The effect of combination chemotherapy (CT) with MMC, VDS and CDDP (MVP-therapy) on brain metastasis from non-small cell lung cancer was studied. Five cases of adenocarcinoma were evaluated. All cases showed neurological improvement after MVP-therapy. In three among five cases experienced PR (more than 50% decrease in size) by brain CT scan. Their survival times were from 6 to 18 months. In order to evaluate strictly the effect of MVP-therapy on brain metastasis from non-small cell lung cancer, a randomized clinical trial of CT alone, CT+ Radiation therapy (RT) and RT alone is recommended.

View full abstract

CEA doubling time was calculated in relapsed cases of lung cancer with elevated postoperative CEA levels. The mean value of CEA doubling time was 165.2 days in 16 cases with local recurrence, 86.7 days in 9 cases with pulmonary metastases, 57.7 days in 29 cases with distant metastases (excluding pulmonary metastases) and 48.6 days in 3 cases with carcinomatous pericarditis. There was significant difference in CEA doubling time between the cases with local recurrence and those with pulmonary metastases (P < 0.05), between the cases with local recurrence and those with distant metastases (P< 0.01), between the cases with local recurrence and those with carcinomatous pericarditis (P< 0.05).
Between CEA doubling time (X: days) and postoperative survival time (Y: days), there was a postitive correlation of Y= 2.79X+ 364.2 (R= 0.509, P<0.01).
The calculation of CEA doubling time may be useful to estimate the recurrent site when there is nothing but CEA elevation as a sign of recurrence, and moreover it may be a prognostic indicator.

View full abstract

Early hilar lung cancers are rare but curable lesions if they are properly diagnosed and treated. The Japanese Lung Cancer Society defined early hilar lung cancer as those that fulfilled the tollowing three microscopical citeria;(1) the lesion is localized proximal to segmental bronchi (2) depth of tumor invasion is confined to within the bronchial wall (3) no lymph node metastasis or distant metastasis. In the past 11 years, we have experienced 21 cases of early hilar lung cancer. In addition, there were 8 cases which fulfilled citeria (1) and (3) but had minute invasion into the lung parenchyma beyond. The bronchial wall. We have designated these lesions as semi-early hilar cancer. These 29 cases were analyzed to elucidate the method of early detection of hilar lung cancer.
The site of the detected lesions was the right upper lobe bronchi in 11 cases, right lower in 6, left upper in 5, left lower in 3, right middle in 2, left main bronchus in 1 and one at the bifurcation of the left upper and lower lobe bronchi. Age distribution ranged from, 49 to 72 years old, being 61.7 years on average. Excluding one female case, all were male. There were 28 cases of squamous cell carcinoma and one case of mucoepidermoid carcinoma. Among the 29 cases, there were 3 cases of non-smokers (one female, and two males, 49 and 72 years old). The smoking index ranged from 400 to 3600 (1031±596 on average). Of the 29 cases, 7 were detected by sputum cytology in mass surveys. All of the lesions were finally diagnosed by bronchofiberscopic examination. An other 22 cases presented with sympoms. Their complaints were bloody sputum in 12 cases, dry cough in 5 cases, fever in 3 cases, general malaise in one case and loss of appetite in one case. All of these 22 lesions were finally diagnosed by bronchofiberscopic examination. In only 6 cases, abnormal chest film findings were pointed out by a retrospective study. Malignant cells in sputum were detected in 13 cases. From the clinical analyses of these 29 cases, it was concluded that mass surveys are effective for early detection of hilar lung cancer. For the early detection of hilar lung cancer, sputum cytology as a screening test followed by bronchofiberscopy for definitive diagnosis are recommended in high risk groups. The high risk group includes male and females over 45 year of age with a smoking index of more than 400, a non-smoking wife of a husband with high smoking index, non-smokers over 70 years old and those having a history of bloody sputum.

View full abstract

We studied patterns of recurrence in 22 cases of small cell carcinoma of the lung who achieved a complete response (CR) or partial response (PR) with the combination chemotherapy consisting of cyclophosphamide, etoposide, aclarubicine, and vincristine or cisplatin and doxorubicine with or without etoposide. The most frequent sites of recurrence were the bone and brain, accounting for 55% and 45% of all first sites of recurrences, respectively. In addition 32% of recurrences were in the lung, while 23% were in the liver, 14% in the mediastinal lymph nodes, and 14% in other distant sites. Consolidation radiotherapy was performed in twelve patients (PR 7, CR 5), in whom local chest recurrence inside the radiated area occurred in 6/7 (86%) patients with PR, whereas in 1/5 (20%) patients with CR.
Respiratory insufficiency related to local tumor recurrence was a possible cause of death in 4 out of 10 patients treated with combination chemotherapy alone. On the other hand, in 10 patients treated with combination chemotherapy and consolidation radiotherapy there were no chest complications directly contributing to death.

