Bronchioloalveolar Carcinoma (BAC) and Lung Transplantation
There is no effective chemotherapy currently available for the diffuse stage of bronchioloalveolar carcinoma (BAC). A group of doctors at the University of Alabama Birmingham did a study on nine patients aged 31 to 58 with BAC and published their paper in 2002. BAC, while it is surely a cancer, tends not invade the rest of the body, but remains in the lung causing death by destruction of lung tissue. The hope is that by replacing the lungs all the cancer cells will be removed and the patient can survive this otherwise hopeless cancer. These nine patients had no hope of surviving without this procedure. Five of these patients had diffuse cancer in both right and left lungs. Four patients had previous surgery with recurrence in the remaining lung. Between 1993 and 1998, all 9 patients underwent transplantation. There were two single-lung and seven bilateral transplants. The procedure was repeated in two cases, in one single-lung transplant and one bilateral transplant. Two patients had mediastinal node metastasis at the time of transplantation, and one of these had a frankly invasive adenocarcinoma. Of the 8 patients with pure bronchioloalveolar carcinoma, six had recurrance of the cancer after transplantation. In two of these patients the tumor was localized and was surgically removed. Of these two one is alive 89 months after transplantation; the other died 82 months after transplantation. Four other patients had a return of their cancer and two died of progressive pulmonary failure. One of these had retransplantation with recurrence. A third patient died of cerebral edema shortly after bilateral retransplantation. The other patient is alive with recurrence 39 months after transplantation and has bronchiolitis obliterans (a destructive inflammatory disease). Two patients without recurrence are well with unrestricted performance levels 87 and 76 months after transplantation. The doctors concluded that lung transplantation produces a powerful palliative outcome in patients with advanced bronchioloalveolar carcinoma, but that the recurrence rate is high. If I read their report right, three of the original nine patients are still living. Transplantation for BAC remains controversial. Nevertheless it is being done in some selected cases, notably at the University of California Medical Center, San Francisco. Doctors are now performing PET scans on these patients and if cancer cells have escaped the lungs, transplantation surgery is withheld.
George L. Zorn, Jr, MDa, David C. McGiffin, MDa, K. Randall Young, Jr, MDb, C. Bruce Alexander, MDc, David Weill, MDb, James K. Kirklin, MD; J Thorac Cardiovasc Surg 2003;125:45-48