The results of a total of 118 cases of inoperable or unresectable lung cancer, which received radical radiotherapy were analyzed.
1) Of the 118 cases 53/118 survived one year (44.9%), 20/115 survived two years (17.4%) and 6/100 survived three years (6.0%) and the median survival was 10.8 months. Eleven cases (9.3%) are still alive with no evidence of recurrence for periods offrom one year and 10 months to 10 years.
2) As the stage advanced, the survival rate generally decreased. There was no significant difference in the survival rates of small cell carcinoma, squamous cell carcinoma and adenocarcinoma, but the survival rate of large cell carcinoma was the worst.
3) Extension of survival was obtained by combining radiotherapy with chemotherapy, especially in small cell carcinoma.
4) The response to therapy was better in small cell carcinoma than in non-small cell carcinoma. A close correlation between the response rate and prognosis was observed. Therefore, it is necessary to obtain complete response by combined treatment with chemotherapy in small cell carcinoma to improve the survival rate, and to obtain partial response or better in non-small cell carcinoma.
5) Radiation therapy may be considered as one of the methods of radical treatment for carcinoma of the lung.

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Female F-344 rats, (50 animals) received intragastric administration of N-nitrosoheptamethyleneimine (NHMI) 3 times a week, for 10 weeks. The cumulative doses were 150, 300 or 600 mg/kg body weight. Various types of tumors developed in the nasal mucosa, trachea, lung and/or esophagus. In the lowest dose group, no malignant tumor was observed. Lung adenomas were common but few tumors developed in the nasal mucosa, trachea or esophagus. In the other two groups, malignant tumors were common. The histological types of tumors in the two groups differed slightly, especially in the nasal mucosa. Neuroblastoma were popular in 300 mg/kg group but squamous cell carcinomas were more common in the highest dose group. Only 1 tracheal tumor was observed in this experiment.
The relationship of cumulative doses of NHMI to the types of tumor and target organs was reported. The influence of the administration schedule on carcinogenicity was also discussed in comparison with the previous findings of Taylor and one of the authors (P.N.)

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Twenty three primary lung cancer cases (5 small cell carcinoma, 16 adenocarcinoma and 2 squamous cell carcinoma) were treated with intermediate dose (500mg./body) Methotrexate therapy (ID-MTX). Fourteen patients were previously treated with intensive polychemotherapy containing conventional doses of MTX. 500mg of MTX dissolved in 500m1 of 4.3% glucose in a balanced salt solution (Solita T3) wasgiven by drip infusion over 6 hours, and followed by continuous infusion of 2500m1 of Solita T3 over 18 hours.
Eighteen hours after completion of MTX infusion, 15mg. of Leucovorin (LV) was administered intravenously. Thereafter, 15mg of LV was administered 12 times orally every 6 hours.
About a half of the patients received only one course of ID-MTX (mean 1.6). Doses of LV were the same as reported by Frei. et al., and this dose of LV might be overdoses for our ID-MTX therapy. In spite of these unfavorable conditions for the effects of MTX, 2PR an 1 MR were obtained in 14 evaluable adenocarcinoma patients. Toxicity was very low in the majority of patients. Myelosuppression, hepatic and renal dysfunc tion due to MTX appeared in only 4 patients who had pleural effusion or chronic hepatitis. These results suggest the safety and effectiveness of ID-MTX as chemotherapy for lung cancer under suitable conditions.

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Ten cases of double cancers (8.1%) were detected out of 124 curatively resected Stage I lung cancer cases, including early stage cases.
All except one of the second cancers were detected after resection (Stomach 3, Lung 2, Colon 1, Liver 1, Uterus 1, Larynx 1, Leukemia 1). Thereafter, a screening program has been established for detecting second cancers at an early stage, especially gastric cancer, lung cancer and colon cancer. Five second cancers (stomach 1, lung 3, breast cancer 1) were detected, in addition to other diseases.

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A regrowth assay method for many in vitro anticancer agent sensitivity tests was examined using established human lung cancer cell lines. It was demonstrated experimentally that it precisely reflected the division delay of the cells exposed to anticanceragents. As most sensitivity tests do not sufficiently allow for the fact that cancer cells have different sensitivities in each phase of the cell cycle, we have devised a new method of measuring the total cell-kill concentration which makes it possible to disregard these differences. The sensitivities of two established human lung cancer cell lines (QG56 and QG90) to Mitomycin-C and Adriamycin were measured by our method. Mitomycin-C had cell cycle phase specificity, and could not yield total-cell-kill even at the high concentration of 15mcg/ml. On the other hand, Adriamycin showed cell cycle phase nonspecificity, and yielded total-cell-kill at a concentration of 10mcg/ml. However the concentration of 10mcg/ml is much higher than the clinically attainable concentration in human serum.

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Pre-treatment clinical T and N evaluations were compared with post-surgical histopathological findings in 330 cases that underwent thoracotomy. Routine diagnosticmethods for the preoperative evaluation of T and N factors included clinical symptoms, physical findings, radiological examination, bronchoscopy, pulmonary arteriography, bronchial arteriography and gallium scanning were used. Recently 66 cases were evaluated by computed tomography (CT) in addition to the above routine diagnostic procedures. The results were as follows:
1) Correct estimation rates of the T and N factors in the 330 cases were 79.7% and 61.8%, respectively. 2) Most cases of mistaken evaluation were concerned with T factor in relation to invasion to adjacent organs, and also with N factor regarding over-and under-estimation of mediastinal lymphadenopathy. 3) Frequent incorrect estimation of the N factor was due mainly to over-estimation of reactive lymph node swelling often observed in squamous cell carcinoma cases or under-estimation of intranodal metastasis without node swelling, frequently noticed in adenocarcinoma cases. 4) The correct estimation rates of the 66 cases evaluated by CT were 77.3% for T factor and 63.6% for N factor, showing no apparent improvement of evaluation accuracy in comparison with that evaluated by routine examinations. This was mainly caused by the fact that the CT induced over-estimation of the T and N factors even if the rate of under-estimation was diminished. However, cases with T3 and N2 diseases showed improvement of evaluation accuracy by the aid of the CT, owing to the improvement of sensitivity and the predictive value of negative test results, compared to evaluation without CT examination.

