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Volume 45 (2005)
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Volume 45, Issue 7
December
Displaying 1-13 of 13 articles from this issue
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REVIEW ARTICLE
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—Molecular Targeted Therapy for NSCLC—Koji Takeda2005 Volume 45 Issue 7 Pages 793-799
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSGefitinib (Iressa®) and erlotinib (Tarceva®), which are epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), have been used in treatment for patients with advanced non-small cell lung cancer (NSCLC). Several clinical trials have revealed important findings in the clinical therapeutic mechanism of EGFR-TKI. In Japan, gefitinib was approved by the Japanese Ministry of Health, Labour and Welfare, for the first time in the world, in July 2002. A large number of patients with NSCLC have received gefitinib. High incidence and mortality due to interstitial lung disease (ILD) induced by gefitinib gave rise to public criticism of the early approval. A randomized phase III trial (BR21) of erlotinib compared with placebo in NSCLC patients with previous chemotherapy showed that erlotinib had a significant survival advantage. Various predictive factors of EGFR-TKIs were revealed by several clinical trials such as female gender, adenocarcinoma, non-smoker, Japanese ethnicity. It is very exciting that EGFR gene mutations are related with response to EGFR-TKIs. This finding is expected to open the door to individualized treatment. Preclinical and clinical studies of molecular targeted therapy are making rapid progress. Recently, a randomized controlled trial of gefitinib compared with placebo in second-line treatment for NSCLC failed to show a significant survival advantage of gefitinib. EGFR mutations were indicated to be reliable predictive factors of response and survival in patients with NSCLC.View full abstractDownload PDF (93K) -
Yukito Ichinose2005 Volume 45 Issue 7 Pages 801-803
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSThe Japan Lung Cancer Research Group conducted a phase III trial in which 999 patients with completely resected stage I adenocarcinoma were assigned to receive either oral administration of UFT (tegafur, 250 mg/m2/day) for two years or no treatment (January 1994-March 1997). At the median follow-up time of 73 months, the overall survival in the UFT group was significantly better than that of the control (p = 0.035). Since 1985 when UFT became available in Japan, a total of 6 phase III trials comparing adjuvant chemotherapy using UFT with observation alone, including the above trial, have been conducted. A meta-analysis of these 6 trials reconfirmed that UFT had a beneficial effect in completely resected stage I non-small cell lung cancer (NSCLC) patients. A phase III trial comparing UFT with platinum-based chemotherapy in completely resected NSCLC patients with pathological stage IB through IIIA disease is also now in the initial stages of implementation.View full abstractDownload PDF (64K) -
Haruhiko Nakayama, Hiroyuki Ito, Shuji Ichinose, Nobusuke Kato2005 Volume 45 Issue 7 Pages 805-809
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBronchoplastic procedures for patients with lung cancer are designed to achieve radical cure with preservation of functioning lung parenchyma. A successful outcome of bronchoplasty with minimal risk requires a reliable technique for bronchial anastomosis and the confirmation of complete resection by intraoperative examination of frozen sections. Maintaining adequate blood flow with minimal tension at the site of anastomosis is essential for a good outcome. The indications for sleeve lobectomy overlap with those for pneumonectomy. Surgical outcome is therefore often compared between sleeve lobectomy and pneumonectomy, but the results of prospective controlled studies have yet to be reported. In this paper, we described a safe, reliable surgical technique for achieving good anastomosis, and compared the efficacy and safety of sleeve lobectomy with those of pneumonectomy through a review of the literature.View full abstractDownload PDF (81K)
ORIGINAL ARTICLE
