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Jitsuo Usuda



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    P2.05 - Interventional Diagnostic/Pulmonology (ID 168)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.05-04 - Development of a New Endobronchial Treatment for Peripheral-Type Lung Cancer (ID 1492)

      10:15 - 18:15  |  Presenting Author(s): Jitsuo Usuda

      • Abstract

      Background

      Photodynanic therapy (PDT), is a treatment modality for many cancers, and uses a tumor-specific photosensitizer and laser irradiation. PDT is recommended as a treatment option for centrally located early lung cancer, not for peripheral-type lung cancer. With conventional laser probes, peripheral lung cancer was not an indication for laser therapy, as it was impossible to irradiate the peripheral lung field. Therefore, we have developed a laser probe in this study, we aimed to develop a new endobronchial treatment for peripheral lung cancer using PDT, and we evaluated the feasibility of PDT for peripheral lung cancer.

      Method

      This phase I study enrolled 7 patients with peripheral lung cancers (primary tumor< 20 mm, stage IA), which were definitively diagnosed by bronchoscopic modalities such as endobronchial ultrasound-guide sheath (EBUS-GS) and brocnhoscopic navigation system such as electromagnetic navigation bronchoscopy (ENB). We administered NPe6 (40mg/m2) as a photosensitizer intravenously, and 4 hours later we accurately introduced the guide sheath (GS) to the peripheral lung cancer lesions using ENB, and we confirmed the tumor lesions by EBUS. After the confirmation of the tumor location, we inserted the new laser probe by ENB.

      Result

      We performed PDT for 3 patients with c-stage IA peripheral lung cancer, using a laser dose (120mW, 50J/cm2), and confirmed the feasibility of the dose. We escalated the laser dose and performed 4 patients using a laser dose (120mW, 100J/cm2). Seven patients met our criteria, and 5 cases were adenocarcinoma and 2 case squamous cell carcinoma. Two weeks and 3 months after NPe6-PDT, complications such as pneumonia and pneumothorax were not found, but one mildly found light skin-photosensitivity. Six months later, we found CR in 3 cases and SD in 4 cases.

      Conclusion

      PDT was a feasible and non-invasive treatment for a peripheral type early lung cancer. In the future, for non-invasive adenocarcinoma such as AIS, NPe6-PDT will become a treatment modality.

      Now, we are planning a physician -initiated clinical trial that conducts PDT for "peripheral small-sized lung cancer patients in whom surgery and radiation therapy are inadequate". For lung cancer cases with interstitial pneumonia combined with low lung function, there are no standard treatments. By expanding the application of PDT to these cases, it is expected to establish a new treatment method that can establish low-cost lung cancer treatment and contribute to improvement of QOL suitable for aging society.

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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-06 - Analysis of Left Atrial Blood Flow Using 4D Flow MRI in the Patient Who Suffered from Cerebral Infarction After Left Upper Lobectomy (Now Available) (ID 465)

      10:15 - 18:15  |  Author(s): Jitsuo Usuda

      • Abstract
      • Slides

      Background

      Cerebral infarction is one of the complication after left upper lobectomy, and it may be caused by thrombus in left atrial. However, the mechanism of incidence of cerebral infarction has not been elucidated. In order to elucidate it, we performed the blood flow analysis of left atrium including the stump of the left upper pulmonary vein, by 4D flow MRI, which is recently very useful for blood flow analysis.

      Method

      We examine blood flow by 4D flow MRI in 3 patients with cerebral infarction after left upper lobectomy.

      Result

      Case1: A 76-year-old woman underwent left upper lobectomy for lung adenocarcinoma (cT1aN0M0 stageIA1). She had atrial fibrillation and took edoxaban, oral anticoagulant medicine. Three days after the surgery, she made cerebral infarction in MRI. By chest CT a thrombus was found near the left upper pulmonary vein stump. Case 2: A 42-year-old woman underwent left upper lobectomy due to lung cancer (cT1aN0M0 stageIA1). She had Cushing syndrome. One month after the surgery, she was diagnosed as cerebral infarction in MRI. There was no evidence of incidence of thrombus by chest CT. Case 3: A 77-year-old woman underwent left upper lobectomy for lung adenocarcinoma (cT3N0M0 stageIIB). Five months after the surgery, she was diagnosed as cerebral infarction in MRI. CT showed thrombus in the left atrial appendage. We performed blood flow analysis in left atrium for the three patients by 4D flow MRI. It showed a decrease in blood flow near the left superior pulmonary vein stump and left atrium around the stump in all patients.

      Conclusion

      We performed blood flow analysis of left atrium by 4D flow MRI, and it was able to visualize the blood flow after left upper lobectomy. The analysis showed the reduction of blood flow not only in the left superior pulmonary vein stump but also in the left atrium. These results suggest that blood flow stagnation may induce the thrombus formation in left atrium, and cause cerebral infarctions. In future, we will compare the blood flow before and after surgery and simulate the blood flow in left atrium. We hope to select patients at high risk for stroke before left upper lobectomy using flow analysis.

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