Lobectomy or pneumonectomy is the standard operation for the treatment of lung cancer. But it will be difficult to apply to the patient with poor performance status. Segmentectomy or wedge resection may be an alternative procedure. However, high local recurrence rate has been reported in many studies. For this reason, pilot study about a combination therapy of wedge lung resection and postoperative radiation therapy was performed to confirm feasibility as a curative therapeutic modality.
Seven cases were studied who could not undergo standard lobectomy because of their poor pulmonary function or an advanced age. All of them had been confirmed to be a N0 stage using a CT scan preoperatively. Wedge lung resection was performed using an auto-suture technique or a manual suture. Complete lymph node dissection was performed in earlier cases, but this only confirmed N0-stage. One or two weeks after the surgery, radiation therapy over dose of 40 Gy was performed for an area, which include remnant lung around the resected cancer and the hilum. All of the patients were followed up over 5 years and their actual survival was evaluated.
Radiation-induced lung fibrosis was observed in all cases, but they could tolerate the procedure without a deterioration of performance status. All cases survived more than five years. Six of them were cancer-free. In one case, cancer recurred 3.5 years after the surgery. First manifestation was the pleuritis carcinomatosa. So it was strongly recommended to search for occult pleural dissemination by means of intrathoracic lavege cytology at the operation.
Combination with the postoperative radiation therapy was considered to be a tolerable and feasible procedure, preventing local recurrence after the limited surgery.
Improved prognosis is a desirable outcome for the patients.
M. Kaneda, None.