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A total of 88 patients with brain metastases from bronchogenic carcinoma were treated by whole brain irradiation between 1972-1981 at National Kyushu Cancer Center.Diagnosis of brain metastases was established in 48 patients by brain CT scan and in 40 patients by brain RI scan.The incidence of brain metastases by histologic type was 13% in adenocarcinoma, 17% in large cell carcinoma, 10% in small cell carcinoma, and 4% in squamous cell carcinoma. The incidence of brain metastases of squamous cell carcinoma was significantly lower than that of the other types.
Of 88 patients with brain metastases, 78 presented with one or more signs and symptoms, but 10 had no neurological complaints. The most common symptoms or signs were headache (55%), nausea and/or vomiting (33%), hemiparesis (31%), and impaired cognitive function (15%).
In 48 patients who were diagnosed by CT scan, 23 had multiple metastases.Sixtytwo patients were treated by whole brain irradiation with doses of more than 40 Gy, following which the improvement of neurological complaints was demonstrated in 88% of the 59 patients, and complete regression was obtained in 30% of 20 patients who were evaluated by CT scan.The median survival of the irradiated patients was 8 months, and it was longer (14 months) when the patients had controlled primary sites and had no other metastatic lesions apart from the brain.

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Nineteen cases of Squamous cell carcinoma in the periphery of the lung were examined cytologically and histologically. Their roentgenological findings were also analyzed. From the cytological and histological characteristics, they were classified into the following four types: 1) keratotic cell type, 2) basal cell type, 3) large cell type, and 4) small cell type.
Keratotic cell and basal cell types showed a clear tumor boundary with broad and shallow notches. Small cell types had many deep notches and were not surrounded by rough cord-shaped shadows. Since tumors of the large cell type had ill-defined tumor edges and rarely showed large notches, the chest X-ray shadows showed much variety. In terms of hematogenous metastasis, large cell and small cell carcinoma seem to be more malignant than keratotic cell and basal cell types. The histogenesis and growth process of these four types and the pattern of necrosis and fibrosis were also discussed.

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From 1972 to 1981, 282 patients with stage III carcinoma of the lung were treated at our institution. The condition of 113 was considered inoperable at diagnosis. Surgery was performed in the remaining 169 patients, of which 51 underwent curative resection, 64 noncurative resection and 54 exploratory thoracotomy. The majority of patients who underwent surgical resection received chemotherapy or radiotherapy or combined radiotherapy and chemotherapy as postoperative adjuvant treatment. We analyzed the survival rate in patients with resected stage III carcinoma according to surgical curability, TN subsets and cell types and compared survival with that of nonresectable patients.
1) The survival rate for all resected patients was 18.3% at 3 years and 11.3% at 5 years. In curative resection, the survival rate was 40.8% at 3 years and 30.6% at 5 years. On the other hand, the survival rate in patients with noncurative resection was markedly poor, resulting in 6.7% at 3 years and 0% at 5 years with a median survival time (MST) of 14 months. The MST in this group was similar to that in patients with exploratory thoracotomy (MST, 12 months) and inoperable carcinoma (MST, 13 months).
2) In patients with complete resection, the 5-year survival for T₃ N_0-1 disease was better than that for T_1-2 N₂ disease (47.7% vs 24.7%). The survival for T₃ N₂ disease, however, was disastrous and all patients died within 2 years after surgery. In patients with noncurative resection, the MST of 28 months for T3 No.1 disease was superior to that of patients with mediastinal lymph node metastases.
3) The 5-year survival for squamous cell carcinoma was better than that for adenocarcinoma (39.6% vs 21.8%). However, this tendency was observed only in patients with complete resection.
In conclusion, we consider that radical lung resection can be indicated in stage III carcinoma if curative resection is expected. However, for patients with T₃ N₂ disease, we cannot expect long-term survival even if the tumor is resected completely.

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Two patients with lung cancer presented with a first manifestation of pneumothorax. The yunderwent right upper lobectomy.Histologically, Case was adenocarcinoma, Case 2 was large cell carcinoma. In. the secondcase, invasion of the hypertrophied visceral pleura was recognized. The cause of pneumothorax was thought to bedirect invasion of the pleura.

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A 60 year-old man was admitted to our hospital complaining of bloody sputum. He was a heavy smoker with a Brinkman Index of 1200. Chest roentgenogram was normal, but fiberoptic bronchoscopy revealed two small tumors in bilateral bronchi, one at the orifice of right B⁶, the other at the bifurcation of the left lingular and the upper division bronchi. Several biopsies demonstrated them to be squamous cell carcinoma, and a diagnosis of synchronous bilateral central type early stage bronchogenic carcinoma was made. After YAG laser irradiation and bronchial arterial infusion (BAI) with MMC, right S⁶ segmentectomy and the wedge resection of the lower bronchus were performed. The resected specimen revealed that the tumor was localized within the bronchial wall, with no metastasis. Further therapy was not done, as the left tumor had disappeared completely. For 15 months from the operation to date, no recurrence has been found. We concluded that a combination of YAG laser irradiation and BAI might be one of the effective therapies against central type early stage bronchogenic carcinoma.

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