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Volume 39, Issue 6
Displaying 1-18 of 18 articles from this issue
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Kazushige Hayakawa, Hideo Niibe1999 Volume 39 Issue 6 Pages 787-795
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSRadiation therapy (RT) has been useful for improving the local control and survival in patients with localized unresectable non-small cell lung carcinoma, and thoracic RT and prophylactic cranial irradiation have also improved disease control in patients with limited small cell lung cancer when combined with systemic chemotherapy. RT has provided relief of symptoms in patients with more advanced disease. In spite of the recent innovations in treatment delivery, however, the overall treatment result of lung cancer is still unsatisfactory. Newer radiotherapeutic methods are expected to hold the promise in increasing the dose to tumor while sparing normal tissue. Recently, heavy ion charged particle therapy, brachytherapy, radioisotope therapy, stereotactic RT, multi-daily fractionation, hyperthermia have shown promise in the treatment of lung cancer. Furthermore, there have been advances in the technology for treatment delivery, especially three-dimensional treatment planning systems, patient fixation tools, respiration synchronous system for RT, diagnostic imaging methods such as magnetic resonance imaging and RI imaging. Progress of the diagnostic technology such as the development of tumor markers must also not be overlooked. For future improvement of the treatment results of lung cancer, it is important that the role of RT in multidisciplinary treatment for lung cancer be established. It is also very important that the majority of oncologists increase their understanding of the role of RT, and that radiation oncologists in our country exert themselves to achieve further progress.View full abstractDownload PDF (1288K) -
Kazuki Nakahara, Sadahiko Masuda, Yoshio Ohse, Minoru Tahara, Akio Yam ...1999 Volume 39 Issue 6 Pages 797-803
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe evaluated prognostic factors and usefulness of repeated pulmonary resection in 29 patients who underwent thoracotomy for metastatic colorectal carcinoma. The cumulative 5-year survival after thoracotomy was 50%, and 10-year survival was 44%(MST: 38M). Fourteen of 29 patients had solitary metastatic lesions (5-year survival 79%) and fifteen had multiple lesions (5-year survival: 15%). Patients with a solitary lesion had better outcome than patients with multiple lesions, but the difference was not statistically significant (p=0.06). There was no statistically significant difference in survival rate between patients with unilateral and bilateral multiple lesions. There was also no significant difference in survival rate in relation to location of primary cancer, disease-free interval, or extent of pulmonary resection. Repeated pulmonary resection was performed in 8 patients; 2 times in 6, 3 times in 2. The longest survivor who underwent repeated pulmonary resection survived for 70 months after the first thoracotomy. The cumulative 5-year survival after the first thoracotomy was 38%(MST: 38M). The MST after the second thoracotomy was 35M, and it was nearly equal to all of patients who underwent thoracotomy for metastatic colorectal carcinoma. We think that repeated pulmonary resection can lead to good outcome for patients with metastatic colorectal carcinoma, and repeated surgery can be useful for pulmonary recurrences after thoracotomy.View full abstractDownload PDF (858K) -
Takeshi Iinuma1999 Volume 39 Issue 6 Pages 805-812
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSObjective: To estimate mortality reduction of lung cancer by mass screening using chest X-rays and helical CT.
Methods: A deterministic model of cancer screening was employed to calculate the number of deaths (A) due to lung cancer in the screened population and those (B) in the unscreened population (background risk) and then derive the relative risk (RR) by calculating A/B and risk difference (RD) by calculating (B-A). Three types of mass screening were evaluated:(1) mass screening with indirect chest X-rays, (2) mass screening with direct chest X-rays and (3) mass screening with helical CT. Results: The calculated RR was 0.90 with 95% confidence interval (0.66-1.23) for screening with indirect X-rays, 0.82 (0.60-1.13) for that with direct X-rays and 0.46 (0.31-0.67) for that with helical CT in a 100, 000 population with an incidence of 100/100, 000 person-years compared to the same population without screening. The 95% CI of RR shows that screening with the two types of chest X-rays is not effective in reducing mortality, since the upper bound of RR exceeds 1.0. However, screening with helical CT may significantly reduce the mortality of lung cancer, since the upper bound of RR is well below 1.0.
