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Volume 49 (2009)
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- Issue 2 Pages 141-
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Volume 49, Issue 2
Displaying 1-15 of 15 articles from this issue
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Original Article
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Makoto Takahama, Ryoji Yamamoto, Nobuhiro Izumi, Hirohito Tada2009 Volume 49 Issue 2 Pages 141-145
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObjective. We retrospectively analyzed the clinical characteristics of the patients on hemodialysis who underwent pulmonary resection for lung cancers. Methods. Among 1969 patients who underwent pulmonary resections at our institution from December 1994 to December 2007, a total of 22 patients on hemodialysis (1.1%) were reviewed in this study. Male patients were 18 cases (81.8%), mean age 65.9 years. Results. Twenty patients underwent lobectomy, 1 underwent a wedge resection and 1 underwent a segmentectomy. The mean duration of pleural drainage and the hospital stay after the operation was 6.4±4.7 days and 16.5±5.1 days, respectively. The histologic diagnoses were squamous cell carcinoma in 12 patients, adenocarcinoma in 7, small cell carcinoma in 2 and adenosquamous carcinoma in 1. The distribution of pathological staging was IA in 8 cases, IB in 4, IIB in 5, IIIA in 3, and IIIB in 2. There was no operative and in-hospital mortality, whereas the overall morbidity rate was 63.6%. The recurrence within 1 year after the operation was observed in 3 cases (16.7%). The median disease free interval was 21 months, ranging from 6 to 94 months. Overall 5-year survival rate was 36.2%. Conclusion. In patients on hemodialysis who undergo pulmonary resection, there is a high incidence of pulmonary and cardiac complications. Careful postoperative management is mandatory during postoperative period.
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Shunsuke Okumura, Takaaki Sasaki, Noriaki Sukou, Masao Harada, Satoshi ...2009 Volume 49 Issue 2 Pages 146-150
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObjective. Single-agent chemotherapy with a third-generation drug is recommended as standard treatment for elderly patients with advanced non-small cell lung cancer (NSCLC). However, the efficacy and safety of platinum-based combination chemotherapy for elderly patients aged 75 years and over with adequate organ function, is still controversial. We conducted the present phase I trial to determine the dose-limited toxicity (DLT), and recommended dose (RD), as well as the safety and efficacy of paclitaxel and carboplatin combination chemotherapy in elderly patients (≥75 years old) with advanced NSCLC. Methods. Paclitaxel and carboplatin were given on day 1. Cycles were repeated every 21 days, for a maximum of 4 cycles. Dose levels 1 to 3 included paclitaxel 175, 175, 200 mg/m2 and the carboplatin area under the curve (AUC) was 5, 6, 6, respectively. Three patients were initially enrolled at each dose level, and if one of them experienced a DLT, 3 additional patients were enrolled at the same dose level. Maximum-tolerated dose (MTD) was defined as the dose level at which 3 or more of 6 patients experienced a DLT. The RD was defined as 1 dose level below MTD. Results. From December 2005 to November 2007, 10 patients were enrolled: 1 was excluded from the evaluation because of refusal of treatment. With regard to the toxicity, 5 patients had grade 3 to 4 neutropenia, and 1 had grade 3 thrombocytopenia. There was no DLT at any dose level, and dose level 3 was determined as the RD. Conclusion. Full-dose paclitaxel and carboplatin combination chemotherapy for elderly patients 75 years old or older with advanced NSCLC was tolerable.
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Keishi Sugino, Kazutoshi Isobe, Naoshi Kikuchi, Yoko Muramatsu, Go San ...2009 Volume 49 Issue 2 Pages 151-156
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObjective. The aim of this study was to assess the characteristic clinical features of lung cancer associated with venous thromboembolism (VTE). Patients and Methods. We conducted a retrospective study of 12 patients who were diagnosed as having lung cancer associated with VTE between April 2003 and April 2007. Clinical features, treatments and prognoses were evaluated. Results. Among 230 patients with lung cancer, 12 patients (8 men, 4 women; mean age 66.1 years) were given a diagnosis of having VTE (5.2%). Of these 8 were adenocarcinoma, 2 squamous cell carcinoma, and 2 small cell lung cancer. All patients received chemotherapy, 4 received long-term corticosteroid therapy, 6 had prolonged immobility and 1 had deep vein thrombosis. Anticoagulants were given to 11 patients, with improved outcome in 6, while the condition deteriorated in 4 and was unchanged in 1. Causes of death were lung cancer in 7, pulmonary thromboembolism in 3 and other disorders in 2, respectively. Median survival in stage III and IV lung cancer with VTE was significantly worse than that in lung cancer not associated with VTE (35 weeks vs. 49 weeks; p<0.008). Conclusion. Lung cancer associated with VTE has a poor prognosis, and is frequently resistant to anticoagulants and chemotherapeutic agents.
