Recent developments in targeted therapy have forced the development of a treatment algorithm for lung cancer based on the pathological subtype. In March 2015, the WHO classification for lung cancer was revised as the 4th edition. The new classification was revised in consideration of clinically significant factors, such as the use of targeted therapies, based upon genetic alterations and/or prognosis. In this section, we outline the WHO classification (4th ed.), and explain the points that have been revised for adenocarcinoma and diagnostic methods for differentiation of the pathological subtype.

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肺癌は癌死亡原因の第一位であり，死亡者数は なお増加傾向にある．外科治療において，現在の肺癌の 標準術式は肺葉切除術である．近年の検診の普及により 小型肺癌に遭遇する機会が増えた．それに伴い楔状切除 や区域切除などの縮小手術に対する機運が高まってき た．臨床試験によって標準である肺葉切除に対する縮小 手術の妥当性が検証中である．また胸腔鏡などの技術の 向上により，小さな皮膚切開創による手術が可能となり， 患者にかかる体の負担も軽減されてきた．今後も様々な 手術手技の向上によって，手術がより低侵襲化していく と思われる．

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Locally advanced non-small cell lung cancer (NSCLC) is a heterogenous disease, with considerable variations in prognosis and treatment options. The treatment for locally-advanced NSCLC is divided into two groups: resectable and unresectable. The standard treatment for unresectable locally-advanced NSCLC is chemoradiotherapy, and advances in EGFR receptor and immune checkpoint inhibitors have produced a number of novel treatment options. The standard treatment for resectable T4 NSCLC is combined resection with the surrounding organ. The exclusion of N2 disease is necessary because the mortality and morbidity rates are very high, and the survival of T4N2 disease is not satisfactory. The treatment for resectable N2 disease remains controversial because only limited merits of resection have been demonstrated in clinical trials. Novel anticancer agents and new molecularly targeted drugs, as well as advances in radiation and surgical technology, are expected to improve outcomes in the near future.

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The standard therapy for early-stage non-small cell lung cancer (NSCLC) is pulmonary lobectomy. However, the Evidence-based Clinical Practice Guidelines for Lung Cancer of 2017 (the Japan Lung Cancer Society) recommend that stereotactic body radiotherapy (SBRT) should be performed as a curative treatment in patients who cannot undergo surgery for medical reasons. SBRT is highly effective against early-stage NSCLC and the adverse events due to RT are tolerable. We have noted the indication of SBRT for early-stage NSCLC.

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Computed tomography (CT)-guided lung biopsy is a useful method for establishing the pathological diagnosis of a lung nodule, mass, or even ground glass opacity. The biopsy is performed with a 20G semi-automatic biopsy needle under local anesthesia. The exclusion criteria include uncontrollable coagulopathy and serious respiratory distress. The clinical application of CT is varied, i.e., to differentiate between primary lung cancer and lung metastasis, to detect epidermal growth factor receptor (EGFR) mutations for treatment with EGFR-tyrosine kinase inhibitor, and to exclude benign deceases, such as tuberculoma, etc. The minor complications include pneumothorax and lung hemorrhage. Pneumothorax can sometimes require the use of a chest tube. The serious complications include air embolism and dissemination via the needle tract. Air embolism may occur and cause neurological deficits by cerebral artery occlusion or cardiac arrest due to coronary artery occlusion.

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Medical therapy for lung cancer refers to chemotherapy using anticancer agents. Anticancer agents are drugs that suppress the growth of cancer and have cell-killing actions. Chemotherapeutic approaches made remarkable progress at the end of the 20th century. Since the beginning of the 21st century, medical therapies for lung cancer have developed further with the advent of molecular targeting agents. This section outlines the history of the development of lung cancer chemotherapy and key drugs for lung cancer, and describes the current state and future prospects of medical therapy

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We assessed whether signal intensity units (SIUs) on intracardiac echocardiography (ICE) images can be used to identify scar tissue in the left ventricle (LV) and, thus, guide ablation of substrate-based ventricular tachycardia. Two-dimensional ICE images were obtained from 12 patients undergoing catheter ablation and were used for 3D reconstruction of the LV. Electroanatomic maps were also obtained. Contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) was performed in 8 of these patients. The SIUs for the ICE images, low-voltage zones on the electroanatomic maps, and late gadolinium-enhancement areas on the CE-CMR images corresponded. Thus, ICE may be useful for identifying LV scar substrate.

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Background: The success rates for ablation of persistent atrial fibrillation (PerAF) are lower than those for ablation of paroxysmal AF (PAF). We investigated whether a relation exists between the presence of sinus rhythm (SR) early in the procedure and the ablation outcome in patients with PerAF. Methods and Results: The study involved 46 patients with persistent AF (< 7 days duration; 7 women, 39 men, aged 60.8 ± 10.0 years; AF duration, 14 [5, 48] months) who underwent pulmonary vein isolation (PVI). Ablation outcomes were compared between patients who were in SR early during the procedure, because 1) SR was present at the start of the procedure (SR group), 2) AF was electrically cardioverted to SR before PVI (DC group), or 3) PVI was performed during AF (AF group). After a 3-month blank period, the incidence of freedom from AF after the single procedure was significantly higher in the SR group compared with that in the DC and AF groups (100%, 46% and 50%, respectively, P = 0.0110), during median follow-up periods of 15.5, 19.4, and 28.2 months, respectively. Conclusion: The presence of spontaneous SR before ablation for PerAF appears to be related to AF-free survival.

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Background: Recurrences within 3 months after radiofrequency catheter ablation of atrial fibrillation (AF) have been reported to be associated with the onset of recurrence after 3 months. Although very early recurrence of AF (VERAF) and early recurrence of AF (ERAF) after cryoballoon (CB) ablation are sometimes observed, little is known about their impact on recurrence beyond a recovery period of 3 months. This study aimed to clarify the characteristics of the VERAF and ERAF of AF after CB ablation. Methods and Results: Ninety patients with PAF (n = 58) and PerAF (n = 32), with a median AF duration since the first diagnosis of 2.5 (5, 48) months, underwent CB-based pulmonary vein isolation (PVI). The freeze cycle duration was set at 180 sec, and an additional freeze cycle of 120 sec was applied. The ECG monitor was recorded during hospitalization, and at the outpatient clinic visits at 2 weeks and 1, 3, 6, and 12 months, including Holter electrocardiograms and ambulatory event electrocardiograms. VERAF (within 3 days) and ERAF (< 3 months) were observed in 14 (16%) and 12 (13%) patients, respectively. Nine patients with VERAF and six with ERAF were AF free during a mean followup period of 12 months. Conclusion: While very early recurrence of AF after cryoballoon-based PVI did not correlate with the clinical outcome, early recurrence of AF after cryoballoon-based PVI correlated with a worse clinical outcome.

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