All issues
Volume 50 (2010)
- Issue 7 Pages 875-
- Issue 6 Pages 791-
- Issue 4 Pages 329-
- Issue 3 Pages 253-
- Issue 2 Pages 115-
- Issue 1 Pages 1-
Volume 50, Issue 2
Displaying 1-16 of 16 articles from this issue
- |<
- <
- 1
- >
- >|
Original Article
-
Katsutoshi Ando, Kazufusa Shoji, Motoji Fukazawa, Akihiko Takeshi, Mas ...2010 Volume 50 Issue 2 Pages 115-121
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. The number of elderly patients who are given diagnoses of clinical stage I lung cancer is predicted to increase with the aging population and the development of diagnostic imaging. We conducted a retrospective study assessing the problems in those cases. Methods. From October 1999 to September 2008, 358 patients were given a diagnosis of clinical stage I lung cancer in Kameda Medical Center. We classified them into 3 groups; the 2nd elderly group (≥75 years), the 1st elderly group (65-74 years) and the non-elderly group (≤64 years), and retrospectively compared them. Results. A total of 111 patients (31.0%) were elderly and 59.5% of these had undergone surgery. The inoperable cases had poorer lung function and a higher ratio of comorbidity including chronic obstructive pulmonary disease, cardiac diseases or kidney diseases. For inoperable patients we selected radiotherapy, including stereotactic radiotherapy (SRT), or best supportive care. The 3- and 5-year overall survival rates and locoregional recurrence rates did not differ between the SRT group and the operative group. Conclusion. The number of patients who cannot undergo resection is predicted to increase with the aging population in Japan. The most important factor concerned with indications for surgery was the presence of comorbid diseases. We need to assess the patient backgrounds including complications, establish clear surgical indications, and continue the development and diffusion of local treatments such as SRT.
View full abstractDownload PDF (558K) -
Atsuhisa Tamura, Kousuke Araki, Junichi Suzuki, Fumihiro Kashizaki, Yo ...2010 Volume 50 Issue 2 Pages 122-129
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSObjective. This study assessed pulmonary mycobacteriosis in patients who had undergone pulmonary resection for lung cancer. Methods. The medical records of 24 pulmonary mycobacteriosis patients following resection of lung cancer, between 1996 and 2007, were retrospectively reviewed. The clinical course, laboratory findings, and radiological findings of these patients were analyzed. Results. There were 14 pulmonary tuberculosis (PTB) cases and 10 non-tuberculous mycobacteriosis (PNTM, Mycobacterium avium complex in 9 and Mycobacterium kansasii in 1) cases, 17 were men, 15 were elderly, the postoperative period was less than 5 years in 15 cases and 18 cases were located in the resected side of the lung. Seven of the 14 PTB cases had recurrence of lung cancer, 6 had a previous history of PTB treatment, 5 had a previous history of other malignancies, and 5 were in performance status (PS) 2, or more than PS 2. These findings suggest that endogenous reactivation may be associated with the onset of PTB. Most of these systemic factors were not present in the 10 PNTM cases, but the fact that 9 of the 10 had a PNTM lesion in the resected side of the lung suggests that aggravation of the pulmonary microenvironment caused by surgery is associated with the onset and progression of PNTM. PTB treatment was effective and the outcome was good if there was no delay in diagnosis. However, the condition of some PNTM cases deteriorated despite treatment, and developed other pulmonary infections such as pulmonary aspergillosis, which were fatal. Conclusion. Careful observation for systemic and radiographic changes is necessary to accurately diagnose pulmonary mycobacteriosis after resection of lung cancer.