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Kenji Ono, Akira Nagashima, Gihei Inaba, Takashi Iwanami, Kosei Yasumo ...2009 Volume 49 Issue 2 Pages 157-161
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObjectives. The purpose of this report is to analyze the indications, postoperative complications and prognosis of completion pneumonectomy (CP) for postoperative recurrent or second primary lung cancer. Materials and Methods. We retrospectively reviewed 9 patients who underwent CP from April 1992 through March 2007. Results. There were 8 men and 1 woman, with an average age of 62 years (range 47 to 71). The histology of the first primary lung cancer was adenocarcinoma in 6 patients, squamous cell carcinoma in 2, and carcinosarcoma in 1. The first primary lung cancer was p-stage IA in 3 patients, p-stage IB in 2, p-stage IIA in 1, p-stage IIB in 2, and p-stage IIIA in 1. The surgical procedures for initial operation were lobectomy or more extensive resection with mediastinal lymph node dissection in all patients. Additional therapy after initial operation was radiotherapy in 2 patients and adjuvant chemotherapy in 4. The pulmonary vessels were ligated intrapericardially in all patients in whom the pulmonary vessel processing method was described in the second operation record. Post-CP complications occurred in 2 patients, in both of whom the complications were atrial fibrillation. Four patients died of cancer recurrence, 1 patient died of pneumonia and 4 patients are alive without recurrence. The actuarial 5-year survival rate after CP was 41.7%.Conclusion. In general, CP is a difficult operation with high postoperative morbidity and mortality rate. However, there is a possibility that CP offers a good prospect for long-term survival in selected patients. CP was considered as one of the effective therapeutic methods for recurrent or second primary lung cancer after initial operation.
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Retrospective Analysis of Chemotherapy for Elderly Patients with Advanced Non-small-cell Lung CancerKazuhito Funai, Kazuya Takamochi, Takahiro Mochizuki, Shigeru Momiki, ...2009 Volume 49 Issue 2 Pages 162-166
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObjective. To perform a retrospective analysis of chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC) in order to evaluate treatment efficacy and toxicity. Methods. We performed a retrospective analysis of 24 patients aged 70 years or more with advanced NSCLC who received chemotherapy from June 2003 to December 2006. Results. The median age was 75 years (range, 70-88). Twenty-four patients received a total of 50 cycles of chemotherapy; 76% (38 of 50 cycles) of which chemotherapies were platinum-based doublet regimens. The regimen of almost all combined chemotherapy patients consisted of carboplatin and paclitaxel. The overall response rate was 17% and disease control rate was 79%. The median survival time (MST) was 15.6 months. Although grade 3/4 neutropenia was observed in 58% of the patients, other toxicities were generally mild. Conclusion. Platinum-based doublet was used in 76% of the 24 elderly patients with advanced NSCLC. Although grade 3/4 neutropenia was observed in 58% of the patients, it was controllable. Chemotherapy performed in the present series was found generally safe. The observed 15.6 month MST was acceptable.
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Hideyuki Nishi, Kazuhiro Washio, Nobukazu Fujimoto, Kenichi Gemba, Tak ...2009 Volume 49 Issue 2 Pages 167-173
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObject. Characteristics and prognosis of patients with asbestos-related lung cancer were evaluated. Methods. We evaluated 98 patients with asbestos-related lung cancer treated in the period 1998-2007 in Okayama Rosai Hospital. Results. The patients consisted of 92 men and 6 women. The mean age, the age of first exposure to asbestos, the period of exposure to asbestos, the latent periods of asbestos-related lung cancer were respectively 71.4 years, 23.5 years, 31.4 years, and 49.3 years. It is suggested that asbestos-related lung cancer patients had been heavily exposed to asbestos because of complicated with asbestosis and the number of asbestos bodies. Statistically, significant differences in clinical pathological factors were recognized regarding age, gender, detection due to symptoms, performance status, pathology and clinical stage between asbestos-related lung cancer and other lung cancer case (431 patients with lung cancer except for pneumoconiosis-related lung cancer) in Okayama Rosai Hospital. The median survival of asbestos-related lung cancer was 20.4 months; 5-year survival rate was 17.2%. However for on other lung cancer cases, the median survival and 5-year survival rate were 18.0 months and 18.5%. Significant differences in survival were recognized between asbestos-related lung cancer and other lung cancer case (p=0.881). A multivariate analysis of all lung cancer cases revealed that age, gender, performance status, detection due to symptoms, stage were significant prognostic factors. But exposure to asbestos was not prognostic factor. The subgroup analysis according to age, gender, performance status, detection due to symptoms, smoking index, stage and pathological type suggested that exposure to asbestos was not a significant prognostic factor. Conclusion. The prognoses of asbestos-related lung cancer affirm to be as poor as that of other lung cancers.