View full abstract

A cytologic examination of pleural lavage was performed before and after pulmonary resection in 102 of 144 patients undergoing curative pulmonary resection for primary lung cancer in the period of 3.5 years. The cytologic results of pleural lavage were positive for malignant cells in 2 of 102 patients (2.0%) before pulmonary resection and in 5 of the 102 patients (4.9%) after the resection. One of the 2 patients with positive cytology before pulmonary resection was T₂ N₀M₀ (P₀), the other was T₂ N ₂ M0 (P₂). Positive cytologic findings on lavage after resection was only seen in patients with adenocarcinoma. No patients with negative hilar and mediastinal nodes for metastasis had positive findings on this cytologic study. In contrast, 2 patients with N₁ disease (9.5 %) and 3 patients with N₂ disease (10%) had positive cytologic findings.

View full abstract

An analysis of the relationship between lymph node metastases and prognoses in surgically resected lung cancer cases was carried out. Ni cases had significantly better prognosis than N2 cases. N2a cases had better prognosis than N2b and N3 cases. In N2 cases, the cases with mediastinal lymph node metastasis at two or fewer stations had better prognoses than cases with mediastinal lymph node metastasis at 3 stations or more. The greater the number of metastatic lymph nodes, the shorter was the median survival time. There was no relationship between the levels of metastatic mediastinal lymph nodes and prognosis.

View full abstract

Based on two different protocols of bronchial artery infusion (BAI) combined with radiation therapy, 80 patients with lung cancer were treated. The first group includes 23 patients with non-small cell carcinoma who were treated by BAI with CDDP (50mg) This was immediately followed by radiation with a large dose (350-400cGy) in a small field to just cover the tumor stain noted on the bronchial arteriogram. By reducing the daily dose from the next day, the weekly dose was adjusted to 900cGy in an unevenly fractionated manner. The second group includes 57 patients who underwent two-drugcombination BAI combined with conventional evenly fractionated radiation, according to histological variants; PEP (30mg) +CQ (6mg) for squamous cell carcinoma, ADR (20-30mg) +MMC (10mg) for adenocarcinoma, large cell carcinoma and small cell carcinoma, PEP (30mg) +MMC (10mg) for adenocarcinoma and large cell carcinoma.
Tumor size reduction measured two weeks after BAI was 62.0±25.4% in cases of small cell carcinoma, 35.0±25.1% in those of non-small cell carcinoma with the twodrug-combination BAI and 44.5±23.9% with BAI of CDDP respectively. The period of tumor size reduction by 50% was 17± 7 days in cases of small cell carcinoma, 36±24days in those of non-small cell carcinoma with two-drug-combination BAI and 31±20days with BAI of CDDP. The survival rate showed no statistical significance whether BAI wascombined or not.
Most of the side effects induced by BAI were transient. However, two-drug-combination caused esophageal ulcer (1 case) and hemoptysis (2 cases) and CDDP caused esophageal ulcer (1 case).
In conclusion, BAI employing anticancer drugs is an effective adjunct to quickly reduce the size of lung cancer. Of all combinations, ADR plus MMC for small cell carcinoma and CDDP for non-small cell carcinoma were contributive to that purpose.

