RPAH Medical Centre
Newtown, New South Wales, Australia
Correspondence to: David J. Barnes, MBBS, FCCP, Respiratory and Sleep Physician, RPAH Medical Centre, Suite 413, 100 Carillon Ave, Newtown, New South Wales 2042; e-mail: firstname.lastname@example.org
To The Editor:
Osaki and colleagues (May 1999)1have recently
reported their experience with bronchial arterial infusion (BAI) of
chemotherapy in centrally located early stage lung cancer. They report
prolonged disease-free survival in six of seven patients treated in
this manner, with one patient dying of massive hemoptysis 3 months
after BAI. While this is an interesting pilot study, there are a number
of questions raised by this report, mainly related to patient
selection. Four patients had a single carcinoma in situ
lesion (stage 0), while the remaining three patients had a carcinoma
in situ lesion in addition to a latter stage carcinoma (T2,
T3, or T4). All isolated carcinoma in situ lesions
seem to have been diagnosed on sputum cytology alone. It is not clear
in the report whether those with isolated in situ lesions
were symptomatic or whether the cytology was done as part of a
screening program for high-risk individuals. No mention is made of
bronchial biopsies, and it is therefore assumed that the diagnosis was
made on cytology alone. Most would agree that this pathologic diagnosis
is difficult to make on cytology alone and usually requires bronchial
A beneficial effect of BAI on survival cannot be assumed from
this pilot study. In the first instance, all invasive carcinomas were
managed by appropriate surgical resection. Secondly, the prognosis of
carcinoma in situ lesions of the bronchus is generally very
good. The finding of carcinoma in situ at the bronchial
margin after resection for bronchogenic carcinoma has been shown to
have no adverse effect on survival, suggesting an inherently good
prognosis for in situ lesions.3–5 Future
studies of BAI would therefore require inclusion of patients other than
those with stage 0 disease.
Patients with carcinoma in situ may not require active
therapeutic intervention, given the absence of any adverse impact on
survival when this pathology is present.
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