Elsevier

Lung Cancer

Volume 33, Issue 1, July 2001, Pages 51-57
Lung Cancer

Early hilar lung cancer — risk for multiple lung cancers and clinical outcome

https://doi.org/10.1016/S0169-5002(00)00241-5Get rights and content

Abstract

In early hilar lung cancer patients, multiple lung cancers frequently develop. The clinical outcome of such patients were studied. A total of 91 patients, 88 men and three women, who were endoscopically diagnosed with early hilar lung cancer were studied retrospectively. Surgery was performed in 46 patients, while organ-sparing treatment, including photodynamic therapy (PDT), Nd–YAG (neodymium–yttrium, argon, garnet) laser vaporization, and radiotherapy, were done for 45 patients. During follow-up, newly developed lung cancers and/or malignancies in other organs were recorded. The average smoking index (cigarettes per day×years) was 1040. Synchronous and/or metachronous multiple lung cancers developed in 26/91 patients (28.6%). Malignancies in other organs were found in 12/91 (13.2%). The smoking index of patients with multiple lung cancers was significantly higher than for other patients. The overall 5 year survival rate was 70.7% in all patients, 76.0% in the surgery group, and 64.4% in the nonsurgery group. The lung cancer-specific 5 year survival rate was 89.8% in all patients, 89.3% in the surgery group, and 90.5% in the nonsurgery group. Early hilar lung cancer frequently accompanies other lung cancers or malignancies in other organs. A favorable prognosis can be obtained with organ-sparing treatment.

Introduction

Most early hilar lung cancers can be diagnosed by sputum cytology [1] followed by endoscopic examination. In addition, patients with this type of lung cancer are usually heavy smokers with poor pulmonary function and often have a high incidence of multiple lung cancers [1], [2], [3]. These clinical aspects are important for the choice of treatment. We have found that early hilar lung cancer can be cured by photodynamic therapy (PDT) alone, if the depth of tumor invasion is limited to within the bronchial wall [4], [5]. Control of early lesions can be also obtained by external beam radiotherapy [6]. However, surgery is still the standard treatment for early hilar cancer [7], [8], [9]. We analyzed 91 patients to clarify their clinical features and to clarify the proper strategy for early hilar lung cancer.

Section snippets

Patients

From 1977 to 1994, 91 patients with endoscopically evaluated centrally located early lung cancers defined by the following criteria were treated in our hospital: (1) the tumor was located within the tracheobronchial tree proximal to the subsegmental bronchi and was within the bronchial wall endoscopically; (2) cancer was confirmed by histologic and/or cytologic examination; and (3) no lymph nodes involvement or distant metastases were detected by radiologic examination.

Surgery

Thirty-four lobectomies,

Results

The patients included 88 men and three women. The average age at the time of diagnosis was 65.2 years (36–81). The initial complaint was cough and sputum in 29 (31.9%), bloody sputum in 24 (26.4%), fever in one (1.1%), and no subjective symptoms in 37 (40.7%) patients. Patients without symptoms were discovered by sputum cytology and/or chest radiographic examination in a mass survey. Eleven (12.1%) patients had subtle infiltrative shadows or areas of atelectases smaller than the subsegmental

Discussion

Centrally located early squamous cell cancer frequently develops in heavy smokers. Synchronous or metachronous multiple lung cancers are found in these patients [1] because of field exposure to carcinogens with daily smoking. In the present study, all 91 patients were smokers, and 47.3% were heavy smokers with smoking indices higher than 1000. The incidence of metachronous lung cancer in hilar early cancers has been reported to be 7.4% [14], 13.8% [9] and 20.4% [3]. During follow-up, we found a

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