Purpose
To determine the role of lung transplantation in the treatment of patients presenting with
bronchogenic carcinoma and end-stage lung disease.
Methods
An international survey was conducted to determine the outcome of patients with bronchogenic
carcinoma in the explanted lung at the time of transplantation. A group of 69 patients
was collected from 33 centers.
Results
Twenty-six patients underwent 29 lung transplantations for advanced multifocal bronchioloalveolar
carcinoma (BAC) as the primary indication for transplantation, and 13 developed a
recurrence, with an overall 5-year actuarial survival of 39%. Incidental bronchogenic
carcinomas classified as stage I (n 22), II (n 12), and III (n 2), or as incidental multifocal
BAC (n 7), were found in the explanted lung of the remaining 43 patients. The 5-year
actuarial survival was 51% in patients with stage I carcinomas, and was significantly better
than for patients with stage II and III carcinomas (survival of 14%) or with incidental
multifocal BAC (survival of 23%). Time from transplantation to recurrence and from
recurrence to death was significantly longer in patients with multifocal BAC than in patients
with other types of bronchogenic carcinoma. In addition, the site of recurrence was limited
to the transplanted lung in 88% of the patients with multifocal BAC, whereas it was always
widespread in patients with other types of bronchogenic carcinoma.
Conclusion
This study demonstrates that long-term survival can be achieved after lung transplantation in
patients with stage I bronchogenic carcinoma or with advanced multifocal BAC.