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ABSTRACT: We report a case of a response to long-term treatment with vinorelbine and zoledronate in a patient with lymph node and multiple bone metastases after lung cancer surgery. CASE: The patient was a 70-year-old male initially examined by a local physician for an abnormal shadow that had been detected on a chest X-ray during a screening examination. CT revealed a mass shadow measuring 28 mm in diameter in the left S10, and because lung cancer was suspected, the patient was admitted to our hospital for the first time and examined. Lung cancer was diagnosed intraoperatively, and left lower lobectomy was performed. The pathological stage was III a, and postoperative adjuvant chemotherapy was performed, but recurrences in the form of lymph node and multiple bone metastases were detected. After diagnosis of the recurrence, the patient was treated with long-term vinorelbine (VNR)biweekly and zoledronate (ZOL) monthly, and a response was obtained. CONCLUSIONS: A patient with postoperative recurrence of lung cancer associated with multiple bone metastases responded to combination chemotherapy with VNR and ZOL. VNR was effective against postoperative recurrence in an elderly lung cancer patient with complications, and could be administered safely long-term. ZOL also had a favorable protective effect against skeletal-related events (SREs) in lung cancer, and the results suggested that it also had an antitumor effect in this patient.
Gan to kagaku ryoho. Cancer & chemotherapy 04/2012; 39(4):641-3.
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Kinya Furukawa,
Junzo Ishida,
Masaharu Inagaki,
Kazuhiko Takabe,
Shigemi Ishikawa,
Mitsuaki Sakai,
Hideo Ichimura,
Koichi Kamiyama,
Takayuki Kaburagi,
Kenji Hayashihara,
Koji Kishi,
Makoto Saito,
Hiroaki Satoh
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ABSTRACT: There is no standard treatment and there are no clearly defined guidelines for the treatment of postoperative recurrent non-small-cell lung cancer (NSCLC). We performed a retrospective population-based study to assess the benefits of treatment with gefitinib in patients with a postoperative recurrence of NSCLC in general clinical practice. This retrospective population-based study was conducted on patients with postoperative recurrent NSCLC who had been treated with gefitinib at 14 institutions in Ibaraki Prefecture between July 2002 and September 2007. The objective response rate to gefitinib therapy was 37.6% for local and distant recurrence. The median survival time following the start of gefitinib therapy was 12 months, and the one-year and two-year survival rates were 48.9 and 28.9%, respectively. The median survival time of the females was 19 months, and the median survival time of the males was 9 months (p=0.002). Univariate analysis showed that female gender, adenocarcinoma, a performance status (PS) of 0-1 and absence of smoking history were favorable prognostic factors. Only female gender and a PS of 0-1 were independent statistically significant prognostic factors in the multivariate analysis. The rate of greater than grade 1 interstitial lung damage as an adverse event was 3.5%. Gefitinib is a feasible treatment for postoperative recurrent NSCLC in general clinical practice, and a good response and prolonged survival were obtained, similar to the findings reported in published clinical studies that were conducted on highly selected patients.
Experimental and therapeutic medicine 01/2012; 3(1):53-59.
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ABSTRACT: and Objective Photodynamic therapy (PDT) has come to be considered as the first choice of treatment for central type early stage lung cancer (CELC). Recent advances in the ability to diagnose CELC, and in photosensitizers, as well as sophisticated clinical management, may improve the therapeutic outcome and expand the indications of PDT.
We made the search for papers on PDT for lung cancer to select the most relevant articles. Based on this review and our recent data, we discussed the best available evidence for the diagnosis, the definition of indications, photosensitizers, and clinical management with regard to PDT.
To obtain complete response (CR) by PDT, the selection of the indications is extremely important, including the extent of the tumor on the bronchial surface and the depth of invasion in the bronchial wall. The development of autofluorescence bronchoscopy (AFB) and endobronchial ultrasonography (EBUS) have had a large impact on diagnostic bronchoscopy for CELC. CELCs less than 1 cm in diameter showed a favorable cure rate by PDT, thus this is a good indication for PDT. The relatively newer photosensitizer NPe6, which has a stronger antitumor effect than Photofrin, showed similar treatment outcome even for large tumors >1.0 cm in diameter. Furthermore, comprehensive management including photodynamic diagnosis before and after PDT should be effective to minimize the possibility of local recurrence after PDT.
The present guidelines of PDT for CELC were established based on the data obtained from studies in the 1980's. We postulate that comprehensive diagnosis and the new generation of photosensitizers may increase the CR rate and expand the indications of PDT for larger tumors.
