Photodynamic therapy for treatment of recurrent adenocarcinoma of the lung with tracheal oligometastasis

INTRODUCTION: Tracheal neoplasms account for less than 0.1% of all malignancies. The majority of tracheal malignancies are secondary neoplasms from direct tracheal invasion from adjacent structures and less commonly from hematogenous or lymphatic spread from distal malignancies. Evidence-based guidelines for management are lacking. Less invasive bronchoscopic ablation modalities are an option for non-operable patients. We report a case of endotracheal oligometastatic adenocarcinoma successfully treated with photodynamic therapy. CASE: A 59-year-old man with past medical history of stage 1 right upper and left upper lobe neoplasm treated with right lobectomy 2 years ago and wedge resection of the lingula ten months ago presented with cough and hemoptysis. Flexible bronchoscopy revealed a 10 mm endoluminal exophytic lesion of the mid-trachea confirmed as lung adenocarcinoma on biopsy. Considering the lack of extra-cartilaginous spread and the small size, a multidisciplinary team recommended local treatment using photodynamic therapy. Surveillance biopsies out to 2 years confirmed lack of disease recurrence. The patient did not experience any adverse effects. CONCLUSION: PDT as first line therapy for a 10 mm oligometastatic endotracheal adenocarcinoma from recurrent pulmonary malignancy with no extra-cartilaginous spread is an effective modality that is well tolerated and produces a durable response, which in our patient led to complete response without recurrence at 24 months and with no adverse effects or complications. Determining depth of tumor penetration is paramount if the treatment is with curative intent. PDT should be considered as part of a multidisciplinary approach for endotracheal malignant disease.