日本肺癌学会編：肺癌診療ガイドライン 2022年版、Ⅱ．非小細胞肺癌（NSCLC）,CQ22．中心型早期肺癌に光線力学的治療法（PDT）は勧められるか？、金原出版、2022.
Takumi Sonokawa, Mitsuo Matsumoto, Kyoshiro Takegahara, Tatsuya Inoue, Yutaka Enomoto, Jitsuo Usuda
Usefulness of simultaneous type image-enhanced endoscope system in photodynamic therapy for centrally located lung cancer.
Photodiagnosis Photodyn Ther. 2021 Sep;35:102345. doi: 10.1016/j.pdpdt.2021.102345. Epub 2021 May 24.
Abstract/Text
BACKGROUND: Photodynamic therapy (PDT) is established as one of the standard treatment options for centrally located early lung cancer. In order to improve the effectiveness of PDT, it is very important to accurately diagnose the extent of the tumor and focus the laser irradiation accurately. With the use of the conventional video-endoscope system, which adopts the frame-sequential (RGB-based) display method, mainly used in Japan, for PDT laser irradiation, the system only recognizes the strong white light, and color information is lost. Therefore, it is difficult to irradiate the lesion while simultaneously observing the lesion. In this study, we investigated the usefulness of a new type of video-endoscope system during PDT.
METHODS: We used ELUXEO 7000® (FUJIFILM, Japan), which is a simultaneous-type video-endoscope system that has been in use at Nippon Medical School Hospital since October 2018. We analyzed the clinical usefulness of the ELUXEO® system for PDT as compared to other endoscope systems, such as EVIS LUCERA ELITE® (Olympus, Japan), an autofluorescence imaging (AFI) system.
RESULTS: After the administration of talaporfin sodium for PDT, the tumor lesion was not visualized in magenta color with AFI, yielding false-negative results. On the other hand, no false-negative results after the administration of talaporfin sodium were obtained with the use of ELUXEO®. Using the ELUXEO® system in the blue light imaging (BLI) mode, we were able to deliver a red laser light while observing the extent of the tumor. Missed laser exposure was avoided and the accuracy of PDT was improved with the use of this system.
CONCLUSIONS: ELUXEO® is useful for accurate evaluation of the extent of centrally located lung cancer and therefore, for accurate laser irradiation of the tumor lesion.
Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.
S A Yousem, L Hochholzer
Mucoepidermoid tumors of the lung.
Cancer. 1987 Sep 15;60(6):1346-52.
Abstract/Text
Mucoepidermoid tumors of lung (MET) are rare tumors derived from the minor salivary gland tissue of the proximal tracheobronchial tree. The authors studied 58 cases of MET confined to the lung and used criteria derived from similar tumors of the salivary glands to separate them into low-grade and high-grade variants. The overwhelming majority of low-grade tumors behaved in a benign fashion, whereas 23% of high-grade tumors resulted in patient death. Prognostic factors which appeared to predict future aggressive behavior included high-grade classification, advanced stage at presentation, and perhaps lymph node metastases.
Taichiro Ishizumi, Ukihide Tateishi, Shun-Ichi Watanabe, Yoshihiro Matsuno
Mucoepidermoid carcinoma of the lung: high-resolution CT and histopathologic findings in five cases.
Lung Cancer. 2008 Apr;60(1):125-31. doi: 10.1016/j.lungcan.2007.08.022. Epub 2007 Oct 1.
Abstract/Text
OBJECTIVE: The purpose of this study was to characterize the high-resolution computed tomography (HRCT) findings of mucoepidermoid carcinoma of the lung and correlate them with the histopathological features.
METHODS: The study included five patients with pathologically proven mucoepidermoid carcinoma who underwent HRCT before treatment. The HRCT findings were then compared with the histopathological features in all patients.
RESULTS: The HRCT images showed lesions in the central lung in four patients and in the peripheral lung in one. All the lesions were well defined nodules or masses with a smooth margin. The contour of the tumours was oval (n=3), round (n=1) or lobulated (n=1). The contrast-enhanced CT images showed marked heterogeneous enhancement with foci of relatively low attenuation in four of the five lesions and mild heterogeneous enhancement in the other lesion. There was an admixed distribution of areas that are heterogeneous in the densities of blood vessels, as highlighted by immunohistochemical staining of CD31. Most mucin-secreting areas of the tumours showed more densely distributed blood vessels, mostly capillaries, in between tumour cell nests, whereas other areas did less. All five patients in our series underwent lobectomy plus lymph node dissection or sampling. All the patients are alive without evidence of disease an average of 50.4 months after surgery (range, 15-82 months; median, 57 months).
CONCLUSION: Mucoepidermoid carcinoma of the bronchus is often visualized as marked heterogeneous contrast enhancement on HRCT images. The results of this study suggest that the presence of abundant microvessels, detected immunohistochemically by microscopic examination, affects the enhancement pattern on HRCT.
M Wu, Q Wang, X-F Xu, J-J Xiang
Bronchial mucoepidermoid carcinoma in children.
Thorac Cardiovasc Surg. 2011 Oct;59(7):443-5. doi: 10.1055/s-0030-1250389. Epub 2011 Mar 25.
