is ESLC treated curatively by PDT?
X-ray negative
CT negative
Central type squamous cell carcinoma
WHO,UICC & IASLC Staging: Stage 0, Tis
Endoscopic criteria (Japan Lung Cancer Society, 1995)
1 Bronchoscopically invisible type
2 Thickening type
3 Nodular type
4 Polypoid type
5 Mixed type
![Page 10: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/10.jpg)
TMU, IUHW, NSCGH
Importance of Early Detection
Lung cancer screening program
Health check examination
For Central type
Sputum cytology
Symptoms: sputum, bloody sputum
Bronchoscopy
Symptoms: cough, bloody sputum
For Peripheral type
CT
![Page 11: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/11.jpg)
TMU, IUHW, NSCGH
Lung Cancer, Japan
1960-1980 Smoker rate 75% in men, 15% in women
1960-1980 Serious air pollution
1980- Improvement of air pollution
1990’s- Decrease of smoker rate: 60%(1990) →32% (2013)
2000- Squamous ca decreased, Adenoca increased
1960-1980 Squamous cell ca 40%, Adenoca 35%
1999-2003 Squamous cell ca 30%, Adenoca 48%
家城隆次郎,他 過去3年間の肺癌における組織型の推移Toyoda Y, et al: Trends in lung cancer incidence by histology in Osaka Jpn J Clin Oncol 2008
![Page 12: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/12.jpg)
TMU, IUHW, NSCGH
Who are indicated for PDT?
High risk people to lung cancer
Heavy smoker
High risk occupations
COPD
Emphysema
Symptom
Bloody sputum
Sputum
Cough
Multiple lung cancer patient
Post operative patients
![Page 13: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/13.jpg)
TMU, IUHW, NSCGH
PDT for Lung cancer (ESLC)
1997~ 2002~
Photofrin 2mg/kg iv Laserphyrin 1mg/kg iv
48 hours prior to PDT 4 hours prior to PDT
PDT with 150 J/cm2 PDT with 100 J/cm2
Excimer/Argon Dye Laser Diode Laser
Shading for 30 days Shading for 5 days
![Page 14: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/14.jpg)
TMU, IUHW, NSCGH
PDT for ESLC
Lt B1+2, 3 (Sq.ca.) 79-year old man
Before PDT 3M after PDT
![Page 15: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/15.jpg)
TMU, IUHW, NSCGH
PDT for ESLC
Before PDT 3M after PDT
Lt. u. br. (Sq.ca.) 68-year old man
![Page 16: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/16.jpg)
TMU, IUHW, NSCGH
PDT for ESLC
Before PDT 3M after PDT
Lt. u. br. (Sq.ca.) 68-year old man
![Page 17: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/17.jpg)
63-year old man
PDD & PDT for ESLC
Carina (Sq. cell carcinoma)
Before PDT PDD 3 M after PDT
Photosensitizer: Laserphyrin + SAFE 3000
TMU, IUHW, NSCGH
![Page 18: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/18.jpg)
Squamous cell carcinoma Rt. B1a-B1b spur 68y, Man
OCT for ESLC (Cis)
Cartilage
SAFE 3000 AF OCT
Pentax SOCT-1000
CisCis
Basement membrane
TMU, IUHW, NSCGH
![Page 19: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/19.jpg)
TMU, IUHW, NSCGH
PDT for ESLC
Before PDT 3M after PDT
Carina (Sq.ca.) 79-year old man
![Page 20: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/20.jpg)
R-upper brB2-3 bifurcation
PDD
PDD
AFD
PDT
AFD
AFD AFD
AFD
PDT
PDTPDT
PDD
L-upper br
Orifice of upper lob
Upper division
Bifurcation of upper div. & B4.5
63-year old man
heavy smoker (Sq. ca.)