View full abstractDownload PDF (1309K) -
Takeshi Mimura, Yoshihiro Miyata, Yasuhiro Tsutani, Riki Okita, Yukari ...2010 Volume 50 Issue 2 Pages 130-135
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSObjective. A major impediment to planning therapeutic strategy for malignant pleural mesothelioma (MPM) is that it is difficult to make a definitive diagnosis in its early stage. A pleural biopsy is recommended in order to collect sufficient tissue samples. We evaluated our results of pleural biopsies, based on full layer resection of the parietal pleura, that were done for diagnosis of MPM. Patients and Methods. We reviewed 12 patients who underwent pleural biopsies from April 2007 to March 2009. When surgical resection, including an extrapleural pnemonectomy (EPP), was to be performed after a final diagnosis of MPM, a complete resection of the previous biopsy route was necessary, including the skin and the chest wall. Thus, a skin incision of 2-3 cm in length was made on the planned incision line for EPP. The endothoracic fascia was exposed, and full layers of the parietal pleura, a specimen 1×2 cm in size, was collected, under direct vision. Intraoperative frozen section diagnosis confirmed that sufficient tissue specimens were obtained. Then, a thoracoscope was inserted through the same hole used for the biopsy, and if necessary, additional pleural biopsies for lesions of the intrathoracic cavity could be performed. Results. We performed 12 pleural biopsies that were given final diagnoses of MPM in 8 cases (4 epithelioid, 1 biphasic and 3 sarcomatoid MPMs) and 4 cases of pleuritis. No perioperative complications associated with the pleural biopsies occurred. Conclusion. For a definitive diagnosis of MPM, it is useful to collect all layers of the parietal pleura by pleural biopsy and to identify lesions of the intrathoracic cavity without frequent thoracentesis.
View full abstractDownload PDF (1097K) -
Kazuhito Funai, Takahiro Mochizuki, Shigeru Momiki2010 Volume 50 Issue 2 Pages 136-140
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSObjective. We conducted a dose escalation study to determine the recommended dose of adjuvant chemotherapy with cisplatin (CDDP) plus vinorelbine (VNR) for Japanese patients with completely resected non-small cell lung cancer (NSCLC). Methods. CDDP and VNR were given intravenously on days 1 and 8 every 4 weeks, for 4 cycles. The following dose levels for CDDP/VNR (mg/m2) were evaluated: 40/20 (level 1), 40/25 (level 2) and 45/25 (level 3), respectively. Cohorts of 3 patients each were enrolled at each dose level. Escalation to the next dose level was permitted if no dose-limiting toxicities (DLT) were observed. If 1 or 2 patients developed DLT, 3 additional patients were enrolled at that dose level. Dose escalation continued until more than one-third of the 6 patients treated at a given dose developed DLT. The maximum-tolerated dose (MTD) was defined as that dose at which all 3 patients or more than 3 of 6 patients within a cohort developed DLT. The recommended dose (RD) was defined as 1 dose level below the MTD. Results. Twelve patients were enrolled in this study. No DLT was experienced at dose levels 1 and 2 of this schedule. Therefore, 3 patients were started at level 3, but all developed DLT. Therefore, the MTD was dose level 3 and the RD was dose level 2. Conclusion. The RD for adjuvant chemotherapy with CDDP plus VNR for Japanese patients was CDDP 40 mg/m2 plus VNR 25 mg/m2 on days 1 and 8, every 4 weeks for 4 cycles.
View full abstractDownload PDF (298K) -
Ran Guo, Takashi Hirano, Takao Kawakami, Yunbo Gong, Masaharu Nomura, ...2010 Volume 50 Issue 2 Pages 141-150
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSObjective. There is a need to establish clinically useful serum biomarkers for effective lung cancer screening. We investigated extracellular proteins secreted or shed from surgically resected lung adenocarcinoma tissue into its primary culture medium. Methods. In 12 lung adenocarcinoma cases, protein specimens from both culture supernatants of adenocarcinoma tissue and the normal peripheral lung (NPL) tissue were labeled with different fluorescent dyes (CyDyeTM: Cy2, Cy3 and Cy5) and co-resolved in single two-dimensional (2-D) gels. Quantitative protein profiles were obtained by differential fluorescence imaging of the gels. Results. The twelve pairs of 2-D gel images of both adenocarcinoma and NPL specimens revealed 34 distinct protein spots, detected in at least 5 gel images and highly concentrated in the adenocarcinoma cultures, on average more than double the concentration of analysis identified all of these protein spots, including napsin A and pulmonary surfactant-associated protein A which are responsible for the development of type II pneumocytes, and are the proteins commonly upregulated in tumor cells. Conclusion. These results suggest the usefulness of the tissue culture method to identify potential serum biomarkers to enable the early detection of lung adenocarcinoma.
