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Volume 50 (2010)
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Volume 50, Issue 7
Displaying 1-11 of 11 articles from this issue
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Report
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Noriyoshi Sawabata, Yoshitaka Fujii, Hisao Asamura, Hiroaki Nomori, Yo ...2010 Volume 50 Issue 7 Pages 875-888
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSThe Japan Lung Cancer Society, Japanese Association for Chest Surgery, and Japanese Respiratory Society jointly established the Japanese Joint Committee for Lung Cancer Registration. In 2010, analyses of 11,663 cases of lung cancer that underwent surgical resection in 2004 were performed, then the findings were registered and collected for analysis by the committee. The survival rate for all cases was 69.6%, while the 5-year survival rate in males (n=7,369) was 63.0% and 80.9% in females (n=4,294). The 5-year survival rates by c-stage (UICC Ver. 6 and Ver. 7) were as follow: IA (n=6,295, 6,295), 82.0% and 82.0%; IB (n=2,788, 2,339), 63.4% and 66.1%, IIA (n=203, 819), 55.4% and 54.5%; IIB (n=899, 648), 48.6% and 46.4%; IIIA (n=940, 1,216), 43.3% and 42.8%; IIIB (n=407, 90), 41.6% and 40.3%; and IV (n=131, 256), 29.1% and 31.4%, respectively. The 5-year survival rates by p-stage (UICC Ver. 6 and Ver. 7) were as follow: IA (n=5,611, 4,978), 85.9% and 86.8%; IB (n=2,398, 2,552), 69.3% and 73.9%; IIA (n=336, 941), 60.9% and 61.6%; IIB (n=977, 848), 51.1% and 49.8%; IIIA (n=1,354, 1,804), 41.0% and 40.9%; IIIB (n=799, 106), 36.7% and 27.8%; and IV (n=188, 434), 27.8% and 27.9%, respectively. The 5-year survival rates by histological type were as follow: adenocarcinoma, 74.9%; squamous cell carcinoma, 59.1%; large cell carcinoma, 53.3%; small cell carcinoma, 52.6%; and adenosquamous cell carcinoma, 50.8%. Operative death occurred in 48 cases (0.4%) and hospital death in 46 (0.4%).
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Review Article
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Hiroyuki Mano2010 Volume 50 Issue 7 Pages 889-893
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSWe discovered a novel fusion-type oncogene EML4 (echinoderm microtubule-associated protein-like 4)-ALK (anaplastic lymphoma kinase) in 4-5% of human lung cancers, which is generated via a small inversion within the short arm of human chromosome 2 (inv [2p]). Through this process, an N-terminal half of the EML4 protein becomes fused to the intracellular tyrosine kinase area of ALK. A coiled-coil region within EML4 leads to constitutive dimerization of EML4-ALK, and thereby induces a marked transforming activity in the fusion kinase. Transgenic mice expressing EML4-ALK in lung epithelial cells generate hundreds of lung cancer nodules soon after birth, but such nodules rapidly disappear in response to the administration of an ALK inhibitor. Therefore, EML4-ALK is likely to be the essential growth driver in those tumors in which fusion occurs. Furthermore, targeting the catalytic activity of EML4-ALK could be a promising means of treating such types of cancer. Phase I/II clinical trials with an ALK inhibitor have already been completed on patients positive for EML4-ALK, which have confirmed the marked therapeutic efficacy of the compound. Today, a phase III trial with the compound is ongoing worldwide. We hope our discovery will thus positively affect the prognosis of hundreds of thousands of lung cancer patients arround the world.
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Original Article
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Daisuke Kasai, Yoshikazu Kotani, Keiko Okuno, Kazuyuki Kobayashi, Yasu ...2010 Volume 50 Issue 7 Pages 894-900
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Sarcomatoid carcinoma of the lung is a relatively rare tumor. We encountered 3 cases of sarcomatoid carcinoma of the lung with marked leukocytosis and elevation of serum granulocyte-colony stimulating-factor (G-CSF) in 2006 and 2007. Cases. Cases were a 56-year-old man, a 57-year-old man and a 70-year-old woman with clinical stage IIIB carcinoma and elevated serum G-CSF levels. We treated all 3 with concurrent chemoradiotherapy. Two of the 3 cases achieved partial response and were well more than 12 months after treatment without any enlargement of their tumors. The remaining case suffered the tumor enlargement and the deterioration of general condition after the first cycle of chemotherapy, and therefore antitumor treatment was abandoned. The findings of leukocytosis highly correlated with therapeutic efficacy. Conclusion. Although the prognosis of patients with sarcomatoid carcinoma with or without G-CSF-producing tumors is reportedly poor, 2 of the present 3 cases responded well to chemoradiotherapy and achieved long-term recurrence-free survival periods.