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Masaaki Inoue, Teruaki Koike, Takehiro Watanabe, Kenichi Togashi, Atsu ...2009 Volume 49 Issue 2 Pages 174-182
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSObjective. To improve surgical related mortality, Niigata Chest Surgery Group registered primary lung cancer patients who were operated on in 2001 and prospectively analyzed these patients. Patients. A total of 558 primary lung cancer patients underwent resection between January 2001 and December 2001. Results. There were 352 men (63.1%) and 206 women (36.9%), with an overall median age of 66.7 years. The overall 5-year survival rate was 65.1%, 55.8% in men and 80.9% in women. Complications related to operations were observed in 37 cases (6.6%) and the operative mortality was 0.7% (4 cases). The 5-year survival rates, in relation to reason for detection were as follows: Screening group (n=284); 75.5%, Other disease group (n=175); 57.3%, Symptomatic group (n=99); 48.8%. The 5-year survival rates estimated by p-stage were: IA (n=297); 79.9%, IB (n=124); 67.4%, IIA (n=16); 66.7%, IIB (n=40); 27.5%, IIIA (n=47); 32.7%, IIIB (n=21); 23.8%, IV (n=13); 0.0%. The 5-year survival rates according to histologic type were: adenocarcinoma 69.5% (n=388), squamous cell carcinoma 52.1% (n=128), large cell carcinoma 61.5% (n=13), small cell carcinoma 71.4% (n=7), carcinoid 62.5% (n=8), and others 64.3% (n=14). Conclusion. We determined the characteristics of lung cancer patients and the results of their operative treatment in Niigata Prefecture. We anticipate registering more lung cancer patients to expand this database of patients. The availability of this database should help to improve the lung cancer treatment in Niigata Prefecture.
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Case Report
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Koichi Fujiu, Hiroyuki Suzuki, Hideaki Miyamoto, Masatoshi Mori2009 Volume 49 Issue 2 Pages 183-186
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. We present a fatal case of drug-induced interstitial lung disease which had been treated with gefitinib for 375 days. Case. The patient was 72-year-old man at the time of the diagnosis of interstitial lung disease. He was an ex-smoker, but he had no history of lung disease except for primary lung cancer. He received 5 cycles of cisplatin and vinorelbine for adenocarcinoma of the right lung with pleuritis carcinomatosa. After that he received 6 cycles of S-1 and cisplatin. In April 2007, he developed peritonitis carcinomatosa due to lung cancer. The cancer cells in the peritoneal effusion showed a mutation of epidermal growth factor receptor (EGFR) gene (exon 19 deletion), and administration of gefitinib (250 mg/day) was started. The medication favorably eliminated the peritoneal effusion. Late in May 2008, he felt shortness of breath. When he came to our hospital early in June, a chest radiograph showed a reticular shadow in the left lung. The chest CT revealed non-segmental diffuse ground glass attenuation with bronchial dilatation, which was compatible with acute interstitial lung disease. Intravenous administration of methylprednisolone (1 g/day, for 3 days) was started, but he died 4 days after the diagnosis.
