Lung cancer with Aspergillus: how should it be treated?

Chihiro Nishio,1 Yasuharu Nakahara,1 Yoshiro Mochiduki,1 Tetsuji Kawamura,1 Shin Sasaki.1

Author address: 

1Internal Medicine, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan


Purpose and Methods In the diagnosing procedures for lung cancer, we detected both malignant cells and Aspergillus simultaneously at the pulmonary lesion in five cases out of the 821 lung cancer patients (0.6%) from January 2000 to March 2003. Treatment recommendations are difficult in this setting, because it is quite rare and the literature consists of single case reports. We reivewed such cases to know the proper treatment for them. Results Previous case reports showed that sixteen of 21 cases were surgically operated without any complication due to aspergillus, three were treated by radiotherapy, and none by chemotherapy. Of the three who had radiotherapy, one was complicated with empyema and one died of respiratory failure just after radiotherapy. Of our five cases, one whose clinical stage was T2N2M0 underwent an operation followed by radiotherapy and plutinum based chemotherapy, one was treated by Gefitinib whose clinical stage T2N3M1, one by plutinum based chemotherapy whose clinical stage T2N2M1, and two by best supporting therapy whose clinical stage T1N0M0 and T2N3M1. Antifungal drug was administrated to only one patient who was treated by Gefitinib, but no exacerbation of Aspergillus infection was seen in any patients. All but one who was treated by plutinum based chemotherapy without any antifungal drug died of lung cancer. Conclusion. Operation was thought to be the best treatment for the lung cancer with Aspergillus if possible, while chemotherapy could be done with caution. Radiotherapy should be avoided.

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Full conference title: 

15th European Respiratory Society annual conference
    • ERS 15th (2005)