Diagnosis and Treatment of Early Lung Cancer: As It Stands Today

Treatment of “early” stage lung cancer should offer the patient the best chance for cure. Disease-free survival after surgical resection of lung carcinoma in situ has been reported as over 90%. For “microinvasive” lung cancer it may be similar. After resection of stage IA non-small cell lung cancer, survival at 5 years is ∼60 to 70%. If endoscopic or bronchoscopic treatments of early stage lung cancer can offer similar disease-free survival with less perioperative mortality, morbidity, and cost, then they may be alternative front-line therapies. Regardless of therapeutic choice, the initial hurdle is developing a practical detection method for early stage disease. This article reviews early stage lung cancer detection by fluorescence bronchoscopy and potential treatment by the endoscopic techniques of photodynamic therapy, brachytherapy, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, electrocautery, and cryotherapy.

KEYWORDS

Photodynamic therapy - cryotherapy - electrocautery - argon plasma coagulation

REFERENCES

• 1 Mountain C F. Revisions in the international system for staging lung cancer.  Chest. 1997;  111 1710-1717
• 2 Colby TV, Koss M, Trauss W Atlas of Tumor Pathology. 3rd ed. Washington, DC; Armed Forces Institute of Pathology 1994: 145-155
• 3 Saccomanno G. Carcinoma in situ of the lung: its development, detection, and treatment.  Seminars in Respiratory Medicine. 1982;  4 156-160
• 4 Saccommano G. Development of carcinoma of the lung as reflected in exfoliated cells.  Cancer. 1974;  33 256-270
• 5 Black H, Ackerman L V. The importance of epidermoid carcinoma in situ in the histogenesis of carcinoma of the lung.  Ann Surg. 1952;  136 44-55
• 6 Frost J K, Ball W C, Levin M L et al.. Sputum cytopathology: use and potential in monitoring the workplace environment by screening for biological effects of exposure.  J Occup Med. 1986;  28 692-703
• 7 Risse E K, Vooijs G P, van't Hof M A. Diagnostic significance of severe dysplasia in sputum cytology.  Acta Cytol. 1988;  32 629-634
• 8 Cortese D A, Edell E S. Role of phototherapy. laser therapy, brachytherapy, and, prosthetic stents in the management of lung cancer.  Clin Chest Med. 1993;  14 149-159
• 9 Woolner L B, Fontana R S, Cortese D A. Roentgenographically occult lung cancer: pathologic findings and frequency of multicentricity during a 10-year period.  Mayo Clin Proc. 1984;  59 453-466
• 10 Nagamoto N, Saito  Y, Sato M et al.. Clinicopathological analysis of 19 cases of isolated carcinoma in situ of the bronchus.  Am J Surg Pathol. 1993;  17 1234-1243
• 11 Hayata Y, Kato H, Amemiya R et al.. Indications of photoradiation therapy in early stage lung cancer on the basis of post-PRT histologic findings.  Prog Clin Biol Res. 1984;  170 747-758
• 12 Ishida T, Inoue T, Sugio K et al.. Early squamous lung cancer and longer survival rates.  Respiration. 1993;  60 359-366
• 13 Woolner L B, David E, Fontana R S et al.. In situ and early invasive bronchogenic carcinoma.  J Thorac Cardiovasc Surg. 1970;  60 275-290
• 14 Gazdar A F, Minna J D. Molecular detection of early lung cancer.  J Natl Cancer Inst. 1999;  91 299-301
• 15 Mao L, Hurban R H, Boyle J O et al.. Detection of oncogene mutations in sputum precedes diagnosis of lung cancer.  Cancer Res. 1994;  54 1634-1637
• 16 Tockman M S, Gupta P K, Myers J D et al.. Sensitive and specific monoclonal antibody recognition of human lung cancer antigen on preserved sputum cells: a new approach to early lung cancer detection.  J Clin Oncol. 1988;  6 1685-1693
