Thirty-six autopsied cases of small cell carcinoma of the lung were examined clinicopathologically. Thirty-two cases were male, four were female and their ages peaked in the seventh decade. The frequency of metastases to other organs was highest in the liver (52.8%), followed by the brain (47.1%), adrenal gland (36.1%), pancreas (25%), bone (25%). Metastases to pulmonary hilar lymph nodes was seen in 66.7% of cases and to retroperitoneal lymph nodes in 55.6%. Pathological findings of the primary site following chemotherapy and/or radiation showed no tumor cells in nine of 30 treated cases and fibrotic scars were seen in six of the nine cases. Bilateral interstitial pneumonitis was the cause of death of seven of the 30 cases. Pneumocystis carinii pneumonia and generalized candidasis, generally unusual complications in lung cancer, were found in our cases. Other complications consisting of ten cases of bronchopneumonia, eight of peptic ulcer and four of other cancer were also recognized.

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The effects of radiotherapy in 256 cases of inoperable non-small cell carcinoma of the lung were analyzed.
The results and conclusion are;
1) Survival rate of all 256 cases was 1 year in 74/256 (28.9%), 2 years 15/229 (6.6%), 3 years 5/202 (2.5%) and the median survival was 5.9 months.
2) As stage advances, the survival rate generally decreased. There were no differences of the survival rates of squamous cell carcinoma and adenocarcinoma, and the survival rate of large cell carcinoma was the worst. Furthermore, according to the irradiation dose, survival in cases that received irradiation of over 5000 rad was higher than in cases receiving under 5000 rad. The higher irradiation dose gave the increased tumor effect and it considered as one reason for better survival.
3) Curability was obtained in stage I cases with irradiation of over 6000 rad, however it was rather poor in stage II. Extension of survival term was considered possible by aggressive radiotherapy of local advanced squamous cell carcinoma.
4) Increased radiotherapeutic effects can be obtained by the combined use of bronchial arterial infusion, with possible extension of survival.

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In a period of 16 years, 8 cases of pleural mesothelioma were seen in Nakano National Chest Hospital. Seven were malignant diffuse and one was benign localized mesothelioma. One patient had a history of definite occupational exposure to asbestos, one had history of probable exposure to asbestos and one patient had a history of injection of Thorotrast into the pleural cavity thirty years ago. The benign localized case had a symptom of hypoglycemic coma and after resection of this tumor that symptcm disappeared. These eight cases, were histologically classified as 1. epithelial (papillary, tubular and solid), 2. atypical epithelial, 3. mesenchymal a. benign fibromatous b. sarcomatous, 4. biphasic. In the biphasic area in this tumor we recognized transition between epithelial cells and mesenchymal cells. This observation supports the concept that mesothelial cells can differentiate into two types of cells, epithelial and mesenchymal.

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This paper describes a statistical analysis concerning a confidence interval for median survival time for 498 male carcinomas of the lung in the presence of rightcensored observations. The cases analyzed were a part of the data from the fourth clinical trial involving 2, 493 cases of lung cancer carried out by the Lung Cancer Task Force Japan Joint Committee on TNM Classification (1978).
Brookmyer & Crowley's stastical methods were used for estimating median survival time and the length of the nonparametric confidence interval. The analytical result in the illustrative data showed that the median survival time was 26.2 months and the length of the nonparametric confidence interval was [23-24] months.

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The effect of bronchial arterial infusion (BAI), used in combined therapeutical trials was evaluated in terms of prolonging the survival of inoperable patients with advanced non-small cell lung cancer. A group of 37 cases receiving treatment consisting of BAI and systemic chemotherapy showed better survival periods than 62 cases treated with systemic chemotherapy alone (p<0.01). There was no significant difference in the survival time of 35 cases treated with a combination of BAI, systemic chemotherapy and radiotherapy, and 62 cases treated with a combination of systemic chemotherapy and radiotherapy. Severe side effects were not observed in the BAI groups

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Thirty-four patients with small cell carcinoma of the lung were treated with a program involving the alternation of two potentially non-cross-resistant combination chemotherapies. All patients received an initial combination of cyclophosphamide, vincristine, methotrexate, and procarbazine (COMP), alternating every four weeks with a combination of VP-16-213, adriamycin, and ACNU (VAN). Eighteen patients had limited disease (LD) and 16 had extensive disease (ED). Of 34 patients, 29 (86%) responded to the therapy with 13 (38%) complete remissions (CR) and 16 (47%) partial remissions (PR). CR rate was 39% for LD, and 37% for ED.The median survival time was 12.5 months for LD patients and 11 months for ED patients. Patients in the CR category lived significantly longer than those in PR or in no remission. Myelosuppression was a major toxic factor; leukocytopenia (<2, 000/μl) occurred in 35% during COMP and in 68% during VAN, and thrombocytopenia (<50, 000/μl) occurred in 6% during COMP and in 15% during VAN. Although this protocol didnot present clear evidence of the delay of onset of drug resistance, the alternating combination chemotherapy demonstrated an obvious improvement over our previous four-drug combination (COMP) in terms of response rate as well as patient survival.