Abstract/Text
Three cases of children, aged 7, 12 and 13 years, respectively, with bronchial mucoepidermoid carcinoma are presented. All patients were primarily misdiagnosed as pneumonitis following common symptoms of prolonged fever, cough, expectoration, and indirect signs of bronchial obstruction by chest roentgenogram, before the tumours in the main bronchi were revealed by chest computed tomography and bronchoscopy. After undergoing lobectomy and systematic lymph node dissection, all three patients recovered uneventfully. Histologically, all the cases were low-grade mucoepidermoid carcinoma; one case additionally had mediastinal lymph node metastasis. The patients have remained in good health during a follow-up of between 1.5 and 6 years. Despite its extremely rare occurrence in childhood, the possibility of bronchial mucoepidermoid carcinoma should be kept in mind when encountering a child presenting with symptoms of recurrent pneumonia.
© Georg Thieme Verlag KG Stuttgart · New York.
Luigi Santambrogio, Ugo Cioffi, Matilde De Simone, Lorenzo Rosso, Stefano Ferrero, Annamaria Giunta
Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report.
Chest. 2002 Feb;121(2):635-6.
Abstract/Text
We report what we believe to be the first case of video-assisted sleeve lobectomy in an adolescent girl who had experienced recurrent episodes of lobar pneumonia and received a diagnosis of low-grade mucoepidermoid carcinoma of the left lower lobar bronchus.
Jimmie Honings, Henning A Gaissert, Ruchira Ruangchira-Urai, John C Wain, Cameron D Wright, Douglas J Mathisen, Eugene J Mark
Pathologic characteristics of resected squamous cell carcinoma of the trachea: prognostic factors based on an analysis of 59 cases.
Virchows Arch. 2009 Nov;455(5):423-9. doi: 10.1007/s00428-009-0843-6. Epub 2009 Oct 17.
Abstract/Text
While squamous cell carcinoma (SCC) is the most common tracheal malignancy, few reports describe the pathologic considerations that may guide intraoperative decisions and prognostic assessment. We reviewed 59 tracheal SCC treated between 1985 and 2008 by segmental resection of the trachea, including resection of the carina in 24% and inferior larynx in 14%. We classified these tumors by grading histologic differentiation and microscopic features used in SCC of other sites. Of 59 tumors, 24% (14 of 59) were well differentiated, 49% (29 of 59) were moderately differentiated, and 27% (16 of 59) were poorly differentiated. Unfavorable prognostic factors were tumor extension into the thyroid gland (all of five so-afflicted patients died of tumor progression within 3 years) and lymphatic invasion (mean survival 4.6 versus 7.6 years). Keratinization, dyskeratosis, acantholysis, necrosis, and tumor thickness did not predict prognosis. As surgical resection is the only curative treatment; the surgeon should establish clean lines of resection using, as appropriate, intraoperative frozen section. The pathologist can provide additional important prognostic information, including tumor differentiation and extent, invasion of surgical margins, and extension into the thyroid.
J P Diaz-Jiménez, J E Martínez-Ballarín, A Llunell, E Farrero, A Rodríguez, M J Castro
Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction.
Eur Respir J. 1999 Oct;14(4):800-5.
Abstract/Text
A prospective controlled randomized trial was performed in order to assess the effectiveness and safety of photodynamic therapy versus laser resection in 31 patients with partial or complete tracheobronchial obstruction due to inoperable non-small cell lung cancer. Fourteen patients received dihaematoporphyrin ether and argon dye laser photoradiation, and 17 patients received Nd-YAG laser resection. Endoluminal obstruction of >75% was found in 77.4% of the patients. Among the symptoms, cough was more severe in the Nd-YAG group (p=0.02). Patients in both groups experienced symptomatic relief after treatment (p=0.003). Patients in the photodynamic therapy (PDT) group showed a significantly longer time until treatment failure (p=0.03) and longer median survival (p=0.007). Bronchitis and photosensitization (both in the PDT group) were the most common adverse effects. There was one death, probably related to treatment, in the PDT group. Photodynamic therapy and neodymium-yttrium aluminium garnet laser resection showed similar effectiveness and safety in the palliation of symptoms. The more prolonged survival in the photodynamic therapy group may have been due to differences in tumour stage between the groups. The degree of obstruction improved after treatment in both groups. In conclusion, photodynamic therapy is a valid method of palliation in partially or totally obstructing non-small cell lung carcinoma.
Gregory M Loewen, Ravindra Pandey, David Bellnier, Barbara Henderson, Thomas Dougherty
Endobronchial photodynamic therapy for lung cancer.
Lasers Surg Med. 2006 Jun;38(5):364-70. doi: 10.1002/lsm.20354.
Abstract/Text
BACKGROUND AND OBJECTIVE: Endobronchial photodynamic therapy (PDT) is a minimally invasive technique for the palliation of major airway obstruction from lung cancer, and for the treatment of endobronchial microinvasive lung cancer.
STUDY DESIGN: Results of reported clinical trials were compared, and the author's preliminary results with second generation photosensitizers were also reviewed.
RESULTS: A review of the clinical experience with endobronchial PDT is provided. Potential advantages of PDT include the duration of palliation achieved through the delayed cellular effects of PDT within tumor. Side-effects from FDA-approved photosensitizer (Photofrin, Porfimer sodium, Axcan Scandipharm, Montreal, Quebec) include skin photosensitivity. HPPH (2-[1-hexyloxyethyl]-2 devinyl pyropheophorbide) is an example of a second-generation photosensitize that shows promise in the treatment of lung cancer, and appears to be free from significant skin photosensitivity.
CONCLUSION: PDT is an effective tool for the palliation of endobronchial lung cancers which obstruct the central airways and is also effective for the treatment of central microinvasive carcinoma and carcinoma in situ of the central airways.
Copyright 2006 Wiley-Liss, Inc.
