Multimodality Therapy with Photodynamic Therapy, Sleeve Lobectomy and Proton Irradiation Curing a Central Type Bronchial Squamous Cell Carcinoma Spreading to the Tracheal Carina

DOI Open Access
  • Kobayashi Naohiro
    Department of General Thoracic Surgery, Tsukuba University Hospital
  • Goto Yukinobu
    Department of General Thoracic Surgery, Tsukuba University Hospital
  • Ishikawa Shigemi
    Department of General Thoracic Surgery, International University of Health and Welfare Hospital
  • Kitazawa Shinsuke
    Department of General Thoracic Surgery, Tsukuba University Hospital
  • Yamaoka Masatoshi
    Department of General Thoracic Surgery, Tsukuba University Hospital
  • Kikuchi Shinji
    Department of General Thoracic Surgery, Tsukuba University Hospital
  • Sato Yukio
    Department of General Thoracic Surgery, Tsukuba University Hospital

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Other Title
  • 気管分岐部へ進展する中心型扁平上皮癌に対して光線力学的治療，管状肺葉切除，陽子線治療で根治を得た1例

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Abstract

Background. A central type bronchial squamous cell carcinoma sometimes spreads along the bronchial wall to the tracheal carina, which requires complicated treatment-strategies for radical cure and preservation of pulmonary function. Case. A 58-year-old man had a medical checkup and abnormal of sputum cytology was detected. Bronchoscopy revealed nodular lesions on a membranous portion of the peripheral right main bronchus, and right B3a. Autofluorescence imaging showed an abnormal area on the tracheal carina, right main bronchus and truncus intermedius. Bronchial biopsies resulted in a pathological diagnosis of squamous cell carcinoma, and showed tumor invasion to the tracheal carina, orifice of the left main bronchus and truncus intermedius. Photodynamic therapy (PDT) of the tracheal carina, and the orifice of the left main bronchus and truncus intermedius was undergone. One month after PDT, right sleeve upper lobectomy was performed. Because cancer cells remained at both bronchial resected margins, proton irradiation was added one month after surgery instead of additional bronchial resection. Then, he had a careful checkup and was alive for seven years without cancer recurrence. Conclusion. Multimodality therapy with PDT, sleeve lobectomy and proton irradiation was performed for bronchial squamous cell carcinoma spreading to the tracheal carina, which could lead to radical cure of tumor, preservation of the right middle and lower lobe. A good clinical course without severe complications was obtained.

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