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Natsumi Matsuura, Shinya Ishikawa, Nariyasu Nakashima, Hitoshi Igai, S ...2010 Volume 50 Issue 7 Pages 901-905
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Bevacizumab is a monoclonal antibody drug which targets vascular endothelial growth factor (VEGF), and is approved for the treatment of patients with unresectable, locally advanced, recurrent or metastatic non-squamous non-small-cell lung cancer (NSCLC). We report the treatment responses and adverse reactions in 4 consecutive patients with advanced or recurrent NSCLC treated using bevacizumab, carboplatin and docetaxel between November 2009 and February 2010. Cases. Patients were 2 men and 2 women between 57 and 68 years old. All patients had adenocarcinoma. Three of 4 patients had been previously treated with surgery, and all had received several regimens of chemotherapy (median, 5.5 regimens; range, 4-7). The Eastern Cooperative Oncology Group performance status was 0 or 1 in all patients. Chemotherapy with carboplatin (area under the curve=6), docetaxel (60 mg/m2) and bevacizumab (15 mg/kg) was given every 3 or 4 weeks for 2 cycles. Chest computed tomography after 2 cycles of treatment showed good response in 2 patients and a tendency for the primary tumor to shrink in 2 patients. Adverse events were grade 4 neutropenia in 3 patients. Grade 1 hemoptysis occurred in 1 patient and grade 1 epistaxis occurred in 3 patients. All events were considered tolerable. Conclusion. We treated 4 consecutive patients with advanced or recurrent NSCLC using 2 cycles of bevacizumab, carboplatin and docetaxel, 2 of them showed good responses.
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Case Report
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Johsuke Hara, Kouichi Nishi, Shingo Nishikawa, Yoshio Tsunezuka, Kazuo ...2010 Volume 50 Issue 7 Pages 906-911
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Primary synovial sarcoma of the pleura and lung is extremely rare. Case. A 35-year-old man was admitted to our hospital because of an abnormal opacity in the right lung. A malignant intrathoracic tumor was suspected and a video-assisted thoracoscopic biopsy was performed. The right thoracic cavity was occupied by a fragile tumor. Histologically, the tumor showed dense proliferation of spindle cells with high rate of mitosis. Immunohistochemical examination was performed, but no definitive diagnosis was obtained. Progression of the tumor was very rapid and he died of respiratory failure 2 months after first presentation. On autopsy, the right lung was compressed and collapsed by the tumor. An SYT-SSX2 fusion gene transcript was detected by reverse transcription polymerase chain reaction (RT-PCR) and direct sequencing using RNA extracted from resected tissue specimens. There was no evidence of tumor except in the pleura. The final diagnosis was primary pleural synovial sarcoma. Conclusion. We report an extremely rare case of primary pleural synovial sarcoma.
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Chisato Matsui, Tomoya Kono, Yasuji Terada, Takashi Hanatani, Hironobu ...2010 Volume 50 Issue 7 Pages 912-915
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Prolonged cancer therapy carries the risk of secondary or third cancer. Among these, we encounter some cases of radiation-induced cancer. Case. A 77-year-old woman had previously received 4 courses of chemotherapy (carboplatin and paclitaxel) and radiotherapy (63.6 Gy) for squamous cell carcinoma of the lung (cT4N2M0, stage IIIB). With satisfactory outcome, no recurrence had been observed for 5 years. A follow-up chest X-ray film and computed tomography (CT) scan revealed a new tumor shadow, initially diagnosed as small cell lung cancer in the irradiated field. Since the second tumor had a different histological diagnosis and appeared in the irradiated field of the initial tumor 5 years previously, we diagnosed radiation-induced cancer. Conclusion. Radiation-induced cancer has a long incubation period, therefore long-term observation necessary.
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Kazunori Shimizu, Hidekazu Suzuki, Tomonori Hirashima, Motohiro Tamiya ...2010 Volume 50 Issue 7 Pages 916-920
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Recent advances in chemotherapy have prolonged the survival of lung cancer patients. However, there have been reports of patients who suffer therapy-related leukemia after chemotherapy. Case. A 64-year-old woman was given a diagnosis of adenocarcinoma (T4N0M0 stage IIIB) in 2004, and received chemotherapy with cisplatin and other drugs from 2004 to 2009, and radiotherapy for brain metastasis in 2008. In January 2009, she was admitted to our hospital with low-grade fever, fatigue, and prolonged neutropenia. A peripheral blood smear revealed a predominance of circulating myeloblasts. Examination of the bone marrow aspirate confirmed acute myelogenous leukemia. We think that therapy-related leukemia developed because of long-term chemotherapy and radiotherapy. Conclusion. Therapy-related leukemia can develop in lung cancer patients who undergo long-term therapy.
