Background: Seventeen patients with (M0) non-small cell lung cancer (NSCLC) without distant metastasis were treated by preoperative endobronchial intratumoral chemotherapy (EITC) followed by surgery. Preoperative intratumoral chemotherapy was performed for the purpose of either reducing the extent of resection or increasing operability. Clinically, in the preliminary diagnostic bronchoscopic examination, the tumor was located in the main stem bronchus closer than 2 cm to the carina [T3] in 12 patients, or at the level of carina or bulging towards the trachea [T4] in 5 patients. In this series of patients, the tumors were originally inoperable due to the inability to achieve a negative margin by standard pneumonectomy techniques. However, EITC rendered resection possible.
Therapeutic methods: EITC consisted of direct injection of a maximum dose of 40 mg cisplatin in aqueous solution (4 mg/ml) into the tumor through a flexible bronchoscope; administered four times: once a week during a 3-week period (on days 1, 8, 15 and 22). Necrotic tumor debris was removed by piecemeal resection with forceps and suction at each session.
Results: In all patients, the bulk of tumor in the main bronchus was eliminated by the end of 3 weeks of EITC treatment. Post-EITC treatment bronchoscopy revealed that primary tumors originated in a lobe or segment without invasion of the mucous membrane of the major bronchus. EITC treatment reduced the extent of tumor such that inoperable tumors became operable. Patients could then undergo conventional surgery successfully without postoperative complications.
Conclusions: In this selected group of 17 patients, EITC was shown to be a safe, effective and easy to perform method for debulking of obstructed airways before surgery; without any important side effects or systemic drug toxicity. Because this type of obstructive lung cancer may lead to inappropriate initial diagnosis, we suggest that obstructive lung cancer patients such as described here, with a potentially a very favorable prognosis, should be considered a distinct clinical entity perhaps best described as "Early NSC Lung Cancer with polypoid growth in a major airway causing the erroneous impression of advanced disease".