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During the past few years there has been a trend towards tissue preserving surgery in the treatment of lung cancer. Eight cases of bronchogenic carcinomas which underwent angioplastic procedures of the pulmonary artery were reported.
We believe the angioplastic procedure, similar to the bronchoplastic procedure, is a useful operative method in regard to preserving normal lung tissue, particularly in patients with advanced age and/or limited respiratory reserves. With this procedure we can avoid pneumonectomy and give patients good quality of postoperative life.
However in respect to the angioplastic procedure we must take care concerning the following items.
1. Infection may cause rupture or stenosis at the site of anastomosis.
2. It is important to avoid causing stenosis at the suture line of the pulmonary artery.
3. Since the lung has dual adjacent components, vessels and bronchi, sleeve resection of the pulmonary artery is limited in length. In these cases replacement with artificial graft such as Gore-Tex may be useful.
4. During the operative procedure the main pulmonary artery and/or bronchus are completely occluded, hence the risk of acute pulmonary edema in the remaining lung increases in operative procedures requiring extended time.

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Two cases of primary lung cancer, one squamous cell carcinoma and one adenocarcinoma, showing characteristic hypertrophic osteoarthropathy were presented. There were no remarkable changes in hormonal investigation preoperatively.
So far in the Japanese literature 43 cases have been reported, but they did not reveal any significant clue to elucidate this phenomen associated with lung cancer.

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In the treatment of lung cancer, the Nd-YAG laser has been used palliatively for the purpose of widening the trachea or major bronchi. Here we report a case of lung cancer treated curatively with the Nd-YAG laser.
The tumor was squamous cell carcinoma located in the orifice of left B¹⁰. It was thought to be early invasive lung cancer and 12 × 0.5 second shots of 50W power were administered to eradicate the tumor.
Left lower lobectomy and mediastinal lymph node dissection was performed 10 days after Nd-YAG laser irradiation. No cancer cells and disappearance of thesmooth muscle layer and re-epithelization could be seen in the portion irradiated.
However, residual carcinoma in situ nests were observed in B¹⁰ and B⁹ in portion that were not readily accessable to the laser beam.
The findings of this case showed that Nd-YAG laser irradiation can obtain eradication of malignant tissue in areas accessable to the laser beam and suggest that varied irradiation approaches (such as combination of conventional high-energy Nd-YAG laser irradiation for protruding tumors with continuous low-power Nd-YAG irradiation or photoactivated tumoricidal agents and suitable laser light sources) may hold great promise in the endoscopic treatment of cancer of various canalicular organs.

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A 74 year-old male, who had undergone sleeve lobectomy of the left lower lobe for stage 1 squamous cell carcinoma, was readmitted to our hospital 2 years and 10 months later because of endotracheal tumor with dyspnea. At bronchoscopy a mass approximately 5 cm in length in the right tracheal wall, was seen to extend to within less than 1 cm of the carina. It was suggested that the tumor mass was due to multiple primary cancer in this patient.
⁶⁰CO radiation followed by local injection of 10 mg of BLM were carried out after construction of a tracheal window and intubation during the early period of the treatment. The mass showed remarkable regression after these treatments.
We reported this case because of interest in postoperative cancer recurrence and devices for treatment other than conventional surgical therapy.

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Three cases of small cell carcinoma of the lung which had undergone combined treatment with radiotherapy and chemotherapy were readmitted to this hospital with increasing, severe, but not localized pain in the lumbar region within 2, 3 and 18 months of completion of treatment. The roentgenograms of the lumbar supine and ^99mTcphosphate bone scan showed no signs of metastases in all cases. Gallium 67 scan in cases 2 and 3, and computed tomography (CT) in case 3 revealed signs of metastases in the abdomen, but of these studies, CT findings were most useful to detect the presence of metastatic masses in the retroperitoneal spaces. The pain in the lumbar region was referred pain due to the lymph node metastases to the retroperitoneal spaces.

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Three carcinoid tumors of the lung with unusual histological morphology, having electron dense granules, are reported. The tumors showed a variety of histological patterns, such as rosette formation, papillary and oncocytic features. The histological patterns are discussed.

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