Laser endoscopic surgery has now achieved a status as effective treatment modality for lung cancer. Especially the effectiveness of photodynamic therapy (PDT) using Photofrin as a photosensitizer was demonstrated in our institution in 1980 for the treatment of lung cancers, and increasing attention has been focused on this new treatment technique. Over the past decade, 211 patients (253 lesions) with central type lung cancers have been treated in our hospital. Overall complete remission was obtained in 36.6% of the 92 lesions, significant remission in 62.2% and no remission was obtained in 1.2%. However, among 76 early stage lesions CR was obtained in 51 (67.1%) and 48 cases were disease free in 1 to 158 months. Other options of PDT are for advanced lesions for opening of bronchi and for preoperative laser irradiation for the propose of increasing operability and reducing the extent of operation.

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We developed a new applicator for endobronchial irradiation using ^<192>iridium thin wires and tested its clinical application in 21 cases of chest X-P negative lung cancer. The applicator could be advanced to the target bronchi in all cases, and the treatment had to be discontinued only 2 times. Recurrence was observed in 2 of the 21 cases. No complications of this tretment were observed. Endobronchial irradiation has been applicable only to larger bronchi by conventional techniques and has been used primarily as a palliative treatment. However, this applicator can be readily and selectively advanced up to subsegmental bronchi, and the spacers placed at its tip, where the radiation source is contained, improve the dose distribution. This technique is considered to be particularly useful for the treatment of early stage central type lung cancers.

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Endoscopic therapy for cancer that involves the tracheobronchial tree is currently available for two distinct types of lesion : radiographically occult superficial squamous cell carcinoma and advanced malignant tumors that cause severe airway obstruction. Photodynamic therapy, which uses a photosensitizing agent, is effective for managing early superficial cancer. Neodymium : yttrium-aluminum-garnet laser therapy has been effective in the palliative management of patients with advanced or recurrent malignant obstructive lesions, either alone or in combination with intraluminal radiation therapy (bronchoscopic brachytherapy). Most recently, endobronchial prosthetic devices (stents) have been used in patients with advanced airway obstruction. The use of each of these four modalities in the bronchoscopic management of lung cancer is reviewed.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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