Conclusion: Introduction of lung cancer screening with helical CT should be con sidered for secondary prevention of lung cancer instead of the present method of chest X-ray radiographs.View full abstractDownload PDF (974K) -
Takashi Eto, Harumi Suzuki, Shinichiro Ohota, Atsuro Honda1999 Volume 39 Issue 6 Pages 813-820
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo elucidate the specific tumor development process of goblet cell (GC) type mucusproducing adenocarcinomas of the lung, 15 patients were studied histologically, morphometrically, radiographically and clinicopathologically. The GC adenocarcinomas form a small central fibrosis mainly of the collapsed elastotic framework, where collagenization is rare. From the initial stage of the tumor growth, the tumor cells showed widespread replacement growth of intermittent patterns along the non-reactive alveolar septa, coexisting with the floating growth in the luminal mucus retention. Furthermore, as the tumor grows, mucus retention makes characteristic overstreched or disrupted alveolar walls to form cavitation. Image analysis disclosed that the elastic framework in alveolar extension was identical or overstreched compared with the normal alveolar walls. Radiographic characteristics depended on the tumor size, whether over 3 cm or not in diameter. In general, the recurrence occurred in cases with larger tumors (over 3 cm in size), and were almost all restricted to the lungs.
These results indicated that GC adenocarcinomas show characteristic growth with specific tumor stroma due to mucus production and may develop into bronchiolo-alveolar carcinoma within the specific sub-type of lung adenocarcinoma, different from most non-mucus producing type adenocarcinomas.View full abstractDownload PDF (12289K) -
Masahiro Endo, Yoshiki Takada, Kayoko Obayashi, Miyako Satouchi, Kiyon ...1999 Volume 39 Issue 6 Pages 821-827
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSObjective: To evaluate the diagnostic yield of transbronchial curettage for peripheral lung cancers smaller than 2 cm in diameter (SLCs), and to compare it with pathologic findings, relationship of drainage bronchi and locations of lung cancers.
Methods: We reviewed operative records of 102 cases with SLCs from January 1995 to December 1997. Transbronchial curettage was performed three times under fluoroscopic guidance based on thin-section computed tomography (CT) scanned from thenodule to the segmental bronchus.
Results: The diagnostic yields of transbronchial curettage for SLCs were 76% overall, 44% in the cases smaller than 10 mm in maximum diameter, 77% in those 11-15 mm and 86% in 16-20 mm lesions. The yields for squamous cell carcinoma and adenocarcinoma with non-replacement growth pattern were higher because of the tumor histopathological characteristics. Drainage bronchi to nodules were pointed out in 79% on thin-section CT. The diagnostic yields of those cases and unknown ones were 83%o 45%, respectively. Diagnostic yields for lesions in the right upper and middle lobes were higher compared with those in the left upper lobe.
Conclusion: The transbronchial diagnostic yield for SLCs was satisfactory, and it depended on the tumor size, the existence of drainage bronchi and histopathology. Transbronchial curettage is considered to be the first diagnostic procedure for nodules larger than 11 mm in diameter with an apparent drainage bronchus.View full abstractDownload PDF (850K) -
Akio Hiraki, Hiroshi Ueoka, Ichiro Takata, Katsuyuki Kiura, Akihiro Be ...1999 Volume 39 Issue 6 Pages 829-833
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSPurpose: Hypercalcemia and leukocytosis are relatively common paraneoplastic syndromes in patients with lung cancer, sometimes occuring simultaneously. To determine the relative frequency and prognostic influence of hypercalcemia and leukocytosis in patients with lung cancer, we reviewed our clinical records.
Patients and Methods: We reviewed the clinical records of 623 lung cancer patients who were initially diagnosed as lung cancer at Okayama University Hospital between 1980 and 1996.
Results: Fifty-one (8.2%) patients developed hypercalcemia and 6 (0.96%) demonstrated leukocytosis. Median survival time (MST) in patients with hypercalcemia (4.4 months) or leukocytosis (2.9 months) was significantly shorter than in all lung cancer patients (MST 9.5 months, p<.001) or stage IV lung cancer. In particular, survival time in 2 patients with concomitant manifestation of hypercalcemia and leukocytosis was extremely short (1.0 months, 1.5 months).
