Spontaneous Regression of Bronchogenic Carcinoma with Five-Year Survival

Abstract

A case history of spontaneous regression of bronchogenic carcinoma for a 5-year period is presented. The patient, a middle-aged male, with the lesion (grade 3, epidermoid) proved inoperable at thoracotomy, showed complete radiologic disappearance of this lesion in the following 6 months. The only factors of possible influence were 2 weeks of postoperative fever coincident with a noncancerocidal amount of irradiation of 1,200 roentgens. This is the first recorded case of complete regression of bronchogenic carcinoma that we can locate in the literature. Of the many factors thought to be partially responsible for instances of tumor regressions reported in the literature, only two, fever and x-radiation, are pertinent in this case. Our patient developed a fever of 100°F. on the fifth postoperative day which persisted for one week and reached 102°F. at one point. After 2 days of normal temperature there was a sudden rise to a high of 103.2° and 102°F. the next day. Penicillin was started at this point and subsequently he became afebrile. The only clinical explanation for this was a possible transient pneumonitis without any specific organism in the sputum culture. In retrospect, the patient believed that he had had intermittent fever and occasional chills for the first month or two after returning home. The second factor of possible therapeutic importance is the effect of radiation. Currently recommended dosage for the average patient with cancer of the lung varies from 4,000 to 6,500 roentgens. Irradiation in the range of 1,200 roentgens is believed by radiotherapists to be an inadequate or noncancerocidal tumor dose. The patient showed essentially no change in the chest lesion while on x-ray therapy. The remarkable clearing of the film occurred sometime in the 6 month interval following discharge. It should be noted that irradiation was given to this patient while he was febrile. Whether or not the fever and radiation were synergistic in effecting an immune response remains to be determined.

Case Details

Personal Characteristics

A 37-year-old white man, j. M., was admitted to the seattle veterans administration hospital on february 27, 1959. He complained of exertional dyspnea for the previous 6 months which had progressed rapidly in the month before admission and was associated with left subscapular pain. History revealed he had consulted his local physician for a chill 3 weeks prior to hospitalization. A diagnosis of pleural effusion secondary to possible pneumonia had been made at that time. The patient had been treated for chronic duodenal ulcer subsequently which had required gastric surgery 3 years before the present illness. Since the latter operation he had had no gastrointestinal complaints and was able to perform his daily work. The patient had smoked one to one and one-half packs of cigarettes daily since the age of 17 (30 pack years).

Clinical Characteristics

Physical examination revealed a well-developed middle-aged male. Other than dullness and decreased breath sounds in the left upper and mid-lung fields, the examination was within normal limits. Laboratory data revealed a hematocrit of 41 and white blood count of 23,600 which subsequently decreased to 10,200. Serologic tests were negative. Alkaline phosphatase was 6.3 units. Multiple sputum cultures revealed normal flora. The plasma protein electrophoretic pattern was normal. Urine and blood cultures were negative. The patient’s blood type was a-rh negative. The admission chest film was interpreted as showing large tumor masses distributed peripherally in the left upper thorax associated with pleural effusion.

Remission Characteristics

A chest film made at this time revealed essentially complete clearing of the tumor opacities present upon discharge. This amazing change in the x-ray study was correlated with a weight gain of 40 pounds and the complete absence of chest complaints.

Treatment & Mechanisms

Proposed Remission Mechanisms

The only factors of possible influence were 2 weeks of postoperative fever coincident with a noncancerocidal amount of irradiation of 1,200 roentgens. Whether or not the fever and radiation were synergistic in effecting an immune response remains to be determined.

Clinical Treatment

Radiation was begun to the upper half of the posterior left chest on march 13, 1959, and 2,100 roentgens measured in air were given to a field measuring 15 x 18 centimeters over a period of 13 days. On march 26, 1959, an anterior portal 14 x 14 centimeters in the same area was started and 1,500 roentgens in air was given in 6 days.

Non-Clinical Treatment

While at home the patient, WHO was fully aware of his disease and anticipated prognosis, states he learned that many patients WHO die of cancer literally starve to death. He subsequently developed a positive attitude toward survival and literally forcefed himself at every opportunity. He volunteered to do manual labor on a farm to be in the outdoors. During the subsequent 2 to 3 months he slowly gained weight and developed increasing strength and well-being.