Lasers in Surgery and Medicine 09/2011; 43(7):749-54. · 2.75 Impact Factor
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ABSTRACT: Approximately 30% of lung cancer patients will develop central airway obstruction (CAO). Interventional therapeutic bronchoscopy including airway stenting (AS) providing immediate and effective palliation is therefore essential to improve quality of life (QoL). However, no report has demonstrated the survival benefit of AS. We retrospectively reviewed 65 patients with CAO due to lung cancer who underwent AS from June 1994 to May 2008. Seventy-nine stents were required. Silicon, metallic, or both stents were placed in 42 (60%), 19 (29%), or eight (11%) patients, respectively. Single stent was required in 53 (83%) patients, double in 10 (14%), and triple in two (3%). AS could provide acute relief of central airway and significant improvement was seen in 98% of patients. Fifty-nine patients with detailed observations were assessed further. Morbidity and mortality rates were 22% and 8%, respectively. AS resulted in 25.2% of one-year survival rate and 6.2 months of median survival time (MST). AS followed by adjuvant therapy provided a four-month increase in MST, although overall survival was not significantly changed. This study represents a single-institution experience. Although an aggressive strategy of AS is justified in order to improve symptoms and QoL, AS itself did not contribute to survival benefit.
Interactive cardiovascular and thoracic surgery 10/2010; 11(4):425-8.
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ABSTRACT: To our knowledge there is no in-depth report on the benefits of airway stenting, which focuses specifically on patients with inoperable advanced lung cancer causing severe central airway obstruction. We evaluated the role of airway stenting as one aspect of the multidisciplinary management of advanced lung cancer.
We performed airway stenting in 40 lung cancer patients, placing a total of 58 stents. Stenting was done as a final modality in 22 patients with terminal-stage lung cancer (group A). The other 18 patients received additional therapy after stenting (group B), 12 (66.7%) of whom were treatment-naïve on admission.
The performance status (PS) and Hugh-Jones classification (H-J) scores improved in both groups after stenting: from 3.56 to 2.48 (P = 0.001) and 4.29 to 3.20 (P = 0.004) in group A, and from 3.15 to 1.25 (P < 0.001) and 4.10 to 2.10 (P < 0.001) in group B, respectively. The median survival time and 1-year survival rate after stenting were 1.6 months and 5.1%, respectively, in group A, and 5.6 months and 25.0%, respectively, in group B.
Airway stenting followed by adjuvant therapy may improve the survival of treatment-naïve patients with severe symptomatic airway obstruction caused by advanced lung cancer.
Surgery Today 04/2010; 40(4):315-20. · 1.22 Impact Factor
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Jitsuo Usuda,
Yoshihiko Tsunoda,
Shuji Ichinose,
Taichirou Ishizumi,
Keishi Ohtani,
Sachio Maehara,
Shoutarou Ono,
Hidemitsu Tsutsui,
Tatsuo Ohira,
Tetsuya Okunaka, Kinya Furukawa,
Yoshikazu Sugimoto,
Harubumi Kato,
Norihiko Ikeda
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ABSTRACT: The ATP-binding cassette (ABC) transporter protein, BCRP (breast cancer resistance protein)/ABCG2 pumps out some types of photosensitizers used in photodynamic therapy (PDT) and causes resistance to the antitumor effect of PDT. The purpose of this study was to investigate the association between the expression of BCRP and the efficacy of PDT using Photofrin, or the second-generation photosensitizer, NPe6, for centrally located early lung cancers. Using human epidermoid carcinoma cells, A431 cells and the BCRP-overexpressing A431/BCRP cells, we examined the effects of BCRP expression on the effect of PDT by cell viability assay in vitro, and investigated the expression of BCRP by immunohistochemical analysis in 81 tumor samples obtained from patients with centrally located early lung cancers. The A431/BCRP cells were more resistant to Photofrin-PDT than A431 cells in vitro, and Fumitremorgin C, a specific inhibitor of BCRP, reversed the resistance. However, there was no significant difference in the antitumor effect of NPe6-PDT between these cells. All of the 81 centrally located early lung cancer lesions were BCRP-positive (2+, 45 lesions; 1+, 30 lesions) and all the patients were male and heavy smokers (>30 pack-years). The expression of BCRP significantly affected the efficacy of Photofrin-PDT in cancer lesions > or =10mm in diameter (P=0.04). On the other hand, NPe6-PDT exhibited a strong antitumor effect, regardless of the expression status of BCRP. Photofrin may be a substrate of BCRP and be pumped out from the cells, therefore, BCRP may be a molecular determinant of the outcome of Photofrin-PDT.