View full abstractDownload PDF (2260K)
Case Report
-
Yusuke Takayama, Hiromi Egawa, Yumi Nakamura, Fumihiro Sugahara, Hiden ...2010 Volume 50 Issue 2 Pages 151-156
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. Pulmonary carcinosarcoma is an extremely rare tumor among lung cancers, having a mixture of carcinoma and sarcoma features histologically, and it is difficult to establish a correct diagnosis preoperatively. Case. A 67-year-old man presented with hemoptysis and chest pain. Chest CT showed a 40-mm tumor in the apex of the right lung. Because malignancy was highly suspected, surgery was performed. The tumor had invaded the chest wall, therefore a right upper lobectomy and chest wall partial resection were performed. On histopathological examination, the tumor mainly showed features of anaplastic carcinoma, but also a small area of a squamous cell carcinoma with distinct keratinization and a large cell neuroendocrine carcinoma (LCNEC). Moreover, small foci of chondrosarcoma were also recognized. According to these histopathological findings, this case was diagnosed as pulmonary carcinosarcoma. The postoperative stage diagnosis was pT3N0M0, stage IIB. Because the histological findings contained LCNEC, chemotherapy with cisplatin and etoposide was performed. However, we performed only 1 cycle of chemotherapy because of the development of herpes zoster. Two years postoperatively, the patient has had no recurrence. We collected and reviewed 87 cases of pulmonary carcinosarcoma reported in the Japanese literature during the past 20 years, with special consideration of their histopathological findings. Conclusion. We report 1 case of pulmonary carcinosarcoma with various pathological features including LCNEC, and reviewed the cases of pulmonary carcinosarcoma reported in the Japanese literature.
View full abstractDownload PDF (1410K) -
Kikuo Shigemitsu, Gen Ito, Akira Shiraki, Takashi Abe, Morihide Ando, ...2010 Volume 50 Issue 2 Pages 157-161
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. Patients with neurofibromatosis type 1 (NF1) have a 10% lifetime risk of developing malignant peripheral nerve sheath tumor (MPNST), and the outcome of MPNST, especially it arises in the trunk, is very poor. Case. We report a case of MPNST in a 34-year-old man with NF1. The patient was referred to our hospital with hoarseness, which a chest X-ray film and computed tomography (CT) revealed to be a large tumor in the right upper mediastinum. He underwent surgery via a partial upper sternotomy with right anterior thoracotomy. The tumor, which derived from the right vagus nerve, was 14×8 cm in size, and appeared pseudocapsulated. Severe adhesion to the trachea and the superior vena cava excluded the possibility of a wide margin resection, although the surgical margin was pathologically negative. In this patient, however, tumor recurred locoregionally without distant metastasis, 6 months after the operation. Both radiotherapy and chemotherapy with carboplatin/etoposide were ineffective, and he died 4 months after recurrence. Conclusion. It is important to consider if an inadequate marginal resection of MPNST requires additional adjunctive therapy.