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Yoshikazu Hasegawa, Kouji Takeda, Tatsuhiko Kashii, Yuu Kawano, Hirofu ...2005 Volume 45 Issue 7 Pages 811-815
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSObjective. Antitumor efficacy and safety of amrubicin were assessed in patients with relapsed or refractory small-cell lung cancer. Patients and Methods. The study population consisted of patients with PS 0-3 small-cell lung cancer. All had undergone one or more regimens of chemotherapy and experienced progression after the last chemotherapy. Amrubicin was intravenously administered at 40 mg/m2 for three consecutive days, and this was repeated every 3 weeks. Results. Between February 2003 and September 2004, 26 patients were treated with amrubicin (9 sensitive and 17 refractory patients). The median number of treatment courses was 3 (range: 1-7). Nine (47.4%) of 19 patients who were treated with a second course of amrubicin required the dose modification. The response rate was 46.2% (95%CI: 26.6-66.6%), and median survival time from the time was 9.4 months (95%CI: 4.6-11.0 months). Grade 4 leucopenia and neutropenia occurred in 42.3% and 73.1%, respectively, and 57.5% were developed grade 4 neutropenia lasting 4 or more days. Grade 3 febrile neutropenia occurred in 42.3%. Grade 3 or 4 thrombocytopenia occurred in 50.0%. Grade 3 or 4 non-hematological toxicities were interstitial pneumonia (one patient) and supraventricular arrhythmia (two patients). Conclusion. Amrubicin monotherapy is considered an encouraging regimen for second-line treatment of small-cell lung cancer. Further investigations are needed to evaluate the optimal dose of amrubicin in patients with previously treated small-cell lung cancer.View full abstractDownload PDF (67K) -
Motoki Yano, Hidefumi Sasaki, Yoshihiro Kobayashi, Haruhiro Yukiue, Hi ...2005 Volume 45 Issue 7 Pages 817-821
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSObjective. To determine the outcome and complications following second lung resection in cases with metachronous second primary lung cancer. Subjects and Methods. Ten cases with metachronous multiple lung cancers were evaluated retrospectively. Results. The average duration from the primary operation to the second operation was 7 years and 9 months. The primary operation was lobectomy or bilobectomy in all cases. The second operation procedures were partial resection in 1 case, segmentectomy in 3 cases, lobectomy in 5 cases and completion pneumonectomy in 1 case. One case with left upper lobectomy in the primary operation and right lower lobectomy in the second operation died one month after the operation because of respiratory insufficiency following acute pulmonary heart failure and pulmonary edema. Conclusions. High mortality has been reported for patients who underwent lobectomy following a contralateral lobectomy in the literature. Intensive and long-term follow-up is necessary for patients even with sufficient pulmonary and cardiac function after bilateral lobectomy.View full abstractDownload PDF (37K) -
Fumiyoshi Ohyanagi, Makoto Nishio, Atsushi Horiike, Fumiko Taguchi, Yu ...2005 Volume 45 Issue 7 Pages 823-828
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSObjective. Gefitinib, a selective epidermal growth factor receptor tyrosine kinase inhibitor sometimes induces severe and fatal interstitial lung disease (ILD). KL-6, Surfactant Protein A and D (SP-A and SP-D) are well known as markers of activity of ILD, but the usefulness of these markers have not been fully clarified in gefitinibinduced ILD. Methods. Sera from 90 patients with advanced NSCLC were obtained at pretreatment and during the time of treatment with gefitinib monotherapy (days 14 to 18), and serum KL-6, SP-A, SP-D levels were examined. The cut-off levels were set for each marker: KL-6, 500 U/ml, SP-D 110 ng/ml, SP-A 43.8 ng/ml. Results. Positive rates of serum KL-6, SP-A and SP-D at pretreatment were 42.2%, 41.1% and 30% respectively. There was no difference in the levels of these markers between ILD cases (5 patients) and non-ILD cases (85 patients). On the other hand, these markers levels decreased in patients who showed an objective response for gefitinib. Conclusion. Serum KL-6, SP-A, SP-D levels are not good markers to predict gefitinib-induced ILD in NSCLC patients, because KL-6, SP-A and SP-D may be produced by non-small cell lung cancer.View full abstractDownload PDF (101K)
