협대역영상으로 조기발견하여 광역동치료를 한 동시다발성 폐암 1예
A case of early-detected synchronous lung cancer by narrow-band imaging treated with photodynamic therapy
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초록
기관지 내에 국한되고 내시경적으로 접근이 가능한 폐암으로 기관지경을 이용한 PDT는 수술적인 치료가 어려운 경우 대안으로 자리잡을 수 있다. NBI는 기존의 기관지경으로 보아서는 악성변화가 뚜렷하지 않은 병변을 발견하는데 있어 우수한 것으로 보인다. 저자들은 식도암에 동반한 다발성의 초기의 비소세포성 폐암을 수술과 더불어 PDT로 효과적으로 치료하였고, 경과관찰하던 중에 NBI로 발견된 또 다른 초기의 비세소포성 폐암을 다시 PDT로 성공적인 치료를 하였다. 앞으로 NBI뿐만 아니라 AF 기관지경, EBUS 등을 이용하여 폐암을 비롯한 기관지 내의 병변에 대한 중재술에 대해 활발한 연구 및 다양한 시도가 필요할 것이다.
Abstract
Surgical resection is the treatement of choice for early stage lung cancer. However, it is hazardous for patients with poor pulmonary function, multifocal endobronchial lesions, a previous history of major lung resection, or an important comorbidity. Under such circumstances, bronchoscopic photodynamic therapy could be considered as a treatment option for patients whose tumors are centrally located and bronchoscopically visible and accessible. We present a patient with radiologically occult synchronous non-small cell lung cancer accompanied by esophageal cancer. The esophageal cancer and a tumor in the right lower lobe were surgically removed, and a carcinoma in situ in the left upper lobe was treated with bronchoscopic photodynamic therapy. Nine months later, another tumor was detected in the right middle lobe by narrow-band imaging. The tumor was treated by photodynamic therapy again. In this case, narrow-band imaging played a crucial role in the diagnosis, and photodynamic therapy ensured complete application of the treatment.
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