2008 Volume 22 Issue 5 Pages 736-740
Background: Pulmonary pleomorphic carcinoma is a rare non small cell lung cancer with a poor prognosis. This carcinoma belongs to the sarcomatoid carcinomas according to the Pathology & Genetics of Tumours of the Lung, Thymus and Heart (World Health Organization Classification of Tumours 2004). We investigated this rare disease to establish an appropriate treatment strategy. Materials and Methods: A total of 6 cases underwent surgical treatment between April 1999 and October 2007 in our hospital. There were four men and two women, with a mean age of 68.3 years (range: 61 to 77). Five cases had a smoking habit. No cases had a confirmed diagnosis before the operation, and all were diagnosed with pleomorphic carcinoma immunohistologically using resected specimens. Results: The locations of tumors were RUL (three cases), RLL (two cases), and LUL (one case). The median size of the tumor was 70 mm (range: 33 to 112 mm) in diameter. All cases exhibited necrotic lesions, and the median ratio was 30% (range: 10 to 100%). Pleural invasion factors were p0 (two cases), p2 (one case), and p3 (three case). Two cases showed lymph node metastasis to the mediastinal lymph nodes. Complete resection was conducted in five cases. However, one case did not undergo complete resection because of a direct invasion to the brachial plexus. Three cases showed recurrence (brain metastasis, bone metastasis, and chest wall recurrence). Recurrent or unresectable cases underwent radiotherapy or concurrent chemoradiotherapy. The chemotherapy regimen was CBDCA and paclitaxel combination. Although only radiotherapy cases showed a poor prognosis, chemoradiotherapy cases revealed a good response. Discussion: Pulmonary pleomorphic carcinoma is characterized by rapid growth, a peripheral site, invasion to the pleura or chest wall, and a poor prognosis. Pleomorphic carcinoma tends to occur in the upper lobe of the lung and peripheral regions. Almost all patients with pleomorphic carcinoma have a smoking habit. Therefore, pulmonary pleomorphic carcinoma may be associated with smoking. Patients with pulmonary pleomorphic carcinomas of stage I tend to show a longer survival than those with stage II or more. Although cases had undergone complete resection, disease recurrences occasionally occurred soon after the radical operation. Two cases showed a good response to concurrent chemoradiotherapy. This concurrent chemoradiotherapy is possibly an important part of the treatment strategy for pulmonary pleomorphic carcinoma. Conclusion: Pulmonary pleomorphic carcinoma has a poor prognosis. Early diagnosis and surgical treatment comprise the most effective therapy at this time. However, closely timed recurrences can occur even with a stage I pleomorphic carcinoma. Although many reports state that chemotherapy or radiotherapy is not effective, this report suggests that concurrent chemoradiotherapy (CBDCA+PAC) might be an effective treatment for pulmonary pleomorphic carcinoma.