Conclusion: These results suggest that both hypercalcemia and leukocytosis are poor prognostic factors in patients with lung cancer.View full abstractDownload PDF (626K) -
Yuichi Takiguchi, Takahiro Uruma, Keiichi Nagao, Kiminori Suzuki, Reik ...1999 Volume 39 Issue 6 Pages 835-842
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSObjective and Methods: The hypothesis that early detection of lung cancer by means of mass screenings should reduce the mortality from the disease eluted the idea to include chest CT examinations in mass screening for lung cancer. The recent development of mobile CT installed in busses has made this feasible. The mobile CT, however, has some mechanical limitations in order to. fit in the small space available. To evaluate the equipment, mobile, conventional, and high resolution CT (HRCT) images of 13 peripherally located small pulmonary lesions, including six neoplastic lesions, were compared.
Results: The results showed that the mobile CT was equivalent to the conventional CT and satisfactory for detecting even very small pulmonary lesions. The mobile and conventional CT, however, are not always sufficient enough to scrutinize detailed structures of the lesions when compared to the HRCT.
Conclusion: The mobile CT is sufficient for mass screening for lung cancer, if followed by HRCT for detected lesions.View full abstractDownload PDF (8193K) -
Noboru Ishikawa, Shigeharu Sawa, Tamotsu Yasuda, Kazuhiko Matsushita, ...1999 Volume 39 Issue 6 Pages 843-848
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA case of one-stage operation consisting of right lower lobectomy, segmentectomy of left upper lobe, mediastinal lymph node dissection, and cardiac lymph node excision is described. A 75-year-old man was referred to our hospital because of an abnormal shadow in the lung field on the chest X-ray films. Because of elevated serum CEA, we performed examination in detail and a single tumor was found at the cardiac lymph node in abdomen. The pathological diagnosis of the left lung lesion was well differentiated adenocarcinoma, and the right one was poorly differentiated squamous cell carcinoma. The right cardiac lymph node was single metastasis from the right lung carcinoma. In spite of advanced age, no complication developed after the operation. The pathological stage was T1N1M1, StageN, but by one-stage operation by the median sternotomy, both tumors were removed completely and this patient has been alive 2 years after the operation without recurrence.View full abstractDownload PDF (6469K) -
Gaku Tanaka, Kouzo Yamada, Kazumasa Noda, Takamitsu Maehara, Youichi K ...1999 Volume 39 Issue 6 Pages 849-855
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground: With the introduction of computed tomography (CT) screenings and progression of imaging analysis, in recent years, we have become able to find synchronous multiple primary lung cancers (especially very small peripheral multiple lesions).
Present cases: We encountered three cases of multiple peripheral adenocarcinomas detected by chest CT screenings. In case 1, two nodules were pointed out in the left lower lobe on high-resolution CT (HR-CT) image. These were diagnosed pathologically as Noguchi type C and type A adenocarcinomas and several atypical adenomatous hyperplasias (AAHs) were also found. In case 2, two nodules of the air-containing type were pointed out in the right upper lobe on HR-CT image. These were diagnosed pathologically as Noguchi type B and type A adenocarcinomas and in addition 16 AAHs were diagnosed. In case 3, two nodules of the solid-density type were pointed out in the left upper lobe on HR-CT image. These were diagnosed pathologically as Noguchi type C adenocarcinomas with different degrees of differentiation. All these cases were suspected to be multiple lung cancers based on the shape on HR-CT images, and they were diagnosed pathologically as multiple lung cancers. Only one of six lesions was diagnosed pathologically before surgery.
