Bronchioloalveolar carcinoma (BAC) has nonspecific clinical and roentgenographic presentations. We reviewed clinical manifestations, radiographic presentations, staging, treatments and survival of BAC.
The records of forty patients (pts.) diagnosed with BAC from January 1995 to June 2003 were reviewed for demographic data, smoking history, symptoms, radiographic presentations, diagnosis, staging, treatment and survival.
The mean age was 67.5 years, 62.5% were females. 75% were smokers. 45%were asymptomatic.(Table 1Clinical and Radiographic PresentationsPercentDyspnea30%Cough27.5%Hemoptysis12.5%Weight Loss12.5%Chest pain5%Non-resolving Pneumonia5%Bronchorrgea2.5%Fever2.5%Solitary Nodule/Mass65%Air bronchogram32.5%Multiple nodules22.5%Pneumonic consolidation12.5%Diffuse interstitial infiltrate5%Cavitary Mass7.5%Atelectasis2.5%Pleurale effusion2.5%Summarizes clinical and radiographic presentations). Preoperative staging showed: 30% stage I, 5% Stage II, 20% stage III and 42.5%stage IV. One pt. was lost to follow up before staging and treatment was initiated. 52.5% were treated surgically (stage I, II&IIIA), 50% underwent lobectomy, one patient had pneumonectomy. The 7 pts with stage IIIA received postoperative radiation (3 pts.) and postoperative radiation and chemotherapy(4 pts), the one pt with stage IIIB received radiation. The 17 pts with stage IV received chemotherapy (6 pts.), radiation (6 pts.), and both chemotherapy and radiation(5 pts). The overall one and two-year survival was 70%&47% respectively (median survival was 22 months). The one and two-year survival for stage I&II was 100%&84% respectively, it was 54%&26% for stage III&IV. The median survival for stage III&IV was 13 months. The overall one, two and three-year survival in pts whom tumor was completely resected was 86%, 64%&47% respectively (median survival was 32 months) it was 43%, 18%&9% respectively for pts who received palliative treatment (median survival was 5 months). The one and two-year survival were higher in asymptomatic than in symptomatic pts (94%&75% vs. 50%&23% respectively), and were higher in females than in males (78%&60% vs. 57%&12% respectively).(Figure 1shows Kaplan-Maier survival curve for pts with stage 1&II vs. III&IV).
The majority of patients have significant smoking history. females represented the majority of our patients. Most patients presented with a solitary mass. Bronchorrhea and air- bronchogram are specific for BAC.The staging, treatment and prognosis of BAC are similar to those with NSCLC.
BAC has nonspecific clinical and radiographic presentations.
R.A. Hamed, None.