12 sessions of PDT
sincee 2010
TMU, IUHW, NSCGH
PDD & PDT for Multiple ESLC
![Page 21: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/21.jpg)
TMU, IUHW, NSCGH
Results of PDT for ESLC
Furuse et al Kato et al Usuda et al
No. 59 264 91
Photosensitizer Photofrin Photofrin(Laserphyin in 16) Laserphyrin
Size (cm) & CR (rate,%)
≦ 1.0 97.8% 93.9% 94.0%
1.0-2.0 50.0% 80.0% 90.4%
2.0< 37.5% 44.1% ---
Ikeda,N,etal Laser in Surg and Med 43:749-754, 2011
Photofrin ® vs Laserphyrin ®
![Page 22: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/22.jpg)
Absorption spectrum and structure of Laserphyrin
N HN
NNH
H3C
H3CH
CH2
CO2NaNaO2C
CH3H3C
NaO2C
H
CO2Na
HCH3
HN
O
Wavelength
Ab
sorb
an
ce
300 400 500 600 700
Photofrin
Talaporfin (Laserphyrin)
Hemoglobin
630nm
664nm
(NPe6)
TMUH & NSCGH
![Page 23: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/23.jpg)
Clinical Use of Photosensitizers
Photofrin (Axcan)*1: Lung ca, Esophageal cancer (Jap, USA, Eur)
Gastric ca, Cervical ca & dysplasia (Jap)
Bladder ca (Can)
Barrett disease (USA, Eur)
Foscan (Biolitec)*2 Head & neck cancer (Eur)
Levulan (DUSA)*3 Keratosis (Can, Latin Am, Kor)
Condyloma (Chin)
Metvix (Photocure)*4 Basal cell cancer (Eur)
Keratosis (USA, Eur, Austr)
Hexvix (Photocure)*5 Bladder cancer (Scand)
MRSAid (Ondine Biomedical) Infection (Can)
ALA (Biofrontera)*6 Keratosis (Ger)
Laserphyrin (Meiji)*7 Lung ca (Jap)
Visudyne (Novartis)*8 AMD (Jap, USA, Eur)
Myopia, Ocular histoplasmosis (USA, Eur)
*1Porfimer sodium,*2Temoporfin,*3Aminolevulic acid,*4Methyl-aminolevulinate,*5Hexaminolevulinate
*65-aminolevulic acid(nanocolloidal),*7Talaporfin sodium,*8Verteporfin
TMUH & NSCGH
![Page 24: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/24.jpg)
5-year survival rate, PDT in ESLC
57.6%
92.5%
0 20 30 40 50 6010
Time (month)
20
0
100
80
60
40Su
rviv
al
rati
o (
%)
Cancer specific survival
Overall survival
57.6%
92.5%
0 20 30 40 50 6010
Time (month)
20
0
100
80
60
40Su
rviv
al
rati
o (
%)
57.6%57.6%
92.5%92.5%
0 20 30 40 50 6010
20
0
100
80
60
40Su
rviv
al
rati
o (
%)
0 20 30 40 50 60100 20 30 40 50 60100 20 30 40 50 6010
20
0
100
80
60
40Su
rviv
al
rati
o (
%)
20
0
100
80
60
40
20
0
100
80
60
40Su
rviv
al
rati
o (
%)
Cancer specific survival
Overall survival
Cancer specific survivalCancer specific survival
Overall survivalOverall survival
TMU, IUHW, NSCGH
![Page 25: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/25.jpg)
Current Status of PDT for Advanced Lung Cancer
1. Palliative treatment for the improvement of QOL
Obstructive pneumonia or atelectasis
2. Chemo/radiotherapy + PDT
+ Immunological response
3. Neoadjuvant PDT for surgery
Possibility of extended surgery after PDT
Possibility of reduction surgery after PDT
TMU, IUHW, NSCGH
![Page 26: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/26.jpg)
Indication Criteria for Advanced Lung Ca
Inclusion1. Dyspnea due to stenosis or obstruction of central bronchus
2. Obstructive pneumonia or atelectasis
3. Possibility of extended surgery after PDT
4. Possibility of reduction of resection volume after PDT
5. Recurrence after radio/chemotherapy
6. Maintenance of QOL in combination with radio/chemotherapy
7. ECOG Performance Status 0-II
8. Adequate organ function
9. Life expectancy at least 12 weeks
10. Written informed consent