• 17 Cortese D A, Kinsey J H, Woolner L B et al.. Clinical application of a new endoscopic technique for detection of in situ bronchial carcinoma.  Mayo Clin Proc. 1979;  54 635-642
• 18 Profio A E, Dorion D R, Balchum O J et al.. Fluorescence bronchoscopy for localization of carcinoma in situ.  Med Phys. 1983;  10 35-39
• 19 Balchum O J, Profio A E, Dorion D R et al.. Imaging fluorescence bronchoscopy for localizing early bronchial cancer and carcinoma in situ.  Prog Clin Biol Res. 1984;  170 847-861
• 20 Hung J, Lam S, LeRiche J C, Palcic B. Autofluorescence of normal and malignant bronchial tissue.  Lasers Surg Med. 1991;  11 99-105
• 21 Qu J, MacAulay C, Lam S et al.. Laser induced fluorescence spectroscopy at endoscopy: tissue optics; Monte Carlo modelling and in vivo measurements.  Opt Eng. 1995;  34 3334-3340
• 22 Qu J, MacAulay C, Lam S, Palcic B. Mechanisms of ratio fluorescence imaging of diseased tissue.  Society of Photo-optical Instrumentation Engineers. 1995;  2387 71-78
• 23 Palcic B, Lam S, Hung J et al.. Detection and localization of early lung cancer by imaging techniques.  Chest. 1991;  99 742-743
• 24 Stepp H, Baumgartner R, Betz C et al.. New developments in fluorescence detection of ALA-induced protoporphyrin IX for cancer detection.  Society of Photo-Optical Instrumentation Engineers. 1997;  3197 68-74
• 25 Baumgartner R, Huber R M, Schultz H et al.. Inhalation of 5-aminolaevulinic acid: a new technique for fluorescence detection of early stage lung cancer.  J Photochem Photobiol B. 1996;  36 169-174
• 26 Lam S, MacAulay C, Hung J et al.. Detection of dysplasia and carcinoma in situ with a lung imaging fluorescence endoscope device.  J Thorac Cardiovasc Surg. 1993;  105 1035-1040
• 27 Lam S, Kennedy T, Unger M et al.. Localization of bronchial intra epithelial neoplasitic lesions by fluorescence bronchoscopy.  Chest. 1998;  113 696-702
• 28 Kurie J M, Lee J S, Morice R C et al.. Autofluorescence bronchoscopy in the detection of squamous metaplasia and dysplasia in current and former smokers.  J Natl Cancer Inst. 1998;  90 991-995
• 29 Lam S, MacAulay C, Leriche J C et al.. Early localization of bronchogenic carcinoma.  Diagnostic and Therapeutic Endoscopy. 1994;  1 75-78
• 30 Lam S, Becker H D. Future diagnostic procedures.  Chest Surg Clin N Am. 1996;  6 363-380
• 31 Lipson R L, Baldes E J. The pathological properties of a particular hematoporphyrin derivative.  Arch Dermatology. 1960;  82 8-11
• 32 Bugelski P T, Porter C W, Dougherty T J. Autoradiographic distribution of hematoporphyrin derivatives in normal and tumor tissue of the mouse.  Cancer Research. 1981;  41 4606-4612
• 33 Dougherty T J. Photodynamic therapy.  Clin Chest Med. 1985;  6 219-236
• 34 Hayata Y, Kato H, Konaka C et al.. Fiberoptic bronchoscopic laser photoradiation for tumor localization in lung cancer.  Chest. 1982;  82 10-14
• 35 Raab C. Über die Wirkung Fluoreszirenden Stoffe auf Infusoria.  Z Biol. 1900;  39 524
• 36 Edell E S, Cortese D A. Photodynamic therapy: its use in the management of bronchogenic carcinoma.  Clin Chest Med. 1995;  16 455-463
• 37 Imamura S, Kusunoki Y, Takifuji N et al.. Photodynamic therapy and/or external beam radiation therapy for roentgenologically occult lung cancer.  Cancer. 1994;  73 1608-1614
• 38 Edell E S, Cortese D A. Bronchoscopic phototherapy with hematoporhyrin derivative for treatment of localized bronchogenic carcinoma: a 5-year experience.  Mayo Clin Proc. 1987;  62 8-14
• 39 Sutedja T G, Postmus P E. Photodynamic therapy in lung cancer: a review.  J Photochem Photobiol B. 1996;  36 199-204
