X-ray therapy and carcinoma of the bronchus; an analysis of the effect on 218 patients of irradiation of the primary lesion.
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The difference in response of human tumours to high and low LET radiation has been investigated in a series of inoperable, histologically confirmed bronchial carcinomas. One hundred and forty-nine were treated with low LET radiation alone (60Co gamma rays) and 108 with a combination of gamma rays and fast neutrons of mean energy 6 MeV, one-fifth to one-third of the effective dose being from neutrons. The response was analysed by histological examination of the autopsy specimens. Tumour cell destruction was found to be significantly greater in the neutron-treated series. The two series were not strictly randomized but were closely similar to terms of tumour volume, histological grade and total treatment time. The sequence of treatments with neutrons and gamma rays (N-gamma, gamma-N, gamma-N -gamma) was found to have no influence on the results.
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Of five patients with epidermoid carcinoma of the lung who were treated with small fields of 80 Gy in 40 fractions/8-11 weeks (TDF123-129) to the hilar region, four patients developed marked stenosis of the proximal bronchi without tumour progression and died of pulmonary insufficiency 1-3 years after radiotherapy. These results should serve as a warning against escalation of the radiation dose, and the upper optimal dose might prove to be less than 80 Gy for the treatment of pulmonary hilar lesions.
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A man with chronic obstructive lung disease presented to the hospital with respiratory failure and a chest x-ray indicated complete radiopacity of the left hemithorax. An endobronchial malignancy was suspected, but unexpectedly left-main bronchial occlusion was found secondary to compression between a descending thoracic aortic aneurysm and an enlarged right pulmonary artery.
Self-expanding metallic stents (SEMSs) are used to palliate malignant esophageal strictures. We describe a patient who had an extensive mediastinal tumor for which he was receiving irradiation therapy; chest pain, hemoptysis, and recurrent Gram-negative pneumonia developed in this patient after stent placement. Fiberoptic bronchoscopy revealed protrusion of the SEMS into the tracheobronchial tree, a novel complication for this new type of stent.
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