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Akane Yoshikawa, Katsuhiko Naoki, Jun-ichi Nitadori, Tomoki Fujii, Hir ...2009 Volume 49 Issue 2 Pages 187-192
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. Pleomorphic carcinoma of the lung is a rare primary pulmonary malignancy and has a poor prognosis. Lung cancer has a low frequency of metastasis to the gastrointestinal tract to the metastasis (8.8%), but some reported that pleomorphic carcinoma of lung has relatively higher gastrointestinal tract metastasis compared to other lung cancer. Case. A 59-year-old man presented with an abnormal chest shadow. He underwent bronchoscopy and non-small cell lung carcinoma was diagnosed. The tumor was completely resected in May 2006, with right upper lobectomy and lymph node resection. The definitive pathological diagnosis was pleomorphic carcinoma of the lung, pathological stage IB. In July 2007, he had a low fever and elevated tumor marker (SCC), PET scan revealed upper abdominal tumor with 15 cm in with no abdominal symptoms. The abdominal tumor was resected and was diagnosed as mesenterium metastasis. Systemic chemotherapy was planned but without having chemotherapy his disease progressed and he died within 3 months with multiple organ dysfunction. Conclusion. We studied metastasis in 30 cases of pleomorphic carcinoma of the lung reported in Japan after 1999 at the time of the WHO revision. Twenty cases with 46 metastases were reported and the highest was gastrointestinal tract metastasis (20%) much higher than that of lung cancer in general (8.8%). Cases of gastrointestinal tract metastasis often present with acute abdomen, therefore it is recommended that abdominal symptoms should be carefully observed during the follow-up of pleomorphic carcinoma of the lung.
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Junzo Ishida, Kinya Furukawa, Gaku Yamaguchi, Makoto Saito2009 Volume 49 Issue 2 Pages 193-197
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. Pulmonary alveolar proteinosis (PAP) is a rare disease, and there have been few reports of PAP associated with lung cancer. We encountered a patient with lung cancer who had been diagnosed PAP many years age. Case. An abnormal shadow was found in the chest roentgenogram of a 66 year-old man, who visited to our hospital. His chest X-ray film showed diffuse ground-glass or granular shadows bilaterally in the lung fields. Transbronchial lung biopsy (TBLB) was performed, and the lesions were diagnosed as PAP. He had no symptom, therefore he was followed up. After one year, he had shortness of breath and visited his home doctor. He was referred to our hospital because of hypoxemia. In the intensive care unit, we performed therapeutic bronchoalveolar lavage fluid (BALF) under general anesthesia, and thereafter repeated therapeutic BALF under local anesthesia was performed after tracheotomy. As a result, PAP was found to be in remission. Since then, he required hospitalization more than once because of hemoptysis caused by lung aspergillosis. He had been in remission for some time with antifungal agent therapy. However, hemoptysis recurred after 5.5 years, and he was admitted to our hospital. CT scan showed a lesion with a cavity in the left S3 and a consolidation 40 mm in diameter in the left S9, which was suspicious of lung cancer. The result of careful examination showed the lesion as a non-small cell lung cancer (T3N0M0, clinical stage IIB). We performed left lower lobectomy and lymph node dissection (ND2a) with partial resections of diaphragm and left upper lobe (aspergilloma). Conclusion. Dysfunction of alveolar macrophages can be recognized in many lung cancer patients. Patients with PAP may be a group at high-risk for lung cancer, and careful long-term follow up study is required in those patients after remission of PAP.
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Shigeki Umemura, Takuya Yano, Hiromichi Yamane, Nagio Takigawa, Katsuy ...2009 Volume 49 Issue 2 Pages 198-201
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. Hyperpigmented linear eruption along the superficial venous network at the injection site (postinflammatory hyperpigmentation secondary to phlebitis): persistent serpentine supravenous hyperpigmented eruption (PSSHE) is a complication occurring rarely in patients treated with docetaxel. Case. Non-small cell lung cancer was diagnosed in a 54-year-old man. In June 2007, he received the first course of chemotherapy (docetaxel (DOC) 40 mg/m2 days 1, 8+cisplatin (CDDP) 40 mg/m2 days 1, 8). On the 10th day after the first infusion from the left cephalic vein, the patient noticed a mildly pruritic, erythematous, bullous eruption around the injection site of the first infusion and a painless linear erythematous eruption following the route of the superficial venous network of the distal portion of the left forearm. The eruption spread proximally up to the anterior aspect of the distal portion of the upper arm. The erythematous eruption was relieved with the administration of topical corticosteroid and was replaced by hyperpigmentation. No eruption occurred after the next 2 further administrations of DOC+CDDP. He received the fourth injection from the left cephalic vein; however, on the 15th day of the second course of chemotherapy, an erythematous and pigmented eruption re-occurred from the injection site of the fourth infusion, following the route of the superficial vein of the left forearm. Conclusion. PSSHE is a rare complication occurring after the injection of docetaxel. More understanding of the mechanism and risk factors, and the establishment of the prevention methods is necessary.