• 40 Hayata Y, Kato H, Konaka C et al.. Photoradiation therapy with hematoporphyrin derivative in early and stage 1 lung cancer.  Chest. 1984;  86 169-177
• 41 Kato H, Kawate N, Kinoshita K et al.. Photodynamic therapy of early-stage lung cancer.  Ciba Foundation Symposium. 1989;  146 183-194
• 42 Edell E S, Cortese D A. Photodynamic therapy in the management of early superficial squamous cell carcinoma as an alternative to surgical resection.  Chest. 1992;  102 1319-1322
• 43 Hayata Y, Kato H, Konaka C et al.. Photodynamic therapy (PDT) in early stage lung cancer.  Lung Cancer. 1993;  9 287-294
• 44 Balchum O J, Dorion D R. Photoradiation therapy of endobronchial lung cancer: large obstructing tumors, nonobstructing tumors, and early-stage bronchial cancer lesions.  Clin Chest Med. 1985;  6 255-275
• 45 Monnier P, Savary M, Fontolliet C et al.. Photodetection and photodynamic therapy of “early” squamous cell carcinomas of the pharynx, oesophagus, and tracheo-bronchial tree.  Lasers Med Sci. 1990;  5 149-169
• 46 McCaughan J S, Williams T E. Photodynamic therapy for endobronchial malignant disease: a prospective fourteen-year study.  J Thorac Cardiovasc Surg. 1997;  114 940-947
• 47 Cortese D A, Edell E S, Kinsey J H. Photodynamic therapy for early stage squamous cell carcinoma of the lung.  Mayo Clin Proc. 1997;  72 595-602
• 48 Kernan J D, Carcovaner A J. Carcinoma of the lung.  Arch Surg. 1929;  18 315-321
• 49 Pancoast H L. Superior pulmonary sulcus tumor.  JAMA. 1932;  99 1391-1396
• 50 Henschke U K, Hiliaris B S, Mahan G D. Remote afterloading with intracavitary applicators.  Radiology. 1964;  83 344-345
• 51 Mendiondo O A, Dillon M, Beach L J. Endobronchial brachytherapy in the treatment of recurrent bronchogenic carcinoma.  Int J Radiat Oncol Biol Phys. 1983;  9 579-582
• 52 Moylan D, Struber K, Unal A et al.. Transbronchial brachytherapy of recurrent bronchogenic carcinoma: a new approach using the flexible fiberoptic bronchoscope.  Radiology. 1983;  147 253-254
• 53 Gaspar L E. Brachytherapy in lung cancer.  J Surg Oncol. 1998;  67 60-70
• 54 Seagren S L, Harrel J H, Horn R A. High dose rate intraluminal irradiation in recurrent endobronchial carcinoma.  Chest. 1985;  88 810-814
• 55 Sheski F D, Mathur P N. Cryotherapy, electrocautery, and brachytherapy.  Clin Chest Med. 1999;  20 123-138
• 56 Macha H N, Wahlers B, Reichle C et al.. Endobronchial radiation therapy for obstructing malignancies: ten years’ experience with iridium-192 high-dose radiation brachytherapy afterloading technique in 365 patients.  Lung. 1995;  173 271-280
• 57 Sutedja G T, Boris G, Van Zandwijl C, Postmus P E. High dose rate endobronchial brachytherapy in the treatment of bronchogenic carcinoma.  Respiration. 1993;  61 167-168
• 58 Tredaniel J, Hennquin C, Zalcman G et al.. Prolonged survival after high-dose rate endobronchial radiation for malignant airway obstruction.  Chest. 1994;  105 767-772
• 59 Perol M, Caliandro R, Pommier P et al.. Curative irradiation of limited endobronchial carcinomas with high-dose rate brachytherapy.  Chest. 1997;  111 1417-1423
• 60 Taulelle M, Chauvet B, Vincient P et al.. High dose rate endobronchial brachytherapy: results and complications in 189 patients.  Eur Respir J. 1998;  11 162-168
• 61 Nori D, Allison R, Kaplan B et al.. High dose-rate intraluminal irradiation in bronchogenic carcinoma.  Chest. 1993;  104 1006-1011
• 62 Saito M, Yokoyama A, Kurita Y et al.. Treatment of roentgenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low dose rate brachytherapy.  Int J Radiat Oncol Biol Phys. 1996;  34 1029-1035