View full abstract

Clinical features of recurrence in patients with lung cancer were examined. Subjects were 232 patients, consisting of 124 adenocarcinomas, 87 squamous cell carcinomas, 13 large cell carcinomas and 8 small cell carcinomas. They underwent absolutely or relatively curative resection in our department between 1973 and 1985
Recurrent disease developed in 119 patients (51% of all examined patients) during the observation period (from the time of resection through 1988). The incidence of recurrence correlated better to the pN factor than to the pT factor.
Hematogenous metastasis occurred in 97 patients (42%). The lung, brain, and bone were the most frequent target organs of metastasis. Hematogenous metastasis developed in at least one of those three organs in 86% of cases.
Local recurrence appeared in 43 patients (19%). Lymphatic metastasis to the hilar, mediastinal, or supraclavicular lymphatic system was the most frequent pattern in local recurrence. Fewer patients showed recurrence at the surgical margin (3%), and pleural or pericardial dissemination (2%). There was no significant difference in the incidence of local recurrence among the four histological types of carcinoma. However, recurrence at the bronchial stump and pleural dissemination were characteristic for squamous cell carcinoma and adenocarcinoma, respectively.
In adenocarcinoma, of 67 patients with recurrence, 27 patients (40%) showed first recurrence more than 2 years postoperatively. However, in other types of carcinoma, only 17% of patients with recurrence were asymptomatic until 2 years or more postoperatively.

View full abstract

In patients resected for lung cancer at Aichi Cancer Center Hospital from 1978 to 1987, the relationship between preoperative serum CEA level and the stage, curability and survival rate were investigated in 407 cases in whom the preoperative serum CEA levels were measured. The serum CEA value was measured by the EIA method, with a cut-off point at 5.0ng/ml. There were 268 patients with normal serum CEA levels, while there were 139 patients with high serum CEA levels.
The diagnostic accuracy between the clinical stage and post-surgical histopathological stage was 62.3% for the normal CEA group and 47.5% for the high CEA group. There was a statistically significant difference (P< 0.01) between the two groups. The 5-year survival rate was 54.4% for the normal CEA group and 30.8% for the high CEA group (P< 0.001).
Also, by classifying patients with serum CEA levels ≥ 5.0ng/ml (69 patients) 5.1-10.0 ng/ml (28 patients) 10.1-20.0 ng/ml, and 42 patients over 20.1 ng/ml, it was clear that the higher the preoperative serum CEA level the more advanced the cancer, the lower the curability and the less favorable the survival rate.
This study indicates that the preoperative serum CEA levels appear to'be a prognostic factor in patients undergoing resection for lung carcinoma.

View full abstract

The effect of lung cancer on the ability of blood lymphocytes to generate lymphokine (IL-2)-activated killer (LAK) activity and of monocytes to regulate the LAK induction were examined. Highly purified lymphocytes (> 99%) and monocytes (> 90%) were separated by counter-flow centrifugal elutriation. LAK activity against Daudi cells was measured by 4-hr ⁵¹Cr release assay. Results showed that the abilities of blood lymphocytes of healthy donors and lung cancer patients to generate LAK activity were similar. Blood monocytes of lung cancer patients significantly augmented the LAK induction at similar levels as did monocytes of healthy donors. When monocytes were stimulated with endotoxin, the monocytes of all healthy donors markedly suppressed LAK induction, whereas the LAK induction was suppressed by monocytes obtained from 7 out of 12 cancer patients, but augmented by monocytes from the remaining 5 patients. Thus, lymphocytes of patients with lung cancer can respond to IL-2 by generating LAK activity, which can be up-regulated by fresh monocytes. These findings indicate that the adoptive immunotherapy with LAK cells and IL-2 could be useful in the treatment of lung cancer.

View full abstract

Boad on 136 patients irradiated from January 1979 through May 1987, the relationship between the size of the primary tumor and the prognosis of the patient with nonsmall cell lung cancer in stages I -III was analyzed. In cases with a tumor size of less than 4cm in diameter, the primary response rate, the local control rate and the cumulative survival rate were significantly better than those in cases with a tumor size of 4cm and more. The 2-year survival rate in the former group was 34%(14/41). In contrast, the CR-rate and the 2-year survival rate of the patients with a tumor size of more than 6cm in diameter were 7% and 5%(2/41), respectively. From these results, it can be concluded that the size of the primary tumor is important as a prognostic factor in radiotherapy for non-small cell lung cancer.

View full abstract

Serum SCC, NSE, CEA and BMG levels were determined in 30 normal controls and 147 patients, including 102 cases of primary lung cancer, 37 cases of benign pulmonary and 8 cases of other chest malignancy. Especially, SCC was elevated in cases with squamous cell carcinoma and NSE in cases of small cell carcinoma. In lung cancer, the combination of SCC NSE and CEA yielded a high positive rate, but high serum level of BMG werenot recognized.
No statistical difference of survival was found between the SCC-positive group and the SCC-negative grouop. Similarly, no statistical difference was obtained between the NSE-positive group and the negative group. SCC and NSE were useful as monitor markers for treatment and as auxiliary means to diagnose lung cancer.

