Chest
Volume 74, Issue 5, November 1978, Pages 531-536
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Cilnical Investigations
Serial Fiberoptic Bronchoscopy during Chemotherapy for Small Cell Carcinoma of the Lung: Early Detection of Patients at High Risk of Relapse

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Serial fiberoptic bronchoscopic examinations were performed during intensive chemotherapy with a combination of drugs in 77 previously untreated patients with small cell carcinoma of the lung. Before treatment, bronchoscopic examination revealed evidence of cancer in 93 percent (70) of the 75 patients studied at that time, including 8 percent (six) in whom the tumor was not evaluable on the chest x-ray film. After therapy was initiated, 36 percent (29) of the 81 procedures performed in patients with a complete response radiographically and 62 percent (33) of the 53 bronchoscopic procedures in those with a partial response or no response showed evidence of tumor. In both of these groups, patients with abnormal findings on endoscopic examination had a much higher rate of relapsing tumor of the chest within a 12-week period. Progression of intrathoracic tumor was first detected solely by bronchoscopic examination in 22 percent (seven) of the 32 episodes of progression. In our hands, repeated fiberoptic bronchoscopic procedures during chemotherapy for small cell carcinoma have yielded information not apparent from the chest x-ray film in a significant number of patients.

Section snippets

Materials and Methods

Serial fiberoptic bronchoscopic examinations were performed before or during therapy (or at both times) in 77 previously untreated patients with small cell carcinoma. Most were referred to our unit for intensive treatment after diagnosis elsewhere. Treatment consisted of alternating regimens of chemotherapy with a combination of drugs;10 radiotherapy was initially given only for lesions of the central nervous system. Bronchoscopic examination was done before treatment, after 6 and 24 weeks of

Results

No deaths and no hemorrhagic or major respiratory complications were observed after these elective bronchoscopic procedures, which included examinations with endobronchial biopsy before treatment in seven patients with the superior vena cava syndrome.

Discussion

Evaluation of the response to therapy in patients with cancer of the lung was not mentioned in a recent review of the indications for fiberoptic bronchoscopic examination;9 however, at least two groups of authors have demonstrated superior survival in patients with lung cancer who are found to be without residual carcinoma at bronchoscopic examination performed after therapy with irradiation.12, 13 Oka et al14 have utilized bronchoscopic examination to assess the effects of therapy with

ACKNOWLEDGMENT

We thank Adi F. Gazdar, M.B., B.S., for reviewing some of the pathologic material and for supplying the illustrations.

References (20)

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Manuscript received February 27; revision accepted May 4.

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