• 63 Strong S M, Jako G J. Laser surgery in the larynx: early clinical experience with continuous CO₂ laser.  Ann Otolaryngol. 1972;  83 769-776
• 64 LaForet E G, Berger R L, Vaughan C W. Carcinoma obstructing the trachea: treatment by laser resection.  N Engl J Med. 1976;  294 941
• 65 Toty L, Personne C, Colchen A et al.. Bronchoscopic management of tracheal lesions using the neodymium yttrium aluminum garnet laser.  Thorax. 1981;  36 175-178
• 66 Ramser E R, Beamis J F. Laser bronchoscopy.  Clin Chest Med. 1995;  16 415-426
• 67 Joffe SN, Oguro Y Advances in Nd:YAG Laser Surgery New York; Springer-Verlag 1988: 111-114
• 68 Goldhill D R, Hill A J, Whitburn R H et al.. Carboxyhemoglobin concentrations, pulse oximetry, and arterial blood-gas tensions during jet ventilation for Nd:YAG laser bronchoscopy.  British Journal of Anesthesia. 1990;  65 749-753
• 69 Gerasin V A, Levashor Y N, Shafirovscy B B et al.. Bronchoscopic laser photocoagulation of superficial cancer of the bronchi.  Chest. 1990;  98 235-236
• 70 Cavaliere S, Foccoli P, Toninello C et al.. Nd:YAG laser therapy in lung cancer: an 11-year experience with 2253 applications in 1585 patients.  J Bronchol. 1994;  1 105-111
• 71 Strauss A A, Strauss S F, Crawford R A. Surgical diathermy of carcinoma of the rectum: its clinical end results.  JAMA. 1935;  104 1480-1484
• 72 Gilfoy F E. Primary malignant tumors of the lower third of the trachea: report of a case with successful treatment by electrofulgaration and deep x-rays.  Arch Otolaryngol. 1932;  16 182-187
• 73 Kernan J D. Carcinoma of the lung and bronchus: treatment with radon implants and diathermy.  Arch Otolaryngol. 1933;  17 457-473
• 74 Moersch H J, Bowing H H. Primary carcinoma of the bronchus treated successfully with surgical diathermy.  Ann Surg. 1935;  102 989-994
• 75 Van Boxem T J, Venmans B J, Schramel F M et al.. Radiographically occult cancer treated with fiberoptic bronchoscopic electrocautery: a pilot study of a simple and inexpensive technique.  Eur Respir J. 1998;  11 169-172
• 76 Lavandier M, Carre P, Rivoire B et al.. High frequency electrocautery in the management of tracheo-bronchial disorders.  Am Rev Respir Crit Care Med. 1996;  75 A477
• 77 Yankauer S. Two cases of lung tumor treated bronchoscopically.  NY Med J. 1992;  71 4-8
• 78 Sutejda G, Van Kralingen K, Schramel F MNH et al.. Fiberoptic bronchoscopic electrocautery under local anaesthsia for rapid palliation in patients with central airway malignancies: a preliminary report.  Thorax. 1994;  49 1243-1246
• 79 Arnott J. On the Present State of Therapeutic Enquiry. London; 1845
• 80 Rand R, Rinfret A, Von Leden H Cryotherapy Springfield, IL; Charles C Thomas 1968: 376-387
• 81 Mathur P N, Wolf K, Busk M F et al.. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial disorders.  Chest. 1996;  110 718-723
• 82 Rubinsky B, Ikeda M. A cryomicroscope using directional solidification for the controlled freezing of biological tissue.  Cryobiology. 1985;  22 55-68
• 83 Maiwand M O, Homasson J P. Cryotherapy for tracheal bronchial disorders.  Clin Chest Med. 1995;  16 427-443
• 84 Vergnon J M, Schmitt T, Alamartine E et al.. Initial combined cryotherapy and irradiation for unresectable non small cell lung cancer.  Chest. 1992;  102 1436-1440
• 85 Homasson JP, Bell NJ Cryotherapy in Chest Medicine Paris; Springer-Verlag 1992: 91-96
• 86 Deygas N, Froudarakis M, Ozenne G et al.. Cryotherapy in early superficial bronchogenic carcinoma.  Chest. 2001;  120 26-31