Exclusion1. Serious complications
TMU, IUHW, NSCGH
![Page 27: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/27.jpg)
PDT for QOL, Advanced Lung Cancer
TMU, IUHW, NSCGH
![Page 28: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/28.jpg)
Improvement of Patients Condition
PaO2
(AV+SD)mmHg66 ± 21 82 ± 14
PS 1.8 ± 0.5 0.8 ± 0.4
Before PDT After PDT
TMU, IUHW, NSCGH
![Page 29: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/29.jpg)
PDT
77y man, heavy smoker
l-upper division, Sq ca
PDT+Chemo(CBDCA+TS-1)
TMU, IUHW, NSCGH
![Page 30: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/30.jpg)
Early stage lung squamous cell carcinoma
CR 93.8-78% (1982-2004, Kato H, Cortese D, Monnier P , Furuse K)
Advanced lung squamous cell carcinoma
1.For QOL (Opening of obstructive bronchus)
PR 100-55% (1982-1999, Kato H, Vincent, Balchum O, McCaughan,
LoCicero, SutedjaT, Wieman, Moghissi)
2.Neo-adjuvant PDT for the surgery
Kato H (J Cardiovasc Surg,1985),
Okunaka T (Diag Thera Endoscopy,1999)
3.Combination therapy with chemotherapy and or radiotherapy
Miyajima K, in press
References of PDT for Lung Cancer
TMU, IUHW, NSCGH
![Page 31: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/31.jpg)
Combination therapy with chemo+radiotherapy
TMU, IUHW, NSCGH
age histology c-stage Chemo KL-6(<500) location rad
1 77 Sq IIA CBDCA+TS-1 226 L-B1+2 +
2 74 LCNEC IIIB NDP+DOC 647 R-intermedius +
3 74 Sq IIBCBDCA+TS-1
CBDCA+VNR655
R Intermedius+
4 69 Ad IV TS-1 530 R-main broncus +
5 75 Sq IV CDDP+DOC 192 R-main bronchus +
6 74 Giant IV CDDP+DOC 846 Basal +
7 72 Sq IV CDDP+DOC 454 Carina +
8 58 Sq IIIB CBDCA+TS-1 175 R-B2,3 +
9 77 Sq IIIA NDP+DOC 647 R-upper bronchus +
10 78 ad IIIACBDCA+PEM+Bev
CBDCA+PTX+Bev960 R-B3 +
11 80 ad IV CBDCA+PEM+Bev 453 R-upper bronchus +
![Page 32: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/32.jpg)
1. Palliative treatment for the improvement of QOL
2. Neoadjuvant PDT for surgery
PDT for advanced lung cancer
TMU, IUHW, NSCGH
![Page 33: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/33.jpg)
Bronchoplasty after preoperative PDT
78y man, Sq.Ca., Stage IIA (T1 N1 M0)
TMU, IUHW, NSCGH
![Page 34: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/34.jpg)
Bronchoplasty by Preoperative PDT
Resection of bifurcation between the left upper and lower bronchi
Before PDT After PDT After resection
TMU, IUHW, NSCGH
![Page 35: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/35.jpg)
PDT plus Bronchoplasty for ESLC
Kato H. et al.
1985
J Thorac
Cardiovasc
Surg 90:420
-429
15 patients received preoperative PDT for the purpose of
either reducing the extent of resection or increasing operability.
Operation was performed 1 to 9 weeks after PDT
5 patients of stage I, originally candidates for pneumonectomy
or bilobectomy, became possible to sleevelobectomy
Okunaka T,
Kato H
1999
Dig Thera
End 5:155
-160
26 lung cancer patients received the preoparative PDT.
The initial purpose of PDT to reduce extent of resection was
achieved 22 out of 26.
7 patients, stage I, tumor invasion to the main bronchus or trunks
intermedius became possible to sleevelobectomy
TMU, IUHW, NSCGH
![Page 36: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/36.jpg)
Future direction of PDT for Lung Cancer
Significant increase of lung cancer throughout world!