Conclusion: In our three cases, imaging analysis was the most reliable basis to refer patients to surgery, and its great value was acknowledged in the diagnosis of peripheral small lesions of the lung.View full abstractDownload PDF (10339K) -
Hiroki Suda, Katsumi Sasaki, Tomita Nakayama1999 Volume 39 Issue 6 Pages 857-862
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 62-year-old asymptomatic man underwent examination of a pulmonary nodule detected by a mass screening. His chest X-ray film, examined at the age of 58 years, showed no abnormal shadows. Chest X-ray film and chest CT showed a solitary nodule without calcification in the right upper lobe (S3b). On dynamic CT, the nodule showed no evidence of obvious enhancement. On T2-weighted MRI, the nodule showed hypointensity. The nodule was diagnosed pathologically as amyloidosis by CT-guided biopsy, and thoracoscopic surgery was performed. Pathologically the nodule was diagnosed as solitary nodular amyloidosis, and an immunohistochemical study revealed AL λ. type protein. There was no sign of amyloid deposit in other organs, so this case was diagnosed as primary solitary amyloidosis of the lung.View full abstractDownload PDF (9131K) -
Hideko Goto, Tatsuo Kato, Hidehiro Kawamura, Chihito Komaki, Kazutoshi ...1999 Volume 39 Issue 6 Pages 863-869
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 64-year-old man was admitted to our hospital because of an abnormal shadow on a chest X-ray. Computed tomography showed a mass in the right lower lobe and a nodule in the left upper lobe. Bronchoscopy revealed mucosal thickening at the bifurcation between left B6a and B6b+c. These lesions were diagnosed as triple lung cancer (well differentiated adenocarcinoma in right S10, poorly differentiated adenocarcinoma in left S1+2 and squamous cell carcinoma in situ the bifurcation between left B6a and B6b+c) by transbronchial biopsy. We treated the patient with anticancer drugs and radiotherapy. About 2 years after diagnosis, serum Ca and PTHrP levels were increased and be suffered consciousness disturbance. Biphosphonate was used to control the serum Ca level, but the patient died of hypercalcemia. Immunohistochemical staining using anti-PTHrP monoclonal antibody revealed PTHrP immunoreactivity in the cancer cells of well differentiated adenocarcinoma in right S10, but the cancer cells of poorly differentiated adenocarcinoma in left S1+2 and squamous cell carcinoma in the spur between left B6a and B6b+c did not have immunoreactivity. This case was considered to be a very rare case with triple lung cancer with hypercalcemia due to elevated PTHrP level.View full abstractDownload PDF (8937K) -
Akio Yamazaki, Sadahiko Masuda, Yoshio Oose, Minoru Tahara, Kazuki Nak ...1999 Volume 39 Issue 6 Pages 871-876
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground: We report a patient who achieved long-term survival with successful treatment of both cerebellar metastasis and primary multiple lung cancer.
Case: A 60-year-old man underwent removal of cerebellar metastasis in June, 1982. At that time, the primary lesion had not been detected. In September, 1986, his chest X-ray film and CT scan showed an irregular mass in the right upper lobe. Right upper lobectomy with mediastinal lymph node dissection was performed under a diagnosis of adenocarcinoma. The histologic findings of the previously resected cerebellar tumor were compatible with the lung cancer. Thus, the TNM stage was confirmed as T2N0M1. In October, 1997, metachronous lung cancer (squamous cell carcinoma) was discovered in the S6 segment of the left lower lobe. Because of poor pulmonary function, we performed S6 segmentectomy as a compromised limited operation. His postoperative course was uneventful. He now remains well and is disease-free 16 years after the initial brain surgery.
Conclusion: Diligent long-term follow-up and aggressive treatment is an option to be considered in patients with solitary brain metastases from lung cancer.View full abstractDownload PDF (9024K) -
Hiroya Minami, Noriaki Tsubota, Yoshifumi Miyamoto, Masahiro Yoshimura ...1999 Volume 39 Issue 6 Pages 877-880
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBack ground: Bronchial fistulas in cases of inoperable lung cancer caused by radiochemotherapy are quite refractory and generally cannot be surgically closed.