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Tatsuo Takama, Masakazu Sugaya, Koji Kuroda, Takeshi Orihashi, Kazuhik ...2010 Volume 50 Issue 7 Pages 921-925
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. We report a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lung associated with pneumoconiosis showing accumulation on 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET). Case. A 76-year-old man was given a diagnosis of pneumoconiosis 20 years previously and had undergone a periodic health examinations for pneumoconiosis. He was referred to our hospital because of a lung nodule in the right S6 with spiculation and pleural indentation. FDG-PET revealed accumulation in the nodule. Right lower lobectomy was performed for diagnosis and treatment. The histopathological findings revealed MALT lymphoma of the lung. Conclusion. MALT lymphoma of the lung is a comparatively rare malignant lymphoma. To the best of our knowledge there are no reports on MALT lymphoma detected during follow-up for pneumoconiosis. However, there have been several reports on accumulation of FDG in MALT lymphoma of the lung on FDG-PET. In this case, we speculated that MALT lymphoma of the lung might have originated from stimulation by chronic exposure of antigens such as fumes and mine dust. MALT lymphoma of the lung should not be excluded when considering the differential diagnosis.
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Osamu Kawamata2010 Volume 50 Issue 7 Pages 926-931
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Diffuse malignant pleural mesothelioma (MPM) has a poor prognosis and there is no consensus on standard therapy. Furthermore, it is difficult to make a definitive diagnosis of MPM. In the present case, chemotherapy was performed after diagnosis by thoracoscopic biopsy. Six years after diagnosis extra-pleural pneumonectomy was performed. Case. A 54-year-old man had pleural effusion pointed out in a medical examination in early, 2001. MPM was diagnosed by pleural needle biopsy at another hospital. However, a diagnosis of MPM was not confirmed by another physician, and the patient was referred to our hospital in 2002. We performed thoracoscopic pleural biopsy in March, 2003, which resulted in a diagnosis of epithelial-type MPM (T1bN0M0 stage IB). We administered chemotherapy, after which we performed extra-pleural pneumonectomy. We confirmed recurrence by additional examination in the postoperative first year, but he is still alive at the time of writing. Conclusion. In order to obtain long-term survival by chemotherapy in such cases, careful consideration of the possibility of early-stage MPM is essential.
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Ryoji Kawano, Masatoshi Gika, Yako Hasegawa, Yukino Yoshimura, Takao H ...2010 Volume 50 Issue 7 Pages 932-936
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Although mucosa-associated lymphoid tissue (MALT) lymphoma has recently been understood to occur in various organs, reports on its development in the thymus are limited. Case. A 59-year-old man had an abnormal shadow with a maximum dimension of 7.5 cm in the anterior mediastinum, pointed out on a computed tomography (CT) scan. It was well-defined with a homogeneous density, suggesting thymoma, and the patient underwent total thymectomy. The pathological diagnosis was MALT lymphoma of the thymus associated with thymic cyst, showing proliferation of centrocyte-like tumor cells (CCL) which were positive on immunohistochemical staining for anti-CD20 and bcl-2 antibodies and λ-type monoclonality of the immunoglobulin light chain. Conclusion. MALT lymphoma is a candidate in the differential diagnosis and treatment of anterior mediastinal lesions.
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Minoru Inomata, Toshimichi Miya, Yutaka Kokubo2010 Volume 50 Issue 7 Pages 937-941
Published: 2010
Released on J-STAGE: February 18, 2011
JOURNAL OPEN ACCESSBackground. Radiation recall pneumonitis is one of the radiation recall reactions which can occur after radiation therapy followed by various drugs. To the best of our knowledge, there is only 1 report of radiation recall pneumonitis induced by gefitinib in the literature. Case. We report a case of a 55-year-old man with recurrent adenocarcinoma of the lung after resections of double cancers in the right upper and middle lobes. Radiation therapy (45 Gy/given in 9 fractions) for a metastatic lesion of the 6th rib was given for pain relief. Then, 4 cycles of chemotherapy consisting of carboplatin and gemcitabine were given, resulting in progressive disease with deterioration of bilateral pleural effusion and no evidence of radiation pneumonitis. Epidermal growth factor receptor (EGFR) mutation (exon 21:L858R) was found in the sample obtained from the pleural effusion, and gefitinib (250 mg/day) was started as second-line chemotherapy. Two weeks later, dry cough and dyspnea on effort appeared, and chest X-ray films and computed tomographic scans showed ground-glass opacities in the right upper lung which exactly corresponded to the previous irradiated field. Gefitnib was stopped and oral prednisolone improved the interstitial pneumonitis. To the best of our knowledge, this is the first report of radiation recall pneumonitis of patient with EGFR mutation induced by gefitinib 8 months after the completion of radiotherapy. Conclusion. When giving gefitinib, a possible radiation recall reaction should also be considered in interstitial lung disease.
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