Curative PDT for the early stage lung cancer
Central type squamous cell carcinoma
Peripheral type adenocarcinoma
TMU, IUHW, NSCGH
![Page 37: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/37.jpg)
Computor navigation
TMU, IUHW, NSCGH
![Page 38: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/38.jpg)
Bronchus LungPoint Ⓡ
TMU, IUHW, NSCGH
Bronchus Medical, Inc.
![Page 39: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/39.jpg)
Adenocarcinoma in situ (BAC)
1.5cm
Noguchi Type A
pT1N0M0
StageⅠA
GGO
TMU, IUHW, NSCGH
![Page 40: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/40.jpg)
normal BAC (mucinous)
Thickening of alveolar wall
Dilatation of alveoli
Increase of interstitial tissue
(Pentax SOCT-2000)
Possibility of definitive diagnosis by OCT
TMU, IUHW, NSCGH
![Page 41: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/41.jpg)
Lung cancer treatments
Worldwide increase of cancer patients
No improvement of death rate of cancer patients
Increase of medical cost of cancer patients
Cancer patients demand:
High quality treatments
Safe treatments
No invasive treatments
Low cost treatments
TMU, IUHW, NSCGH
H.Kato et al: Analysis of the Cost-effectiveness of PDT in Early Stage Lung Cancer.
Diagnostic and Therapeutic Endoscopy; 6,9-16,1999
![Page 42: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/42.jpg)
Medical expenses of PDT vs Surgery
PDT 760,000yen ($ 8,444)
DPC 249, 430yen ($ 2,772)
PDT procedure 87,100 ( 967)
Laserphyrin 387,200 ( 4,302)
Bronchoscopy 25,000 ( 277)
Surgery 1,700,000yen ($ 18,888)
DPC 274,200yen ($ 3,046)
Surgical procedure 1,050,000 ( 11,666)
Anesthesia, drugs 300,000 ( 3,333)
TMU, IUHW, NSCGH
H.Kato et al: Analysis of the Cost-effectiveness of PDT in Early Stage Lung Cancer.
Diagnostic and Therapeutic Endoscopy; 6,9-16,1999
![Page 43: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/43.jpg)
Photosensitizers, future
Infrared range photosensitizers
Texaphyrin, Benzopophyrin derivatives
Compound metalic photosensitizers
Tungsten, Gold (Au-NPe6) for X-ray and Synchrotron
Micelle, Nano-particle compound photosensitizer
Phthalocyanine-nanoparticle (albumin, liposome etc)
Targeted photosensitizers
Molecular targeted photosensitizer
Targeting via ligand-receptor interlaction
(Cancer cell recepter)
Small molecular
Antibody-conjugate (EGFR, HER2, Tumor-vessel
specific fibronectin variant (EDB domain
TMU, IUHW, NSCGH
![Page 44: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/44.jpg)
Lights, future
LED
Long wavelength laser
X-ray
Synchrotron radiation
X-ray laser
TMU, IUHW, NSCGH
![Page 45: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/45.jpg)
Japan Society of Lung Cancer, Japanese Photodynamic Association, Japan Society of Laser Surgery and Medicin
Diagnosis of early stage lung cancer
Pathological T1A, Tcis
Endoscopical early-stage lung cancer
Normal chest X-ray and CT imaging
No evidence of metastasis to lymph nodes
Superficial tumor not more than 2.0 cm in diameter
Obvious peripheral margin of the tumor
Guideline of PDT for ESLC
TMU, IUHW, NSCGH
![Page 46: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/46.jpg)
Toward Lung Cancer Eradication
Smoking cessation & clean air
Early detection
Early localization
Early treatment by PDTTMU, IUHW, NSCGH
![Page 47: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/47.jpg)
Development Toward Ideal Therapy
TMU, IUHW, NSCGH
Early detection
High quality treatments
Safe treatments
No invasive treatments
Low cost treatments
![Page 48: PDT for Lung Cancerjlrc.jp/pdf/lecture/2015/20150503.pdfPDT for Lung Cancer Current status in clinical practice and 10 years in future Harubumi Kato Tokyo Medical University International](https://reader031.fdocuments.us/reader031/viewer/2022042002/5e6df7b1d16bd23c24722b0d/html5/thumbnails/48.jpg)
謝 謝
TMU, IUHW, NSCGH