View full abstractDownload PDF (785K) -
Arinobu Toda, Isao Matsumoto, Makoto Oda, Go Watanabe2010 Volume 50 Issue 2 Pages 162-165
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. Elevated serum creatine kinase (CK) is a potential tumor marker in patients with lung cancer. Case. A 61-year-old woman visited our hospital because of an abnormal shadow detected on her chest X-ray film during a routine medical checkup. On admission, her CK level was elevated, but with a normal pattern of distribution of the CK isoenzymes. A diagnosis of neuromuscular disease was excluded on clinical and neurophysiological examinations. Chest CT showed an irregularly-shaped mass in S10 of the left lung. Sputum cytology and bronchial brushing cytology confirmed a diagnosis of squamous cell carcinoma (cT2N0M0 stage IB), and a left lower lobectomy with lymph node dissection was performed. Immunohistochemistry revealed focal staining of the tumor with both anti-CK-MM and anti-CK-BB antibodies. At the time of writing, 5 years after the operation, the patient remains alive without recurrence. Conclusion. We concluded that the lung tumor cells in this patient produced CK and that elevation of the serum CK level may serve as a marker of tumor recurrence.
View full abstractDownload PDF (978K) -
Takashi Shibusa, Kikuo Onuma, Mitsunori Higuchi, Kenichi Misa2010 Volume 50 Issue 2 Pages 166-171
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. We report a case of squamous cell lung cancer that developed 15 years after surgical resection and chemotherapy for small cell lung cancer (SCLC). Case. An 80-year-old man who had undergone resection and cisplatin, etoposide and doxorubicin chemotherapy on a diagnosis of SCLC 15 years previously at the age of 66, visited our hospital. He complained of wheeze and dyspnea. He was given a diagnosis of squamous cell lung cancer and treated with radiotherapy which improved his symptoms, and he showed response. Conclusion. Patients with stage I SCLC may have a good outcome when treated with a combination of surgery and adjuvant chemotherapy. Careful observation is necessary for patients with long-term survival of SCLC to detect double cancer.
View full abstractDownload PDF (1331K) -
Seijiro Sato, Toru Shirato, Ken-ichi Togashi, Kazuhiro Sato2010 Volume 50 Issue 2 Pages 172-177
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. Carcinosarcoma of the lung is a rare malignant tumor. As no effective treatment other than surgery has been established, its outcome is often poor. Case. The patient was a 65-year-old woman who had undergone atypical mastectomy to treat right breast cancer at the age of 61. After 47 months, a mass of about 3 cm was detected in the S3 region of the right lung on chest CT during a follow-up examination. Bronchoscopic findings suggested primary adenocarcinoma of the lung, and upper and middle lobectomy of the right lung and ND2a were performed. Histopathological examination indicated carcinosarcoma of the lung, in which poorly differentiated adenocarcinoma and chondrosarcoma were mixed, and which was T2N1M0 p-stage IIB. After surgery, adjuvant chemotherapy using gemcitabine was given. Twenty-five months after this surgery, breast cancer metastasis to the femur, and images of multiple masses in bilateral lungs were noted. The lung masses were also considered to be breast cancer metastasis, and chemotherapy using TS-1®, carboplatin, paclitaxel, and docetaxel was given, but the patient developed respiratory insufficiency and died 42 months after surgery for carcinosarcoma of the lung. Conclusion. We report a patient who developed carcinosarcoma of the lung after surgery for breast cancer.
View full abstractDownload PDF (920K) -
Emiko Sugawara, Jiro Kumagai, Aya Sanai, Fumi Fukushima, Tomohide Sato ...2010 Volume 50 Issue 2 Pages 178-185
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. Pulmonary spindle cell carcinoma is a rare lung cancer which was first classified in 1999 by the World Health Organization (WHO). Case. A 70-year-old man was admitted to our hospital because of bloody sputum, right-side chest and back pain, and an abnormal lung shadow. He was originally given a diagnosis of poorly differentiated non-small cell lung carcinoma based on cytology. The tumor had invaded the bones, and the patient received radiotherapy and chemotherapy, both of which were ineffective. The cancer progressed and he died 5 months later. An autopsy revealed that the cancer was sarcomatoid carcinoma (subgroup, spindle cell carcinoma) according to the 2004 WHO classification of tumors. It was difficult to distinguish the carcinoma from sarcomatoid mesothelioma by pathological examination alone. Initial chest computed tomography had showed a lung mass that led to the diagnosis of sarcomatoid carcinoma. The cause directly leading to his death was respiratory failure caused by diffuse alveolar damage. Conclusion. Pulmonary spindle cell carcinoma is believed to have a poor prognosis and is sometimes difficult to distinguish from sarcomatoid mesothelioma. Additional study of cases is needed to confirm this disease entity and to develop better treatments.
