Chest
Clinical InvestigationsInitial Combination Therapy with YAG Laser Photoresection and Irradiation for Inoperable Non-Small Cell Carcinoma of the Lung: A Preliminary Report
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Materials and Methods
All patients who presented with obstruction of a major bronchus secondary to inoperable non-small cell lung cancer were considered for entry into this protocol. Nearly complete (more than 50 percent) exophytic obstruction of at least one major bronchus was a precondition for entry into the study. Isolated lobar obstruction was included only if it was believed to contribute to respiratory insufficiency or postobstructive pneumonia (or both). Patients with small cell carcinoma were excluded,
Results
There were 12 men and seven women patients studied, with a mean age of 62±9 years (Table 1). Squamous cell carcinoma was present in 13 patients and adenocarcinoma and poorly differentiated carcinoma in three cases each. Multiple areas of significant obstruction (more than 50 percent) were present in seven patients, and complete obstruction of at least one major bronchus was noted in ten patients. Tracheal obstruction accounted for eight of 31 sites of laser treatment, main-stem bronchi for 15
Discussion
The majority of patients with newly diagnosed carcinoma of the lung will not be surgical candidates. Conventional therapy currently entails chemotherapy for small cell carcinoma and irradiation for non-small cell carcinoma, with relatively rapid initial responses noted in many of the former patients. Some inoperable patients with non-small cell lung cancer will present with central airway obstruction and associated respiratory insufficiency or postobstructive pneumonitis (or both). Previously,
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Manuscript received September 9; revision accepted November 22.