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Takashi Ichinose, Jotaro Shibuya, Tatsuaki Watanabe, Goro Kimizuka2009 Volume 49 Issue 2 Pages 202-206
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. By stereotactic radiosurgery or surgical treatment of brain metastases and resection of the primary tumor in non-small cell lung cancer, the patient outcome can be improved in pN0 but can hardly be improved in pN1-2. Case. A 45-year-old woman was referred to our hospital because of a 3×3-cm nodule in the upper lobe of the left lung on a chest radiograph. Chest CT revealed a 3×3-cm nodule in the upper lobe of the left lung and a swollen #5 lymph node. The nodule was found to be adenocarcinoma by brushing cytology via bronchofiberscopy. Cranial MRI revealed brain metastasis. She underwent a left upper lobectomy. Histologic examination revealed papillary adenocarcinoma and metastases to #5 and #12u lymph nodes. Three weeks after thoracotomy, she underwent gamma knife surgery of the brain metastasis. Five months and 8 months after thoracotomy, she underwent gamma knife surgeries of recurrent multiple brain metastases. She received 2 courses of chemotherapy consisting of cisplatin and gemcitabine. Fifteen months and 41 months after thoracotomy, she underwent gamma knife surgeries of recurrent multiple brain metastases. She is now apparently disease-free from lung cancer, 76 months after thoracotomy.
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Takeshi Masuda, Kazuhide Fukuhara, Takashi Yoshida, Kikuo Nakano, Keni ...2009 Volume 49 Issue 2 Pages 207-213
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. Lung cancer with carcinomatous meningitis has a poor prognosis and it is necessary to establish novel treatments to improve outcome. Erlotinib has not been reported to have been used after gefitinib therapy in a case with brain metastases and carcinomatous meningitis. Case 1. A 70-year-old woman having an adenocarcinoma of the lung (pathological stage IIIB) was treated with gefitinib therapy, but metastases in the adrenal gland and brain were detected. During carboplatin+paclitaxel therapy the brain metastases progressed to carcinomatous meningitis. Case 2. A 58-year-old woman having an adenocarcinoma of the lung (pathological stage IIIB) was treated with gefitinib therapy, but pleural metastases and carcinomatous meningitis were detected. Result. Tumors in both cases had epidermal growth factor receptor (EGFR) gene mutations. Erlotinib therapy improved symptoms and laboratory findings of brain metastases and carcinomatous meningitis. Conclusion. Our result suggested that erlotinib therapy should be effective for carcinomatous meningitis from lung cancer patients with EGFR gene mutation.
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Kunihiko Shimizu, Akio Komuro, Nobuyuki Hamanaka, Miki Takahashi, Shou ...2009 Volume 49 Issue 2 Pages 214-219
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESSBackground. Recently, the number of reports describing paraneoplastic neurological syndromes (PNS) associated with small cell lung cancer (SCLC) has been increasing. In these reports, most cases have been related to antineuronal antibodies and first treatment effect. There have been no cases showing relapse. Case. A 63-year-old man presented with deteriorating cerebellar manifestations such as ataxic gait and dysarthria in May 2007. Chest CT demonstrated a nodule in the upper lobe of the left lung, and SCLC (cT4N2M0) was diagnosed by transbronchoscopic lung cytology. Although there were no known antineuronal antibodies detected, no other causative diseases could be recognized; therefore, paraneoplastic cerebellar degeneration (PCD) associated with SCLC was diagnosed. Marked improvements of both SCLC and PCD symptoms were obtained with chemotherapy (carboplatin and irinotecan). In January 2008, the patient noticed muscle weakness. Based on the distinctive electromyogram findings, a diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) was made. The patient was given a diagnosis of SCLC relapse associated with elevated tumor marker. Although chemotherapy was administered, the patient experienced no symptomatic relief. However, he is currently doing well without exacerbation 6 months after the onset of relapse. Conclusion. We reported a rare case of PNS accompanied by another type of PNS at relapse.
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Short Report
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Yoshio Tsunezuka, Daisuke Saitoh, Ryu-ichi Waseda, Tsuyoshi Yachi, Yos ...2009 Volume 49 Issue 2 Pages 220-221
Published: 2009
Released on J-STAGE: May 25, 2009
JOURNAL OPEN ACCESS
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