View full abstractDownload PDF (1820K) -
Maki Miyamoto, Mikio Takamori, Kengo Murata, Akihiko Wada, Akira Fujit ...2010 Volume 50 Issue 2 Pages 186-193
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSBackground. Primary angiosarcoma of the heart is an extremely rare disease with very poor outcomes in patients with lung metastasis and no established standard chemotherapy. We report a case of angiosarcoma of the heart with multiple metastasis treated with chemotherapy using docetaxel, and radiotherapy. We also review 30 previous reports from Japan on angiosarcoma of the heart with lung metastasis. Case. A 65-year-old man who complained of lumbago, hemoptysis and left leg pain visited a local clinic. Radiological studies demonstrated multiple nodular shadows in both lungs. Computed tomography (CT) revealed multiple nodules in both lungs, liver, left iliac bone, and right atrium. A diagnosis of angiosarcoma was confirmed by a CT-guided needle biopsy of the left iliac bone and surgical biopsy of the right gingiva. The patient was treated with 2 cycles of chemotherapy with docetaxel, immunotherapy with teceleukin, and local radiotherapy. He died on the 80th hospital day from pulmonary hemorrhage. An autopsy revealed poorly differentiated angiosarcoma of the right atrium. Conclusion. While the outcome of angiosarcoma of the heart with lung metastasis is generally very poor (mean survival: 2-3 months), some recent cases have responded favorably to chemotherapy and survived for relatively long periods. We believe that it would be beneficial to accumulate data on chemotherapy and chemosensitivity according to histologic subtypes of angiosarcoma.
View full abstractDownload PDF (1674K)
The 24th Lung Cancer Mass Screening Seminar
-
Hiroshi Tomita, Rumi Ikeda, Tomotaka Osada, Hiroshi Soda, Shigeru Kohn ...2010 Volume 50 Issue 2 Pages 194-200
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSObjective. To clarify the current status and problems of screening for lung cancer in Nagasaki Prefecture. Methods. Study-1: The results of lung cancer mass screening by chest radiography and sputum cytology for 6 years between 2001 to 2006 were analyzed. Study-2: All municipalities in Nagasaki Prefecture received questionnaires entitled "Checklist for screening project evaluation" and "Investigation report", in order to evaluate the quality of lung cancer screening conducted in 2006. Results. Study-1: A total of 422,622 participants were screened during 6 years, and 308 patients with lung cancer were detected (detection rate 72.9/100,000). There were 156 (51%) clinical or pathological stage I cases among the 308 patients. Study-2: The participation rate was 20.1% for lung cancer screening conducted in 2006; the proportion of cases requiring detailed examination was 4.8%, and percentage of cases receiving detailed examination was 78.6%. The lung cancer detection rate was 0.08%, and the positive prediction value (PPV) was 1.7%. Satisfactory quality control of mass screening was not necessarily performed in each municipality. Conclusions. Controlling the quality of mass lung cancer screening and achieving a higher participation rate are necessary to realize a effective lung cancer screening. Officials responsible for lung cancer screening should assign mass screening to the appropriate institution with a view to high accuracy. It is also necessary for the screening agency to raise the detection rate of clinical stage I cases. Furthermore, it is necessary to increase understanding about the importance of quality control by informing the inhabitants of Nagasaki Prefecture about screening accuracy.