J F Dumon
A dedicated tracheobronchial stent.
Chest. 1990 Feb;97(2):328-32.
Abstract/Text
A dedicated tracheobronchial stent to be used in the treatment of external compression of the main airway is described. This stent is made of molded silicone. Its outside surface bears regularly placed studs to prevent displacement. First results are encouraging. So far, 118 prostheses have been placed in 66 patients. Tolerance was excellent and complications were rare. Migration occurred 12 times: in seven cases an early prototype that was poorly designed had been used. Obstruction was noted in two cases without major problems. Mean follow-up at the time of this writing is three months, with the longest follow-up 19 months.
Becker HD. Stenting of central airways. J Bronchology. 1995; 2: 98-106.
T Miyazawa, M Yamakido, S Ikeda, K Furukawa, Y Takiguchi, H Tada, T Shirakusa
Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses.
Chest. 2000 Oct;118(4):959-65.
Abstract/Text
STUDY OBJECTIVE: To assess the uncovered Ultraflex nitinol stent (Boston Scientific; Natick, MA) for its efficacy and safety.
DESIGN, SETTING, AND PATIENTS: Between October 1997 and October 1998, we carried out a prospective multicenter study at six hospitals in Japan. Fifty-four Ultraflex stents were inserted in 34 patients with inoperable malignant airway stenosis using a flexible and/or a rigid bronchoscope under fluoroscopic and endoscopic visualization.
MEASUREMENTS AND RESULTS: Clinical, endoscopic examination, and pulmonary function on days 1, 30, and 60 after stent implantation showed improvement. In 19 patients (56%), stent implantation was performed as an emergency procedure because of life-threatening tracheobronchial obstruction. Immediate relief of dyspnea was achieved in 82% of the patients. The dyspnea index improved significantly after implantation (before vs. days 1, 30, and 60; p<0.001). Significant improvements were observed in obstruction of airway diameter (81+/-15% before vs. 14+/-17% on day 1, 12+/-12% on day 30, and 22+/-28% on day 60; p<0.001). Vital capacity (VC), FEV(1), and peak expiratory flow (PEF) increased significantly after stent implantation: before vs immediately after VC (p<0.01), FEV(1) (p<0.001), and PEF (p<0.05). The main complications were tumor ingrowth (24%) and tumor overgrowth (21%). After coagulation with an Nd-YAG laser or argon plasma coagulation, mechanical coring out using the bevel of a rigid bronchoscope was necessary in patients showing tumor ingrowth or overgrowth. Removal and reposition were possible in case of misplacement. There were no problems with migration and retained secretions. The median survival time of patients was 3 months. The 1-year survival rate was 25.4%.
CONCLUSIONS: In this study of the Ultraflex nitinol stent, we have demonstrated that patients were relieved from dyspnea, which contributed to improved quality of life, with minimal complications. This stent can be used safely, even in the subglottic region. Owing to its excellent flexibility and biocompatibility, the stent is also indicated in certain complicated situations, eg, narrow stenosis, hourglass stenosis, curvilinear stenosis, bilateral mainstem bronchial stenoses, and long stenosis of varying diameters.
Kinya Furukawa, Junzo Ishida, Gaku Yamaguchi, Jitsuo Usuda, Hidemitsu Tsutsui, Makoto Saito, Chimori Konaka, Harubumi Kato
The role of airway stent placement in the management of tracheobronchial stenosis caused by inoperable advanced lung cancer.
Surg Today. 2010 Apr;40(4):315-20. doi: 10.1007/s00595-008-4058-2. Epub 2010 Mar 26.
Abstract/Text
PURPOSE: To our knowledge there is no in-depth report on the benefits of airway stenting, which focuses specifically on patients with inoperable advanced lung cancer causing severe central airway obstruction. We evaluated the role of airway stenting as one aspect of the multidisciplinary management of advanced lung cancer.
METHODS: We performed airway stenting in 40 lung cancer patients, placing a total of 58 stents. Stenting was done as a final modality in 22 patients with terminal-stage lung cancer (group A). The other 18 patients received additional therapy after stenting (group B), 12 (66.7%) of whom were treatment-naïve on admission.
RESULTS: The performance status (PS) and Hugh-Jones classification (H-J) scores improved in both groups after stenting: from 3.56 to 2.48 (P = 0.001) and 4.29 to 3.20 (P = 0.004) in group A, and from 3.15 to 1.25 (P < 0.001) and 4.10 to 2.10 (P < 0.001) in group B, respectively. The median survival time and 1-year survival rate after stenting were 1.6 months and 5.1%, respectively, in group A, and 5.6 months and 25.0%, respectively, in group B.
CONCLUSIONS: Airway stenting followed by adjuvant therapy may improve the survival of treatment-naïve patients with severe symptomatic airway obstruction caused by advanced lung cancer.
Takashi Suzuki
What is the best management strategy for adenoid cystic carcinoma of the trachea?
Ann Thorac Cardiovasc Surg. 2011;17(6):535-8.
Abstract/Text
T Ayabe, Y Matsuzaki, M Edagawa, M Asado, T Onitsuka
A novel interventional therapy using the combination of bilateral bronchial stent dilatation and percutaneous cardiopulmonary support for critical airway obstruction due to metastatic carcinomatous carina.
Ann Thorac Cardiovasc Surg. 1999 Oct;5(5):331-5.
