Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
J Thorac Oncol. 2010 Jan;5(1):62-8. doi: 10.1097/JTO.0b013e3181c42287.
Patients with centrally located early lung cancer (CLELC) are often heavy smokers with a considerably high risk of multiple primary lung cancer (MPLC) lesions; treatment strategies for such patients must preserve the cardiopulmonary function.
Between July 2004 and July 2008, patients with CLELC underwent photodynamic therapy (PDT) using NPe6, second-generation photosensitizer at Tokyo Medical University Hospital. Among these patients, we retrospectively analyzed MPLC, which was treated by surgery plus PDT or PDT alone and examined the effectiveness of PDT, and we propose a treatment strategy for patients with MPLC.
A total of 64 patients with CLECL received NPe6-PDT, and MPLCs were found in 22 patients (34.4%) using sputum cytology and a bronchoscopical examination using autofluorescence bronchoscopy. Among these 22 patients, 10 patients underwent surgery for primary lung cancer and underwent NPe6-PDT for the treatment of secondary primary CLELC, one patient underwent PDT for CLELC as a primary lesion followed by an operation for peripheral-type lung cancer as a secondary primary lesion, and 11 patients underwent PDT alone for MPLC lesions (28 lesions) that were roentgenographically occult lung cancers. Among these 22 patients with MPLC including peripheral-type lung cancers, which were resected by surgery, all 39 CLELC lesions exhibited a complete response after PDT, and all patients were alive.
For patients with lung cancer with a long-term history of smoking, careful follow-up examinations after surgical resection are needed considering the incidence of metachronous primary lung cancers. PDT can play an important role for the treatment strategy for MPLC.
中央型早期肺癌（CLELC）患者通常为重度吸烟者，发生多原发性肺癌（MPLC）病变的风险较高；此类患者的治疗策略必须保留心肺功能。
2004 年 7 月至 2008 年 7 月，东京医科大学医院的患者接受了 NPe6 第二代光敏剂的光动力疗法（PDT）治疗。在这些患者中，我们回顾性分析了 MPLC，这些患者接受了手术加 PDT 或单独 PDT 治疗，并检查了 PDT 的有效性，并为 MPLC 患者提出了一种治疗策略。
共有 64 例 CLELC 患者接受了 NPe6-PDT，22 例患者（34.4%）通过痰细胞学检查和使用自体荧光支气管镜的支气管镜检查发现了 MPLC。在这 22 例患者中，10 例患者因原发性肺癌接受了手术，并对第二原发性 CLELC 进行了 NPe6-PDT 治疗，1 例患者因原发性 CLELC 接受了 PDT 治疗，随后因周围型肺癌作为第二原发性病变进行了手术，11 例患者因 MPLC 病变（28 处）单独接受了 PDT 治疗，这些病变是 X 线隐匿性肺癌。在这 22 例包括周围型肺癌在内的 MPLC 患者中，所有 39 例 CLELC 病变在 PDT 后均表现出完全缓解，所有患者均存活。
对于有长期吸烟史的肺癌患者，考虑到同时性原发性肺癌的发生率，手术切除后需要进行仔细的随访检查。PDT 可以在 MPLC 的治疗策略中发挥重要作用。