CASE REPORT
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Masaki Hara, Yasunori Matsuzaki, Tetsuya Shimizu, Masaki Tomita, Takan ...2005 Volume 45 Issue 7 Pages 829-832
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. Distant metastatic lesions of lung cancer are generally regarded as inoperable. This case report describes long-term survival achieved with surgical resection of primary and metastatic lesions in combination with perioperative chemotherapy. Case. A 62-year old man was referred to our institution with an irregularly shaped right upper lobe nodule in October 1999. Intraoperative frozen section of the nodule at the time of right upper lobectomy and mediastinal lymph node dissection confirmed adenocarcinoma of the lung. A left humeral head lesion identified by bone scintigraphy in January 2000 was confirmed to be metastatic adenocarcinoma by biopsy. Following 2 courses of chemotherapy (CDDP & TXT) the patient underwent left humeral head resection and reconstruction in April 2000. The final pathologic examination failed to demonstrate any malignant cells in the specimen, which was interpreted to indicate a complete histologic response to chemotherapy. Five years later, the patient is well without evidence of recurrence. Conclusion. Long term survival in a patient with primary lung cancer and a solitary bone metastasis was achieved through lobectomy, perioperative chemotherapy, and resection of the metastatic lesion.View full abstractDownload PDF (131K) -
Katsunada Fujimoto, Takanori Akagi, Motokimi Shiraishi, Takashige Kura ...2005 Volume 45 Issue 7 Pages 833-837
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. Gefitinib is administered to patients with adenocarcinoma of the lung with poor response to previous anticancer chemotherapies. However, adverse effects such as diarrhea, are serious problems for those patients. Case. A 71-year-old woman with adenocarcinoma of the lung was admitted to our hospital (clinical stage IIIB) in February 2002. She underwent anticancer chemotherapy, including platinum, repeatedly. Since the response was poor, she was treated with 250 mg gefitinib daily. As severe diarrhea developed, gefitinib was stopped for 7 days, and gefitinib with a reduced dose (250 mg/every second day) was given. Three months later, partial response was obtained with a 44% reduction rate in tumor size by RECIST (Response Evaluation Criteria in Solid Tumors). Conclusion. There are no reports on patients with adenocarcinoma of the lung in whom successful clinical effect without adverse effects were observed by alternate day administration of gefitinib. After considering for sensitivity to gefitinib, it is necessary to study the relationship between pharmacokinetics of gefitinib with alternate day administration and clinical effects as well as the standard administration. Such studies would contribute to advances in increased clinical efficacy of gefitinib with reduced economical problems.View full abstractDownload PDF (73K) -
Takashi Sekine, Jin Sakamoto, Tsuyoshi Takahashi2005 Volume 45 Issue 7 Pages 839-843
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. It is reported that about 30% of patients who have primary lung cancer present with elevated serum levels of CA19-9, but reports of lung cancer producing CA19-9 are rare. Case. A 52-year-old man presented with right shoulder pain. His chest X-ray film revealed right pleural thickening. Laboratory tests showed elevated levels of CEA (147 ng/ml) and CA19-9 (1220 U/ml). Pleural biopsy revealed adenocarcinoma. Right upper lobectomy with chest wall resection was done after chemoradiotherapy. Immunohistochemistry of the resected specimen revealed positive staining of tumor cells for CA19-9. Conclusion. We reported a rare case of primary lung cancer with CA19-9 production that was confirmed by immunohistochemical analysis of the resected tumor.View full abstractDownload PDF (108K) -
Katsuhiro Okuda, Masaaki Sano2005 Volume 45 Issue 7 Pages 845-849
