The Journal of the Japan Society for Respiratory Endoscopy

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There has been a dramatic expansion in the role of the bronchoscope as a therapeutic instrument, "Interventional Bronchology", not only for advance bronchogenic carcinoma but also for early cancer. There is now considerable interest in the potential of PDT for treating early bronchial carcinoma. Similarly laser light can be used to detect tumors by fluorescence at an early, and therefore more treatable stage, when they may elude routine bronchoscopy. The total number of early stage lung cancer cases was 107 consisting of 126 lesions, and complete remission was obtained in 85 cases (107 lesions) out of 103 cases (126 lesions, 84.9%) and partial remission in 19 lesions. Eighty patients (98 lesions) were disease free from 2 to 200 months, however, 5 patients died with lung cancer. The survival curve was calculated by the Kaplan and Meier method. The overall survival rate is 68.3%. PDD is another aspect of photodynamic reaction. The effectiveness of a new excimer laser endoscopic imaging fluorescence analyzer system using the photosensitizer for the detection of tumors was evaluated. Autofluorescence (550±10nm, green fluorescence) from normal sites, red fluorescence (670 nm) of chlorine e6 in areas of cancer and the red fluorescence/green fluorescence ratio (R/G ratio) as the color image can be detected respectively. The greatest chlorine e6 fluorescence from the lesion was obtained at 3 hour after injection and the fluorescence disappeared at 24 hours. The greatest difference in the fluorescence of chlorine e6 and the R/G ratio in areas of tumor and in normal areas were observed at 5 hours after administration. At this period, chlorine e6 fluorescence from normal sites was negligible. These data suggest that fluorescence photodiagnosis may effective in the detection of cancers.

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We inserted Dumon stents in 35 patients with malignant tracheobronchial stenoses. The outcomes of stenting in three groups of patients were analyzed. Group A consisted of 12 patients received no further treatment after stenting (definite stenting). In group B, twelve patients received radio and/or chemotherapy after stent placement and stents remained in place during follow-up (definite stenting). And in eleven patients in group C, stents were removed after radio/chemotherapy (temporary stenting). Immediate relief of dyspnea was achieved in 89% of patients. Patients in group C, having the stent removed after radio and/or chemotherapy showed the best survival characteristics. The median survival time after stent placement of patients in groups A, B, and C was 4, 6, and 12 months, respectively. A significant difference in survival was found among the three groups (p=0.0235). Stenting is effective for the immediate and lasting relief of symptoms in patients with severe malignant obstruction of major airways. Especially in patients who received temporary stenting, stenting combined with successful treatment such as radio/chemotherapy gave a meaningful and significant improvement of quality of life with prolonged survival.

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