Abstract/Text
For an inoperative critical airway obstruction (bilateral bronchial stenoses) from a carcinomatous carina due to the mediastinal lymphnodal metastasis from uterine cancer, we succeeded in improving the patient's severe dyspnea by the combination of bilateral bronchial stent dilatation and a percutaneous cardiopulmonary support (PCPS) system. The imminent airway stenosis with severe dyspnea may have a high risk of asphyxia and contact-flooding during implanting of the stent. By the novel use of PCPS in advance for blood-oxygenation as a respiratory support, we could safely perform the interventional therapy of bronchial expandable metallic stents, and the patient obtained a good quality of life without dyspnea until she died of systemic metastatic cachexia. This technique may possibly be approved as an option for temporary remission therapy of a critical airway obstruction.
K Kameyama, M Maeda, T Okamoto, A Sugita, E Hayashi, K Nakamoto
[Stent intubation for the airway stenosis under PCPS].
Kyobu Geka. 1999 Dec;52(13):1078-83.
Abstract/Text
Placement of stents for the tracheal or carinal stenosis have a meaning of maintaining the airway. Failure of the stenting causes death. In cases of severe airway stenosis and low pulmonary function, the pulmonary support method should be performed instead of intubation and mechanical ventilation. Generally, PCPS (percutaneous cardio-pulmonary support system) is used as a pulmonary support. This method was very useful to place stents for airway stenosis. We concluded that PCPS was useful in emergency cases, and in cases of severe fixed type airway stenosis and low pulmonary function it had be on stand-by.
Takeshi Shiraishi, Takayuki Shirakusa, Masafumi Hiratsuka, Satoshi Yamamoto, Akinori Iwasaki, Katsunobu Kawahara
Stenting for critical airway stenosis under percutaneous cardiopulmonary support.
Jpn J Thorac Cardiovasc Surg. 2004 Dec;52(12):592-6. doi: 10.1007/s11748-004-0032-0.
Abstract/Text
Airway stenting for severe central airway stenosis is inherently a dangerous procedure. There is the risk of critical airway obstruction due to bleeding, tumor debris, and airway perforation during the procedure. Once such situations occur, percutaneous cardiopulmonary support (PCPS) can be one of the most valuable rescue options to prevent critical hypoxic complications. At our institute, four of 49 patients who received stenting or other airway intervention required PCPS support (8%). Two of these cases required PCPS to be performed in an emergency setting during the procedure while the procedure was elective in the other 2. All procedures were performed effectively and safely without any complications caused by PCPS, including massive airway bleeding due to anticoagulant treatment. Patients were able to be weaned off PCPS uneventfully. PCPS is considered to be a valuable procedure in remedying critical hypoxic situations during airway intervention.
日本肺癌学会編：肺癌取扱い規約（第8版）．金原出版、2017．.
V Paul Doria-Rose, Pamela M Marcus, Eva Szabo, Melvyn S Tockman, Myron R Melamed, Philip C Prorok
Randomized controlled trials of the efficacy of lung cancer screening by sputum cytology revisited: a combined mortality analysis from the Johns Hopkins Lung Project and the Memorial Sloan-Kettering Lung Study.
Cancer. 2009 Nov 1;115(21):5007-17. doi: 10.1002/cncr.24545.
Abstract/Text
BACKGROUND: : Two randomized controlled trials of lung cancer screening initiated in the 1970s, the Johns Hopkins Lung Project and the Memorial Sloan-Kettering Lung Study, compared 1 arm that received annual chest X-ray and 4-monthly sputum cytology (dual-screen) to a second arm that received annual chest X-ray only. Previous publications from these trials reported similar lung cancer mortality between the 2 groups. However, these findings were based on incomplete follow-up, and each trial on its own was underpowered to detect a modest mortality benefit.
METHODS: : The authors estimated the efficacy of lung cancer screening with sputum cytology in an intention-to-screen analysis of lung cancer mortality, using combined data from these trials (n = 20,426).
RESULTS: : Over (1/2) of squamous cell lung cancers diagnosed in the dual-screen group were identified by cytology; these cancers tended to be more localized than squamous cancers diagnosed in the X-ray only arm. After 9 years of follow-up, lung cancer mortality was slightly lower in the dual-screen than in the X-ray only arm (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.74-1.05). Reductions were seen for squamous cell cancer deaths (RR, 0.79; 95% CI, 0.54-1.14) and in the heaviest smokers (RR, 0.81; 95% CI, 0.67-1.00). There were also fewer deaths from large cell carcinoma in the dual-screen group, although the reason for this is unclear.
CONCLUSIONS: : These data are suggestive of a modest benefit of sputum cytology screening, although we cannot rule out chance as an explanation for these findings. Cancer 2009. (c) 2009 American Cancer Society.
Deesha Patel, Ajiri Akporobaro, Nyasha Chinyanganya, Allan Hackshaw, Clive Seale, Stephen G Spiro, Chris Griffiths, Lung-SEARCH Investigators
Attitudes to participation in a lung cancer screening trial: a qualitative study.
Thorax. 2012 May;67(5):418-25. doi: 10.1136/thoraxjnl-2011-200055. Epub 2011 Nov 21.
Abstract/Text
BACKGROUND: Earlier diagnosis of lung cancer is key to reducing mortality. New evidence suggests that smokers have negative attitudes to screening and participation in lung cancer screening trials is poor (<1 in 6 of those eligible). Understanding participation is important since uptake in screening trials is likely to predict uptake in screening programmes. A qualitative study of people accepting and declining participation in the Lung-SEARCH screening trial was conducted. Two questions were addressed: Are the screening methods offered acceptable to patients? Why do some people take part and others decline?