Case: A 45-year-old man with squamous cell carcinoma in the right lung underwent two courses of induction chemotherapy (135mg CDDP, 5mg VDS, 13.5mg MMC) and radiation therapy (2Gy×22 times) for invasion of the right main bronchus, the pulmonary artery and superior vena cava. Just before the end of the second course, the empyem second to the bronchial fistula caused by tumor necrosis developed in the right upper bronchus, and fenestration was performed. After the operation, his condition improved remarkably, however the fistula enlarged into the right main bronchus and the purulent discharge flowed into the left lung. An expandable metallic stent (EMS) covered with polyuretane was inserted in the trachea and the left main bronchus to break aspiration pneumonia. As the covered EMS was too unstable to be fixed, a bare EMS was inserted in a stent-in-stent fashion. After the procedure he was followed at the O. P. D. and lived a relatively comfortable life for 9 months until his death due to tumor.
Conclusion: We inserted the covered EMS in a stent-in-stent fashion to successfully obliterate a large bronchial fistula.View full abstractDownload PDF (3644K) -
Manabu Haga, Hiroyuki Hirahara, Akira Iwashima, Hiroshi Tsukada, Takah ...1999 Volume 39 Issue 6 Pages 881-885
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 77-year-old man had undergone gastrectomy on June 30, 1992, because of gastric cancer (type II, t1n1, stage I B). When transurethral resection of the prostate was performed because of prostatic cancer in January 1998, a chest X-ray film showed abnormal shadow in the left middle lung field. Chest CT demonstrated a 4 cm-sized tumor in left S6 with slight pleural effusion, and a needle biopsy specimen revealed large cell carcinoma (cT4N0M0, stage IIIB). On March 11, 1998, effusion was sampled thoracoscopically and was negative for malignancy. There was no pleural dissemination. Left lower lobectomy with mediastinal node dissection was performed by open thoracotomy. Histological examination demonstrated large cell carcinoma with poorly differentiated adenocarcinoma (tub, pap) accompanied subcarinal lymph node metastasis. Immunohistologically the lymph node was positive for prostate specific antigen (PSA). The pathological stage was IB (T2N0M0) for lung cancer, and stage D2 for prostatic cancer. The patient has been receiving hormonal therapy for advanced prostatic cancer after these treatments.View full abstractDownload PDF (6815K) -
Akihiro Yoshimoto, Hiroshi Tsuji, Eisuke Takazakura, Toshio Watanabe, ...1999 Volume 39 Issue 6 Pages 887-893
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe investigated four cases whose sputum cytology were positive, while chest Xray film, computed tomography, and bronchoscopic examination were negative. Bronchoscopic examination was performed as far as the segmental bronchi of the right upper lobe, right middle lobe, right lower lobe, left upper lobe, and left lower lobe bronchi on different days. Brushing cytology and cytology of bronchial secretions were performed for each segmental bronchi with a freshly sterilized fiberscope and brush.
In two cases, cancer cells were found and could be localized. One was diagnosed as squamous cell carcinoma in the right B3 and the other as squamous cell carcinoma in situ in the periphery right B3ai. In two cases, the tumors could not be localized in spite of repeated bronchoscopic examination. To localize occult lung cancer, detailed bronchoscopic information must be combined with brushing cytology and bronchial secretion cytology after brushing from all the segmental bronchi using a freshly sterilized fiberscope and brush. In the present series, however, two of four cases could not be localized. Further examinations are needed.View full abstractDownload PDF (10044K) -
Kazutoshi Kotani, Shigeki Makihara, Yoshiki Umemori, Tadashi Maeda1999 Volume 39 Issue 6 Pages 895-900
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground: Large cell neuroendocrine carcinoma of the lung is defined as a poorly differentiated and high grade neuroendocrine tumor.
Case: A 78-year-old man was admitted for further evaluation of an abnormal shadow on a chest X-ray film. Chest CT showed a nodular mass 4.5 cm in diameter in the left upper lobe (S3). Histological malignancy was revealed by a transbronchial lung biopsy. Left upper lobectomy was performed. The case was pathologically confirmed as pulmonary large cell neuroendocrine carcinoma with adenocarcinomatous features.
Conclusion: Pulmonary large cell neuroendocrine carcinoma with adenocarcinomatous features is very rare and this is the first reported case in the Japanese literature.View full abstractDownload PDF (7290K) -
1999 Volume 39 Issue 6 Pages 901-927
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (4455K) -
1999 Volume 39 Issue 6 Pages 928-939
Published: October 20, 1999
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (1809K)
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