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. We report a difficult case of tracheal cancer with tracheal stenosis that was to diagnose and treat. An unconscious patient was brought to our emergency room. Chest X-ray and CT scan revealed tracheal stenosis. Case. A 62-year-old man collapsed unconscious outside his house in the early morning. The arterial blood test showed the PaCO2 to be 127 mmHg. Brain CT scan revealed no problem, but chest X-ray and CT scan revealed severe tracheal stenosis. We decided that tracheal stenosis had caused CO2 narcosis. On CT scan, his tracheal stenosis looked quite severe, but the character of the tumor causing it was not clear. Thus, we performed bronchofiberscopic examination to observe and biopsy his trachea under a percutaneous cardiopulmonary support system (PCPS). The softness of the tumor permitted nasotracheal intubation. Pathological examination revealed squamous cell carcninoma. Radiation therapy reduced the tumor size, and the patient was able to walk back home. Conclusion. This case had severe tracheal stenosis due to tracheal cancer, diagnosed by bronchofiberscopic examination performed under the PCPS in the emergency room and was treated by radiation therapy with nasotracheal intubation. The result of this case also suggests the usefulness PCPS in order to prevent a tracheal blockade.View full abstractDownload PDF (89K) -
Katsuhiko Shimizu, Shintaro Hirata, Mitsuru Miyazaki, Nobuoki Kohno, Y ...2005 Volume 45 Issue 7 Pages 851-856
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. Desmoplastic malignant pleural mesothelioma (DMM) is a subtype of malignant pleural mesothelioma, and very rare, especially in Japan. Case. A 69-year-old man was referred to our hospital to investigate an abnormal shadow on chest X-ray. On admission, his chest radiograph showed pleural effusion on the left side and chest computed tomography showed irregular pleural thickening. A thoracoscopic examination was performed, and histological findings led to a diagnosis of DMM. The patient was treated with induction chemotherapy combining cisplatin and gemcitabine, followed by extrapleural pneumonectomy. The effect of chemotherapy was evaluated a stable disease. Conclusion. There is no standard therapy for DMM. In this case, the extrapleural pneumonectomy was safely performed after induction chemotherapy.View full abstractDownload PDF (172K) -
Tomohisa Okuma, Toshiyuki Matsuoka, Akira Yamamoto, Masami Toyoshima, ...2005 Volume 45 Issue 7 Pages 857-861
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. We apply percutaneous CT-guided radiofrequency ablation (RFA) for unresectable lung tumors. With this new treatment, we encountered 2 cases of cavity formation followed by inflammation, 3 weeks after RFA for lung metastases from colorectal cancers. Cases. Two patients, 61- and 57-year-old men with lung metastases from colorectal cancers were considered inoperable. During RFA, severe complications were not encountered, and they were discharged on day 8 after ablation. Three weeks after ablation, however, they both contracted a fever and abscess formation on chest X ray and CT scans. They were treated with IV and oral antibiotics, and recovered after the treatment. Conclusion. We should bear in mind that cavitation usually changes after RFA and may often overlap infection.View full abstractDownload PDF (104K) -
Tomohiro Takami, Takashi Niimi, Tetsuya Oguri, Hiroyoshi Maeda, Shigek ...2005 Volume 45 Issue 7 Pages 863-867
Published: 2005
Released on J-STAGE: May 12, 2006
JOURNAL OPEN ACCESSBackground. Thyroid cancer often causes lung metastasis or direct invasion to the trachea but endobronchial metastasis is rare. Case. This case was a 65-year-old man whose thyroid was totally resected following a diagnosis of thyroid cancer (papillary carcinoma) less than 5 years previously. Two years previously, multiple small nodules were found in chest CT, and were diagnosed as lung metastasis. In 2004 he had hemoptysis, and was admitted to the Division of Respiratory Disease at our hospital. Fiberoptic bronchoscopy revealed a polypoid lesion in the left upper bronchus. A biopsy specimen showed papillary adenocarcinoma, and immunohistochemistry revealed abundant thyroglobulin-positive cells; thus, this case was diagnosed as endobronchial metastasis from thyroid cancer. Conclusion. This was a rare and interesting case of endobronchial metastasis from thyroid cancer.View full abstractDownload PDF (112K)
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