METHODS: The qualitative study used semi-structured interviews with 60 respondents from three groups: (a) trial participants providing an annual sputum sample; (b) trial participants with a sputum sample showing abnormal cytology and thus undergoing annual CT scanning and bronchoscopy; and (c) those declining trial participation.
RESULTS: Most respondents (48/60, 80%) viewed sputum provision, CT scanning and bronchoscopy as largely acceptable. Those declining trial participation described fear of bronchoscopy, inconvenience of travelling to hospitals for screening investigations and perceived themselves as having low susceptibility to lung cancer or being too old to benefit. Patients declining participation discounted their risk from smoking and considered negative family histories and good health to be protective. Four typological behaviours emerged within those declining: 'too old to be bothered', 'worriers', 'fatalists' and 'avoiders'.
CONCLUSION: Sputum provision, CT scanning and bronchoscopy are largely acceptable to those participating in a screening trial. However, the decision to participate or decline reflects a complex balance of factors including acceptability and convenience of screening methods, risk perception, altruism and self-interest. Improving practical and changing cognitive aspects of participation will be key to improving uptake of lung cancer screening.
日本肺癌学会編：肺癌診療ガイドライン 2022年版、Ⅰ．肺癌の診断,CQ8．中枢気道の前浸潤性病変や早期癌が疑われる症例に，自家蛍光（autofluoresense）観察/狭帯域光観察（narrow band imaging）は勧められるか？、金原出版、2022.
Timothy C Kennedy, Annette McWilliams, Eric Edell, Tom Sutedja, Gordon Downie, Rex Yung, Adi Gazdar, Praveen N Mathur, American College of Chest Physicians
Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
Chest. 2007 Sep;132(3 Suppl):221S-233S. doi: 10.1378/chest.07-1377.
Abstract/Text
BACKGROUND: An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways.
METHODS: Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee.
RESULTS: White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques.
CONCLUSIONS: AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.
S Lam, T Kennedy, M Unger, Y E Miller, D Gelmont, V Rusch, B Gipe, D Howard, J C LeRiche, A Coldman, A F Gazdar
Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy.
Chest. 1998 Mar;113(3):696-702.
Abstract/Text
BACKGROUND: In the treatment of lung cancer, the best outcome is achieved when the lesion is discovered in the intraepithelial (preinvasive) stage. However, intraepithelial neoplastic lesions are difficult to localize by conventional white-light bronchoscopy (WLB).
OBJECTIVE: To determine if autofluorescence bronchoscopy, when used as an adjunct to WLB, could improve the bronchoscopist's ability to locate and remove biopsy specimens from areas suspicious of intraepithelial neoplasia as compared with WLB alone.
METHOD: A multicenter clinical trial was conducted in seven institutions in the United States and Canada. WLB followed by fluorescence examination with the light-induced fluorescence endoscopy (LIFE) device was performed in 173 subjects known or suspected to have lung cancer. Biopsy specimens were taken from all areas suspicious of moderate dysplasia or worse on WLB and/or LIFE examination. In addition, random biopsy specimens were also taken from other parts of the bronchial tree.
RESULTS: The relative sensitivity of WLB + LIFE vs WLB alone was 6.3 for intraepithelial neoplastic lesions and 2.71 when invasive carcinomas were also included. The positive predictive value was 0.33 and 0.39 and the negative predictive value was 0.89 and 0.83, respectively, for WLB+LIFE and WLB alone.
CONCLUSION: Autofluorescence bronchoscopy, when used as an adjunct to standard WLB, enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions that may have significant implication in the management of lung cancer in the future.
N Ikeda, H Honda, T Katsumi, T Okunaka, K Furukawa, T Tsuchida, K Tanaka, T Onoda, T Hirano, M Saito, N Kawate, C Konaka, H Kato, Y Ebihara
Early detection of bronchial lesions using lung imaging fluorescence endoscope.
Diagn Ther Endosc. 1999;5(2):85-90. doi: 10.1155/DTE.5.85.
Abstract/Text
The performance of the Lung Imaging Fluorescence Endoscope (LIFE) system was compared with conventional bronchoscopy in 158 patients: 68 patients with invasive cancer, 42 patients with abnormal sputum cytology findings (12 early cancer and 26 dysplasia), 17 cases with resected lung cancer and 31 smokers with symptoms. The respective results of conventional bronchoscopy and LIFE for detection of dysplasia were; sensitivity 52% and 90% (biopsy basis), 62% and 92% (patient basis). Fluorescence bronchoscopy may be an important adjunct to conventional bronchoscopy to improve the localization of subtle lesions of bronchus.
Norihiko Ikeda, Hidetoshi Honda, Aeru Hayashi, Jitsuo Usuda, Yasufumi Kato, Masahiro Tsuboi, Tatsuo Ohira, Takashi Hirano, Harubumi Kato, Hiromi Serizawa, Yoshimitsu Aoki
Early detection of bronchial lesions using newly developed videoendoscopy-based autofluorescence bronchoscopy.
Lung Cancer. 2006 Apr;52(1):21-7. doi: 10.1016/j.lungcan.2005.11.009. Epub 2006 Feb 23.
