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(Chest. 2000;117:1525.)
© 2000 American College of Chest Physicians

Bronchial Arterial Infusion for Lung Cancer

David J. Barnes, MBBS, FCCP

RPAH Medical Centre Newtown, New South Wales, Australia

Correspondence to: David J. Barnes, MBBS, FCCP, Respiratory and Sleep Physician, RPAH Medical Centre, Suite 413, 100 Carillon Ave, Newtown, New South Wales 2042; e-mail: dbarnes{at}nsw.bigpond.net.au

To The Editor:

Osaki and colleagues (May 1999)1 have recently reported their experience with bronchial arterial infusion (BAI) of chemotherapy in centrally located early stage lung cancer. They report prolonged disease-free survival in six of seven patients treated in this manner, with one patient dying of massive hemoptysis 3 months after BAI. While this is an interesting pilot study, there are a number of questions raised by this report, mainly related to patient selection. Four patients had a single carcinoma in situ lesion (stage 0), while the remaining three patients had a carcinoma in situ lesion in addition to a latter stage carcinoma (T2, T3, or T4). All isolated carcinoma in situ lesions seem to have been diagnosed on sputum cytology alone. It is not clear in the report whether those with isolated in situ lesions were symptomatic or whether the cytology was done as part of a screening program for high-risk individuals. No mention is made of bronchial biopsies, and it is therefore assumed that the diagnosis was made on cytology alone. Most would agree that this pathologic diagnosis is difficult to make on cytology alone and usually requires bronchial biopsy.2

A beneficial effect of BAI on survival cannot be assumed from this pilot study. In the first instance, all invasive carcinomas were managed by appropriate surgical resection. Secondly, the prognosis of carcinoma in situ lesions of the bronchus is generally very good. The finding of carcinoma in situ at the bronchial margin after resection for bronchogenic carcinoma has been shown to have no adverse effect on survival, suggesting an inherently good prognosis for in situ lesions.3 4 5 Future studies of BAI would therefore require inclusion of patients other than those with stage 0 disease.

Patients with carcinoma in situ may not require active therapeutic intervention, given the absence of any adverse impact on survival when this pathology is present.

References

  1. Osaki, T, Hanagiri, T, Nakanishi, R, et al (1999) Bronchial arterial infusion is an effective therapeutic modality for centrally located early-stage lung cancer. Chest 115,1424-1428[Abstract/Free Full Text]
  2. Tao, LC, Chamberlain, DW, Delarue, NC, et al (1982) Cytologic diagnosis of radiographically occult squamous cell carcinoma of the lung. Cancer 50,1580-1586[CrossRef][Medline]
  3. Law, MR, Hodson, ME, Lennox, SC (1982) Implications of histologically reported residual tumour on the bronchial margin after resection for bronchial carcinoma. Thorax 37,492-495[Abstract]
  4. Snijder, RJ, Brutel de la Riviere, A, Elbers, HJ, et al (1998) Survival in resected stage 1 lung cancer with residual tumor at the bronchial resection margin. Ann Thorac Surg 65,212-216[Abstract/Free Full Text]
  5. Nagamoto, N, Saito, Y, Sato, M, et al (1993) Clinicopathological analysis of 19 cases of isolated carcinoma in situ of the bronchus. Am J Surg Pathol 17,1234-1243[CrossRef][ISI][Medline]




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