Early hilar lung cancer — risk for multiple lung cancers and clinical outcome
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.
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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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Cited by (28)
Early Lung Cancer Detection
2018, Clinics in Chest MedicinePreinvasive disease of the airway
2017, Cancer Treatment ReviewsCitation Excerpt :Which bronchoscopic treatment modalities are available? The American College of Physicians and other authors advocate surgical treatment for CIS and early lung cancers in the airway [4,6,7,118]. Despite these lesions being small, their central location means around 70% of individuals require a lobectomy, and the remaining either a bilobectomy or pneumonectomy for curative resection [4].
Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines
2013, ChestCitation Excerpt :Another high-risk group is a subset of patients with previous early central squamous cell carcinoma (SqCC) for whom the reported rate of metachronous lesions appears even higher, with up to nearly 30% having a second central carcinoma develop within 4 years.59 In another study,60 13 patients with early central airway SqCC underwent PDT and had an AFB and a WLB at 1, 2, and 3 months then at every 3 months for the first year and every 6 months thereafter for a median follow-up of 30 months to detect local recurrence (Table S3). Treated patients met the following criteria: (1) histologically proven SqCC; (2) endoscopically visible distal tumor margins and accessibility to laser irradiation; (3) tumor size < 2 cm; (4) no metastasis in hilar or mediastinal lymph nodes and no distant metastasis (stage 0, Tis N0 M0; stage I, T1 N0 M0) seen on chest and abdominal CT scan, brain MRI, and PET/CT scan; and (5) normal CXR and CT findings that did not detect primary lung tumor.
Sputum cytology examination followed by autofluorescence bronchoscopy: A practical way of identifying early stage lung cancer in central airway
2009, Lung CancerCitation Excerpt :A recent study also showed that the prevalence of occult endobronchial malignancy in high risk patients with moderate sputum atypia was found to be high [8]. Early central squamous carcinoma, especially stage 0 disease had excellent prognosis with 5-year survival >90% [9,10], however, stage 0 lung cancer or microinvasive lung cancer was difficult to be detected by white light bronchoscope due to its small size [11]. Autofluorescence bronchoscope (AFB), which utilized the difference in fluorescence intensity between normal tissue and cancer, had been shown to be several times more sensitive in detecting precancerous/preinvasive lesions when compared with WLB [12–14].
Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)
2007, ChestCitation Excerpt :It is also estimated that 2 to 13% of patients surviving small cell carcinoma per patient per year will have NSCLC develop. In a subset of patients with previous early central SqCC, the reported rate of metachronous lesions appears even higher with up to nearly 30% having a second central carcinoma develop within 4 years.41, 42 Weigel et al43 reported findings in 31 AFB examinations on 25 patients after complete resection of NSCLC, in which three lesions of moderate/severe dysplasia and one microinvasive cancer developed during an average of 20.5 months postoperative follow-up in 12% of patients The relative sensitivity of AFB over WLB was 3.0.