Abstract/Text
The combination of white light and autofluorescence bronchoscopy has been reported to show better sensitivity in detecting dysplasia and cancer of the bronchus than white light alone. However, fiberoptic bronchoscopy has been replaced by videoendoscopy at most leading facilities for over a decade. To avoid interruption of the videoendoscopy examination to perform fiberscopy-based autofluorescence examination as well as enhancing the sensitivity of intraepithelial lesions, autofluorescence diagnosis system integrated into a videoendoscope (SAFE 3000, Pentax, Tokyo) was created. A total of 154 consecutive patients were studied using this system, containing 83 known or suspected lung cancer cases, 46 of the cases with abnormal sputum cytology findings, 10 follow up cases following lung cancer operations, and 15 heavy smokers with respiratory symptoms. Abnormal findings were recognized by white light and/or SAFE 3000 at 166 sites and biopsies were taken to evaluate the relationship between endoscopic findings and pathology results. The sensitivity of the system for CIS+dysplasia was 65% in white light and 90% in SAFE. This videoendoscopy-based autofluorescence system had significantly higher sensitivity for intraepithelial lesions than white light videoendoscopy alone.
Jitsuo Usuda, Hidemitsu Tsutsui, Hidetoshi Honda, Shuji Ichinose, Taichirou Ishizumi, Takeshi Hirata, Tatsuya Inoue, Keishi Ohtani, Sachio Maehara, Kentarou Imai, Yoshihiko Tsunoda, Mitsuhiro Kubota, Norihiko Ikeda, Kinya Furukawa, Tetsuya Okunaka, Harubumi Kato
Photodynamic therapy for lung cancers based on novel photodynamic diagnosis using talaporfin sodium (NPe6) and autofluorescence bronchoscopy.
Lung Cancer. 2007 Dec;58(3):317-23. doi: 10.1016/j.lungcan.2007.06.026. Epub 2007 Aug 15.
Abstract/Text
BACKGROUND: We had previously developed the possibility of use of a photodynamic diagnosis (PDD) system using a tumor-selective photosensitizer and laser irradiation for the early detection and photodynamic therapy (PDT) for centrally located early lung cancers. Recently, we established the autofluorescence diagnosis system integrated into a videoendoscope (SAFE-3000) as a very useful technique for the early diagnosis of lung cancer.
PATIENTS AND METHODS: Twenty-nine patients (38 lesions) with centrally located early lung cancer received PDD and PDT using the second-generation photosensitizer, talaporfin sodium (NPe6). Just before the PDT, we defined the tumor margin accurately using the novel PDD system SAFE-3000 with NPe6 and a diode laser (408nm).
RESULTS: Red fluorescence emitted from the tumor by excitation of the photosensitizer by the diode laser (408nm) from SAFE-3000 allowed accurate determination of the tumor margin just before the PDT. The complete remission (CR) rate following NPe6-PDT in the cases with early lung cancer was 92.1% (35/38 lesions). We also confirmed the loss of red fluorescence from the tumors immediately after the PDT using SAFE-3000. We confirmed that all the NPe6 in the tumor had been excited and photobleached by the laser irradiation (664nm) and that no additional laser irradiation was needed for curative treatment.
CONCLUSIONS: This novel PDD system using SAFE-3000 and NPe6 improved the quality and efficacy of PDT and avoided misjudgement of the dose of the photosensitizer or laser irradiation in PDT. PDT using NPe6 will become a standard option of treatments for centrally located early lung cancer.
H C Grillo, D J Mathisen
Primary tracheal tumors: treatment and results.
Ann Thorac Surg. 1990 Jan;49(1):69-77.
Abstract/Text
One hundred ninety-eight patients with primary tracheal tumors were evaluated in 26 years. One hundred forty-seven tumors were excised (74%): 132 (66%) by resection and primary reconstruction, seven by laryngotracheal resection or cervicomediastinal exenteration, and eight by staged procedures. Eleven more were explored. Forty-four squamous cell carcinomas were resected, 60 adenoid cystic, and 43 assorted tumors, benign and malignant. Eighty-two patients underwent tracheal resection with primary reconstruction, and 50 had carinal resection and reconstruction. Surgical mortality for resection with primary reconstruction was 5%, with one death after tracheal and six after carinal repair. Six patients had stenosis after tracheal or carinal resection; all underwent reresection successfully. Nearly all patients with squamous or adenoid cystic carcinoma were irradiated postoperatively. Twenty of 41 survivors of resection of squamous cell carcinoma are living free of disease (some for more than 25 years), 39 of 52 with adenoid cystic carcinoma (up to nearly 19 years), and 35 of 42 with other lesions (5 lost to follow-up). Comparison of length of survival of patients with squamous cell carcinoma and adenoid cystic carcinoma who are alive without disease with those who died with carcinoma supports surgical treatment (usually followed by irradiation). Positive lymph nodes or invasive disease at resection margins appear to have an adverse effect on cure of squamous cell carcinoma; such an effect is not demonstrable with adenoid cystic carcinoma.
Takanori Kanematsu, Tomofumi Yohena, Tadashi Uehara, Chie Ushijima, Hiroshi Asoh, Ichiro Yoshino, Yukito Ichinose
Treatment outcome of resected and nonresected primary adenoid cystic carcinoma of the lung.
Ann Thorac Cardiovasc Surg. 2002 Apr;8(2):74-7.
Abstract/Text
BACKGROUND AND OBJECTIVE: The incidence of primary adenoid cystic carcinoma of the lung is relatively rare and the optimal treatment strategy is still unclear.
METHODS: Sixteen adenoid cystic carcinoma patients were treated at our institute from 1972 to 1998 and their clinical features, treatments and survivals were reviewed.