View full abstractDownload PDF (1931K) -
Tomio Nakayama, Takaichiro Suzuki, Youko Kusunoki2010 Volume 50 Issue 2 Pages 201-205
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSObjective. It is necessary to establish a system to evaluate the quality of lung cancer screening in prefecture, because there is a large variation in quality in each municipalities and facilities. Method. The Osaka Prefectural Committee for Management of the Lung Cancer Screening System has published the referral rate standings, the detailed consultation rate and the detection rate of lung cancer by municipality and speculating as to why accuracy was low, in the annual reports since 2005. Results. A chart, compared with a table of conventional analysis, was easier for the prefectural clerical officers to understand the analysis. Osaka Prefecture has posted annual data from each municipality using a chart on its website since 2006. Conclusion. Displaying quality assurance data on the website was useful for analysis by the prefectural officers, but merely expecting voluntary improvement in the municipalities is insufficient. Based on the present analysis, the prefectural committee must suggest a concrete remedial plan.
View full abstractDownload PDF (946K) -
Mitsuya Maeda2010 Volume 50 Issue 2 Pages 206-210
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSCancer has been the leading cause of death in Japan since 1981. The Japanese government implemented the Comprehensive 10-year Strategy for Cancer Control (1984-1993) and the New 10-year Strategy to Overcome Cancer (1994-2003) to tackle cancer. Since 2004, the 3rd-term Comprehensive 10-year Strategy for Cancer Control has been implemented in order to promote cancer research and disseminate high quality cancer medical services, with the slogan "Drastic reduction in cancer morbidity and mortality". In 2005, the Japanese Ministry of Health, Labour and Welfare (MHLW) developed the Cancer Control Headquarter in order to promote multidisciplinary activity for comprehensive cancer control, and launched the Action Plan 2005 for Promotion of Cancer Control. In 2006, the ministry developed a new Cancer Control Office section in the Health Service Bureau, MHLW. In 2006, the Cancer Control Act was approved and the law has been implemented since 2007. Based on this law, the Basic Plan to Promote Cancer Control programs was discussed by the Cancer Control Promotion Council, and approved by the Japanese Cabinet in 2007. This plan covers 5 years (from 2007 to 2011). Two overall goals of this plan are "Reduction of cancer deaths" and "Reduction of burden among all cancer patients and their families and improvement of quality of life". The 7 specific fields of this plan are "Cancer medical services", "Developing medical facilities", "Cancer care support and information services", "Cancer registry", "Cancer prevention", "Early detection", and "Cancer research".
View full abstractDownload PDF (300K) -
Tadaoki Morimoto, Tokiko Endo, Masatoshi Okazaki, Mamoru Fukuda, Katsu ...2010 Volume 50 Issue 2 Pages 211-218
Published: 2010
Released on J-STAGE: June 17, 2010
JOURNAL OPEN ACCESSIn Europe and the United States, breast cancer mortality has decreased. This is because detection of early-stage breast cancers has increased due to the widespread use of mammographic screening, and the standard systemic treatments based on evidence-based medicine (EBM) have been established. On the other hand, in Japanese women, both the morbidity and mortality of breast cancer are increasing. Breast cancer screening, using only clinical breast examination (CBE), has long been performed as mass-screening. Mammographic screening for breast cancer was recommended in a notification issued by Ministry of Health, Labour and Welfare in 2000. An important aspect of mammographic screening is quality control. The Central Committee on Quality Control of Mammographic Screening (Central Committee) was launched by 6 screening-related societies, and has attempted to establish a quality control system in Japan. Mammographic screening rate in Japan is currently about 20%. With such a low rate, it is absolutely impossible to reduce the mortality of breast cancer. This paper describes the current status and the quality control system of mammographic screening in Japan, and also the status of breast cancer screening in Europe and the United States. We also referred to the problems of breast cancer screening in Japan, and described the need of concrete measures for implementation of quality control systems in accordance with the aim of improvement of cancer screening rate (up to 50%), support of finance, and population-based screening (organized screening) based on the Cancer Control Act.
View full abstractDownload PDF (919K)
- |<
- <
- 1
- >
- >|