View full abstract

Cisplatin plus vindesine plus ifosfamide (CIV) combination chemotherapy was compared with cisplatin plus vindesine (CV1) and cisplatin plus vinblastine (CV2) in the treatment of advanced non-small cell lung cancer.
Response rates of CIV, CV1 and CV2 were 47.6%, 33% and 33%, respectively. However, no statistical differences were recognized among them and no patients achieved complete response with any method. Concerning toxic effects, leukocytopenia and thrombocytopenia were seen more frequently in CIV and CV2 than in CV1 (p <0.01). There were no differences in nonhematologic toxicities among CIV, CV1 and CV2.

View full abstract

An assessment was made of the critical factors of empyema in 5 patients who developed symptoms after surgery for lung cancer. Symptoms developed from 2 to 84 months after surgery (average, 33.8 months). In all cases we confirmed that the empyema was not due to bronchial fistula.
Radiotherapy was presumed to be the cause of the development of empyema, because 2 patients who developed empyema more than 6 years after surgery and the one who developed it 4 months after surgery all had a history of pneumonitis due to rediation exposure. Furthermore, the empyema developed at the same site at which the pneumonitis occured.

View full abstract

A case of small cell lung' carcinoma, measuring 1.0cm in greatest dimension, was surgically resected. As the tumor showed pulmonary hilar lymph node metastases, it was pathologically graded as T1N1M0 (Stage II). Characteristically, the tumor grew subepithelially along the longitudinal axis of a small bronchus. Recurrence in the mediastinal lymph nodes appeared after surgery, and chemotherapy and radiation therapy were performed. The patient is alive 2 years and 5 months after surgery.

View full abstract

A case of primary lung cancer with stromal ossification is reported. A 61-year-old man had been known to have an abnormal shadow in the left lower field on chest roentgenogram for five years. Left lower lobectomy with tumor was performed, and adenocarcinoma was diagnosed based on the resected tumor. The stroma of the tumor showed islands of osseous tissue adjacent to carcinoma cells, which were thought to be induced by the adenocarcinoma tissue. As far as we know, previous reports of ossification associated with primary lung cancer other than carcinoid are extremely rare.

View full abstract

Three cases of diffuse metastatic leptomeningeal carcinomatosis (DMLC) associated with adenocarcinoma of the lung are reported. As multidisciplinary treatment has improved the prognosis of lung cancer patients, the incidence of DMLC is expected to increase. Special attention should be paid during examinations of lung cancer patients for early diagnosis and treatment of DMLC. Though intrathecal administration of MTX brought about degeneration or disappearance of malignant cells in the CSF, no clinical improvement was obtained.

View full abstract

A pulmonary blastoma in a 72-year-old male originated in the right lower lobe and developed mainly extrapulmonarily, forming a firm capsulated mass. The surface was rough with several small nodulations. No apparent invasion into the adjacent stuructures was observed and it was extirpated with a part of attached lung. The cut surface was yellowish gray, bulging and solid, but fragile and showed some hemorrhagic degeneration. Gross extracapsular invasion was not demonstrated. Histologically, the presence of epithelial components resembling fetal lung and mesenchymal components including striated muscle indicated pulmonary blastoma. In some parts, carcinoid-like pattern was also observed. Immunohistochemical study proved the existence of cells positive for CEA and HCG within the tumor. The elevated blood level of CEA and AFP returned to normal after the tumor extirpation. However, the level of CEA again increased, with that of HCG, and continued untill the patients succumbed to the disease, 60 days after the surgery, due to spinal invasion and pulmonary metastases.
This is the first case of pulmonary blastoma with documented CEA, AFP and HCG as tumor markers.

View full abstract

A 71-year-old male was admitted because of left pleural effusion. The examination of effusion failed to reveal a diagnosis. After drainage, the effusion decreased with pleural thickening remaining. Some weeks later, the effusion increased again and pleural thickening increased. The clinical course and X-ray findings resembled those of diffuse pleural mesothelioma. However, on abdominal ultrasonography, right renal tumor was found by chance, and pleural biopsy proved metastasis of renal cell carcinoma. At autopsy, the left lung was entirely covered by thickened pleura with some nodules immediately beneath the pleura. Thoracic metastasis of renal cell carcinoma with diffuse pleural spread is rare.

View full abstract