RESULTS: Half of all patients were female and the median age was 46 ranging from 30 to 64. All primary lesions were located in the central bronchial tree and 80% of the patients had some symptoms. Eleven patients underwent a resection of the tumor with/without plasty of the trachea or bronchus. Although 6 (55%) of 11 patients had a microscopic residual tumor after resection, 5 patients who received postoperative radiotherapy survived without recurrence from 3 to 17 years. Five patients received radiotherapy as their initial treatment and all tumors responded well to the treatment. The 5-year and 10-year survival rates were 91 and 76% without local recurrence in the resected group and 40 and 0% in the nonresected group, respectively.
CONCLUSION: These observations suggest that surgical resection should be selected first whenever possible, and, in addition, adenoid cystic carcinoma is sensitive to radiotherapy.
Benjamin D Webb, Garrett L Walsh, Dianna B Roberts, Erich M Sturgis
Primary tracheal malignant neoplasms: the University of Texas MD Anderson Cancer Center experience.
J Am Coll Surg. 2006 Feb;202(2):237-46. doi: 10.1016/j.jamcollsurg.2005.09.016. Epub 2005 Nov 21.
Abstract/Text
BACKGROUND: Primary malignant neoplasms of the trachea are very rare and data relating to them are limited. This study was conducted to review the presentation, management, and outcomes of primary tracheal cancers at our institution, a large multidisciplinary cancer center.
STUDY DESIGN: Retrospective chart review was conducted for all patients found to have a pathologic diagnosis of primary tracheal malignancy.
RESULTS: Since 1945, 74 patients were diagnosed with primary tracheal cancers. Among these, 34 (45.9%) were squamous cell carcinomas, 19 (25.7%) were adenoid cystic carcinomas, and 21 (28.4%) were of other histologic types. Presenting symptoms were most frequently dyspnea (55.4%), hemoptysis (48.6%), cough (41.9%), and hoarseness (35.1%). Most patients (77.3%) were former or current smokers, particularly those with squamous cell carcinoma (93.3%). For the entire group of 74 patients, the 5-year disease-specific mortality rate was 72.9% and the 5-year all-cause mortality rate was 79.3%. Patients who had adenoid cystic carcinoma and those with cervical primaries had better rates of disease-specific and overall survival than others (p = 0.036 and 0.006 for the former patient group and p = 0.006 and 0.030 for the latter patient group). Among patients with incident disease treated at our institution (n = 45), those undergoing primary operation with adjuvant radiotherapy appeared to have better disease-specific and overall survival rates compared with those undergoing primary radiotherapy with or without chemotherapy (p = 0.0002 and 0.0003, respectively). Although those undergoing operation and receiving radiotherapy did better than those undergoing operation alone, the difference was not statistically significant.
CONCLUSIONS: Primary tracheal cancers are very rare, and our results should be viewed with caution, given that our population comprised a small heterogeneous group treated over a 60-year period. Although squamous cell carcinoma was the most common pathology in smokers, adenoid cystic carcinoma was more prevalent among nonsmokers. Operation with adjuvant postoperative radiotherapy is recommended for most patients.
Jimmie Honings, Henning A Gaissert, Alissa C Weinberg, Eugene J Mark, Cameron D Wright, John C Wain, Douglas J Mathisen
Prognostic value of pathologic characteristics and resection margins in tracheal adenoid cystic carcinoma.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1438-44. doi: 10.1016/j.ejcts.2010.01.005. Epub 2010 Mar 30.
Abstract/Text
OBJECTIVE: We investigate the influence of tumour and resection characteristics on survival in adenoid cystic carcinoma (ACC) of the trachea.
METHODS: A retrospective study of 12 laryngotracheal, 58 tracheal and 38 carinal resections for primary ACC in 108 consecutive operative survivors between 1962 and 2007 was conducted. Postoperative radiotherapy was administered to 82% of patients (89/108). Depth of invasion, extramural extent, organ invasion, perineural growth, margin status and lymph node involvement were described.
RESULTS: The tumour was intramural in 15% (16/108), extramural in 85% (92/108) and invaded adjacent organs in 20% (22/108). Airway margins were grossly positive in 9 (8%), microscopically positive in 59 (55%) and negative in 40 (37%) of 108 resections. Adventitial (radial) margins of transmural sections were grossly positive in 3 (3%), microscopically positive in 95 (88%) and negative in 10 (9%) cases. Perineural growth was present in 37 (34%) and absent in 12 (11%); it was not observed in 59 (55%) cases. Lymph nodes were positive in 16 (15%) and negative in 45 (42%) cases; it was not sampled in 47 (44%) cases. Median overall survival (OS) and disease-free survival (DFS) for the entire group were 17.7 and 10.2 years, respectively. OS was longer after resection with: negative airway margins (20.4 vs 13.3 years, P=0.028) and negative radial margins (21.7 vs 13.3 years, P=0.050); absence of extramural disease (21.7 vs 13.3 years, P=0.007), perineural growth (22.8 vs 7.5 years, P=0.011) or lymph node metastases (16.8 vs 6.1 years, P=0.017). DFS was longer after resection with: negative airway margins (16.6 vs 9.3, P=0.005) and absence of extramural disease (17.9 vs 9.3 years, P=0.008), perineural growth (17.9 vs 6.6 years, P=0.033) or lymph node metastases (10.2 vs 3.0 years, P=0.005).
CONCLUSIONS: After tracheal resection for ACC, limited tumour extent and complete resection are associated with longer overall and disease-free survival. Long-term survival (>10 years), however, is also observed after tracheal resection of locally advanced ACC.
Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Lara P Bonner Millar, Diana Stripp, Joel D Cooper, Stefan Both, Paul James, Ramesh Rengan
Definitive radiotherapy for unresected adenoid cystic carcinoma of the trachea.
Chest. 2012 May;141(5):1323-6. doi: 10.1378/chest.11-0925.
Abstract/Text
Adenoid cystic carcinoma is a rare malignancy that usually originates in the salivary glands of the head and neck but has rarely been known to originate in the trachea. This histology has a predilection for perineural invasion and a tendency for both local and distant recurrences. While surgical resection is the mainstay of treatment of tracheal adenoid cystic carcinoma, tumor size, location, and patient comorbidities may preclude surgery, and the optimal nonsurgical management remains undefined. In the absence of locoregional lymph node metastases, we recommend highly conformal radiotherapy alone to a dose of 80 Gy. We report on two patients with unresectable disease who were treated with definitive radiotherapy: one using conventional photons and one treated with a combination of photon and proton beams. Both patients were treated to a dose of 80 Gy with acceptable toxicities and objective clinical and radiographic response. The patient treated with conventional photons has no evidence of recurrent disease at 5 years; the patient treated with protons has continued evidence of response without evidence of disease recurrence 11 months after treatment.
Scott A Laurie, Lisa Licitra
Systemic therapy in the palliative management of advanced salivary gland cancers.
J Clin Oncol. 2006 Jun 10;24(17):2673-8. doi: 10.1200/JCO.2005.05.3025.
Abstract/Text
Cancers of the salivary glands are unusual lesions that vary widely in their histologic appearance and molecular characteristics. Likewise, there is a wide spectrum of biologic behavior, ranging from low-grade, minimally invasive tumors, to highly lethal malignancies. There are few data on the role of systemic therapies in the management of these cancers, and chemotherapy is generally reserved for the palliative management of advanced disease that is not amenable to local therapies such as surgery and/or radiation. The majority of patients for whom systemic therapy is considered will have either adenoid cystic carcinoma, mucoepidermoid carcinoma, or high-grade adenocarcinoma. This article will review the available literature regarding the use of palliative chemotherapy for patients with advanced salivary gland cancer of these histologies, with an emphasis on the potential role of targeted agents. There is a need for a determined, coordinated effort to conduct high-quality clinical trials in patients with these rare cancers.
Sandeep Samant, Michiel W van den Brekel, Merrill S Kies, Jim Wan, K Thomas Robbins, David I Rosenthal, Coen Rasch, Randal S Weber
Concurrent chemoradiation for adenoid cystic carcinoma of the head and neck.
Head Neck. 2012 Sep;34(9):1263-8. doi: 10.1002/hed.21905. Epub 2011 Nov 15.
Abstract/Text
BACKGROUND: We performed a retrospective review of patients with nonresected head and neck adenoid cystic carcinoma (ACC) treated with concurrent chemoradiation.
METHODS: Sixteen patients (nasopharynx 7, oropharynx 4, trachea 3, oral and nasal cavity 1 each) were treated at 3 tertiary care centers. Six patients received intraarterial cisplatin and 10 received intravenous cisplatin or carboplatin concurrently with radiation.
RESULTS: Thirteen patients are alive, 7 without signs of disease with a median follow-up of 61 months. Tumor progression was noted in 8 patients (50%) (distant metastasis in 5 patients and local tumor progression in 3 patients) with a median time to progression of 25 months (range, 4-52 months). Overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) rates at 5 years were 87%, 39%, and 61%, respectively.
CONCLUSION: Concurrent chemoradiation is a feasible treatment option and may lead to sustained locoregional tumor control in patients with nonresected ACC of the head and neck.
Copyright © 2011 Wiley Periodicals, Inc.
Audrey P Calzada, Mia Miller, Chi K Lai, David A Elashoff, Elliot Abemayor, Maie A St John
Adenoid cystic carcinoma of the airway: a 30-year review at one institution.
Am J Otolaryngol. 2012 Mar-Apr;33(2):226-31. doi: 10.1016/j.amjoto.2011.07.003. Epub 2011 Sep 9.
Abstract/Text
PURPOSE: The purpose of the study was to evaluate the treatment results of adenoid cystic carcinoma (ACC) of the airway at a single institution during a 30-year period.
MATERIALS AND METHODS: All cases of ACC of the airway over a 30-year period at one tertiary care institution were reviewed retrospectively. The demographics, treatment modalities, pathologic characteristics, and outcomes were evaluated.
RESULTS: Eleven patients were treated for ACC of the airway with an age range of 25 to 72 years (median, 48 years). Six patients presented with ACC in the larynx, and 5 patients had ACC of the trachea. All patients underwent surgical excision and radiation; 9 of 11 patients had postoperative external beam radiation, 1 patient had preoperative external beam radiation, and the remaining patient had postoperative neutron beam therapy. Four patients with tracheal ACC and none with laryngeal ACC had microscopic or grossly positive margins after surgery (P = .048). Eighty percent of patients had perineural invasion on pathology. Two patients with tracheal ACC had local recurrence of disease, which occurred at 1 and 10 months postoperatively. One patient with laryngeal ACC died of distant metastatic disease at 16 months. Follow-up varied from 4 to 168 months (median, 31 months).
CONCLUSIONS: We report high disease-free survival rates for ACC of the airway in patients who underwent definitive surgical resection followed by postoperative radiation. There is a higher risk for local recurrence and positive surgical margins with distal tracheal location. Distant disease ultimately determines survival.
Published by Elsevier Inc.
