Elsevier

Lung Cancer

Volume 39, Issue 1, January 2003, Pages 49-53
Lung Cancer

Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study

https://doi.org/10.1016/S0169-5002(02)00309-4Get rights and content

Abstract

Bronchoscopic treatment (BT) has a curative potential for patients with intraluminal microinvasive radiographically occult lung cancer (ROLC). We report the long-term follow-up in a group of 32 patients, ineligible for surgery, in whom ROLC was diagnosed and treated with BT. Tumors were strictly ⩽1 cm in size, intraluminally located in the central airways, with no bronchial wall invasion or extraluminal tumor growth on high resolution CT (HRCT), with visible distal margin under conventional and autofluorescence bronchoscopy (AFB). BT was given with curative intent and consecutive patients were treated with photodynamic therapy (five patients), Nd-YAG laser therapy (one patient), electrocautery (24 patients) and argon plasma coagulation (two patients). Follow-up evaluation at 3–4 months interval included HRCT scans, both conventional and AFB, including biopsies and brush cytology for histological evaluation. The average follow-up period was 5 years (range: 2–10 years). In three patients local recurrence was again successfully treated with electrocautery. Sixteen patients died during follow-up. Eight of the nine patients who died due to lung cancer had a previous resection of a more advanced stage lung cancer up to 5 years before BT of the ROLC. The remaining seven patients cause of death was not related to lung cancer. Sixteen patients are still alive without any tumor recurrence. These data showed that BT is an effective treatment modality for high-risk patients with ROLC, who are not eligible for surgical resection.

Introduction

Lung cancer continues to be the most common fatal malignancy of men and women. The poor prognosis is attributable to the lack of successful treatment in advanced disease and the morbid implications of recurrent or subsequent cancer [1], [2]. Therefore, the therapeutic focus is now shifting towards early detection [3], [4], [5]. Within the currently available methods for early detection the role of low-dose spiral CT is mainly for lesions in the parenchyma, [6], [7] whereas screening of sputum also may detect the so-called intraluminal microinvasive radiographically occult lung cancer (ROLC) in the central part of the tracheo-bronchial tree. Early screening and detection of early-stage lung cancer of the individuals at risk is futile, if no treatment resulting in cure exists or if the outcome of the patient is not influenced by the early detected lung cancer. Since patients with lung cancer usually have concomitant diseases such as severe COPD or cardiovascular problems, it may become questionable whether detecting early-stage lung cancer in these individuals may have any impact on mortality [8], [9], [10].

For answering the latter question, a randomised clinical trial comparing treatment versus non-treatment in patients with severe COPD and/or cardiovascular problems with proven microinvasive lung cancer is desirable. However, significant numbers of patients are needed to address this issue and as micro-invasive cancers fulfilling the inclusion criteria for such a trial are usually detected by chance it is practically impossible to perform this kind of study. Besides this it will be questionable if leaving early detected lung cancer untreated is ethically acceptable. Informed consent of these patients might result in a high number of refusals for participation in a randomised clinical trial.

The only way to get some information on the clinical course in these patients is careful analysis in a phase II type-study evaluating the result of treatment of ROLC in a group of patients with significant co-morbidity. We describe in this report the long-term outcome in this particular of group of patients treated by bronchoscopic treatment (BT).

Section snippets

Methods

Patients were recruited out of a group of patients referred to our hospital for BT between 1993 and 1999. Follow-up has been ⩾2 years in all patients. Before treatment, there was always a consensus about the treatment strategy between the surgical oncologist, radiotherapist and the pulmonologist. Inclusion criteria were (1) Surgical non-resectable candidates due to poor lung function and/or the presence of multiple primaries; (2) A strictly ⩽1 cm in size, intraluminal microinvasive-ROLC

Results

Thirty-two patients, 28 male and four female, with ROLC were staged, also bronchoscopically and treated. Follow-up has been at least 2 years. In the five patients with multiple ROLCs found at different sites in both lungs, BT achieved complete eradication of all microinvasive tumor lesions.

Follow-up data are summarised in Table 2. As on May 2001, 16 of patients (50%) are still alive after BT, with an average follow-up of 5 years (range 2–10 years). Three patients who are still alive, developed

Discussion

We described the long-term outcome of BT in a group of patients with ROLC who were not candidates for surgical resection due to significant comorbidity. We reported previously that after accurate staging of ROLC [12], [15], any BT, irrespective of the modality, may be applied with curative intent. Very early lung cancer in the central airways are only several mm thick [20], [21], [22] and have no metastasis to the regional lymph nodes [23], [24]. In the current study, no complication occurred

Conclusion

BT by means of any intraluminal treatment modality such as electrocautery, is an effective treatment for patients with intraluminal microinvasive-ROLC [9]. This is also true for patients who are not eligible for surgery, provided accurate staging of these central airway cancers can be carried out. Strict intraluminal cancer with visible distal margin using AFB-LIFE, without bronchial wall invasion and extraluminal growth on HRCT are primary candidates for BT with curative intent. Survival will

References (35)

  • T.L Petty

    Screening strategies for early detection of lung cancer. The time is now

    J. Am. Med. Assoc.

    (2000)
  • F.R Hirsch et al.

    Early detection of lung cancer: clinical perspectives of recent advantages in biology and radiology

    Clin. Cancer Res.

    (2001)
  • B.E Johnson

    Second lung cancer in patients after treatment for an initial lung cancer

    J. Natl. Cancer Inst.

    (1998)
  • M Kaneko et al.

    Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography

    Radiology

    (1996)
  • E.F Patz et al.

    Screening for lung cancer

    N. Engl. J. Med.

    (2000)
  • W.C Black

    Overdiagnosis: an underrecognized cause of confusion and harm in cancer screening

    J. Nat. Cancer Inst.

    (2000)
  • P.M Marcus et al.

    Lung cancer mortality in the Mayo lung project: impact of extended follow-up

    J. Natl. Cancer Inst.

    (2000)
  • Cited by (49)

    View all citing articles on Scopus
    View full text