Palliative re-irradiation for in-field recurrence after definitive radiotherapy in patients with primary lung cancer.

AIM: To evaluate the efficacy and toxicity of palliative re-irradiation for in-field recurrence of primary lung cancer after radiotherapy. PATIENTS AND METHODS: Forty-four patients with locally recurrent lung cancer after radiotherapy were retreated with external beam radiation therapy. To evaluate palliative effectiveness, 31 symptoms in 25 patients were analyzed, while all patients were analyzed to evaluate pulmonary toxicity. RESULTS: The median time between prior and secondary irradiation was 12.6 months. Prior radiation doses ranged from 50 to 70 Gy and retreatment ranged from 30 to 60 Gy. The median survival after re-irradiation was 6.5 months. After treatment 74% (23 out of 31) of the symptoms had improvement or complete resolution. After re-irradiation, acute Grade 2 and 3 pulmonary toxicity were recognized in 3 patients each. No significant factors were observed regarding pulmonary toxicity. CONCLUSION: Re-irradiation with moderate doses for recurrent lung cancer after definitive radiotherapy is promising in palliating the symptoms and shows acceptable toxicity.

[A case of hypersensitivity pneumonitis caused by inhalation of Mycobacterium avium from a home bath with a circulating water system].

A 26-year-old man presented with complaints of exertional dyspnea and cough. The patient has already been given corticosteroids at a previous hospital. Chest CT revealed small centrilobular nodules with diffuse ground-glass opacities in both lungs. Lung biopsy specimens at thoracoscopy revealed non-necrotizing granulomas, patchy foci of mononuclear cell infiltration and fibrous thickening of alveolar septa, and Masson's bodies in bronchioles. Sputum culture showed the growth of Mycobacterium avium complex (MAC). Culture of water from the bath tub of his home showed MAC. Administration of antituberculous drugs and corticosteroids, and avoidance of bathing at home resulted in the improvement of his symptoms and CT findings. We believe the case is hypersensitivity pneumonitis to MAC in an immunocompetent patient, simulating hot tub lung. Hypersensitivity pneumonitis caused by MAC is rare in Japan.

[Occluding spiral embolus for treatment of refractory pulmonary fistula].

A 57-year-old man was admitted for pulmonary emphysema. Volume-reduction-surgery (VRS) was performed. Three days later, after he coughed hard, the right lung collapsed. Although surgery was repeated, the air leakage continued. Air leakage was immediately reduced by means of bronchial embolization with a spiral embolus. We suggest that bronchial embolization with a spiral embolus causes little harm and is an effective treatment for refractory pulmonary fistula in poor-risk patients.