Lung cancer in patients who had received thoracoplasty for pulmonary tuberculosis

Background: In Japan in the 1950s, thoracoplasty was a powerful therapy for pulmonary tuberculosis. Now there are many aged people who have tuberculos is sequelae caused by thoracoplasty. We have encountered some cases of lung cancer among these people. Methods: To elucidate the features of lung cancer occurring after thoracopl asty for pulmonary tuberculosis, we reviewed for analysis 20 such cases. Results: There were 17 men and three women, aged 55 to 78 years (mean 65 ye ars). AII had respiratory dysfunction and most were cigarette smokers. Lung cancers were located in the upper lobes in nine cases, in the middle lobe in one and in the lower lobes in 10. Ten lung cancers were in the thoracopl astied lung and the remaining 10 in the opposite lung. Histologically, squa mous cell carcinoma was predominant (11 cases). Eight lung cancers were det ected in stages I and II and 12 in stages ill and IV. Most cancer lesions w ere separate from tuberculosis lesions. Surgical resection was selected in only three of 11 stages I-IIIA cases in consideration of respiratory dysfun ction and/or ventilatory impairment due to thoracoplasty. Chemotherapy and/ or radiotherapy were performed in nine and supportive care alone was perfor med in eight. Fourteen patients died of lung cancer and four died of cor pu lmonale due to tuberculosis sequelae. Five-year survival was achieved in on ly one surgical case. Eight of the nine patients who received chemotherapy or radiotherapy died within 1 year, and, further, seven of eight patients w ho received supportive care died within 6 months. Conclusion: Lung cancer in the patients who had received thoracoplasty occu rred in each lung and every lobe, independent of thoracoplasty. In addition , delay of detection was such that stage Ill-IV cases were in the majority, there were some limitations in therapeutic benefits related to thoracoplas ty and the prognosis was very poor. Physicians should avoid delay in the de tection of lung cancer through careful follow-up of such patients.