Lung cancer (Amsterdam, Netherlands) 05/2009; 67(2):198-204. · 3.14 Impact Factor
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Hidemitsu Tsutsui,
Mitsuhiro Kubota,
Masae Yamada,
Akihiko Suzuki,
Jitsuo Usuda,
Hiroshi Shibuya,
Kuniharu Miyajima,
Kiminori Sugino,
Koichi Ito, Kinya Furukawa,
Harubumi Kato
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ABSTRACT: Airway stenting can be a valuable therapeutic option for symptomatic airway stenosis, but its role in the palliation of advanced thyroid cancers invading the upper airway is unclear. This study examined the hypothesis that durable and replaceable silicone stents would give better results than self-expanding metallic stents.
A retrospective analysis was conducted of consecutive patients stented for laryngotracheal obstruction due to thyroid cancer. Stenting was performed via a rigid bronchoscope when airway patency after dilatation was <or=50% of normal. Symptomatic improvement, Hugh-Jones (H-J) classification, Eastern Cooperative Oncology Group performance status (PS), and complications were analysed.
There were 37 stenotic lesions treated in 35 patients. The most common sites for these lesions were in the inclusive area extending from the cricoid cartilage to the first tracheal ring (26/37 lesions, 70%). Forty-five stents (12 silicone, 20 metallic, 13 T-tubes) were used in 43 interventions. All patients showed immediate symptomatic relief and significant improvement in both PS and H-J classifications. Critical complications were supraglottic stenosis (5/43 interventions, 12%) and, of those same five cases, stent migration was seen in all but one (4/45 implantations, 9%). As these complications occurred only in patients in whom the silicone stents had been placed in close proximity to the cricoid cartilage (5/10 patients, 50%), this emphasizes the unsuitability of silicone stents in such cases. The median survival time from stenting was 8 months. The 1-year survival rate was 40%.
Airway stenting can achieve significant palliation in patients with thyroid cancer and airway obstruction. The study showed that for the most common lesions, the uncovered Ultraflex stent is associated with fewer critical complications than the silicone stents.
Respirology 06/2008; 13(5):632-8. · 2.42 Impact Factor
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Jitsuo Usuda,
Hidemitsu Tsutsui,
Hidetoshi Honda,
Shuji Ichinose,
Taichirou Ishizumi,
Takeshi Hirata,
Tatsuya Inoue,
Keishi Ohtani,
Sachio Maehara,
Kentarou Imai,
Yoshihiko Tsunoda,
Mitsuhiro Kubota,
Norihiko Ikeda, Kinya Furukawa,
Tetsuya Okunaka,
Harubumi Kato
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ABSTRACT: We had previously developed the possibility of use of a photodynamic diagnosis (PDD) system using a tumor-selective photosensitizer and laser irradiation for the early detection and photodynamic therapy (PDT) for centrally located early lung cancers. Recently, we established the autofluorescence diagnosis system integrated into a videoendoscope (SAFE-3000) as a very useful technique for the early diagnosis of lung cancer.
Twenty-nine patients (38 lesions) with centrally located early lung cancer received PDD and PDT using the second-generation photosensitizer, talaporfin sodium (NPe6). Just before the PDT, we defined the tumor margin accurately using the novel PDD system SAFE-3000 with NPe6 and a diode laser (408nm).
Red fluorescence emitted from the tumor by excitation of the photosensitizer by the diode laser (408nm) from SAFE-3000 allowed accurate determination of the tumor margin just before the PDT. The complete remission (CR) rate following NPe6-PDT in the cases with early lung cancer was 92.1% (35/38 lesions). We also confirmed the loss of red fluorescence from the tumors immediately after the PDT using SAFE-3000. We confirmed that all the NPe6 in the tumor had been excited and photobleached by the laser irradiation (664nm) and that no additional laser irradiation was needed for curative treatment.
This novel PDD system using SAFE-3000 and NPe6 improved the quality and efficacy of PDT and avoided misjudgement of the dose of the photosensitizer or laser irradiation in PDT. PDT using NPe6 will become a standard option of treatments for centrally located early lung cancer.
Lung Cancer 01/2008; 58(3):317-23. · 3.43 Impact Factor
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ABSTRACT: A 59-year-old male was referred to our hospital with the chief complaint of a painless scrotal mass. A 6 X 4.5 X 4 cm elastic hard mass with irregular surface was palpable in the right scrotum. We diagnosed a tumor in the right scrotum and resected the tumor surgically. Histopathologically, the tumor was liposarcoma of the right scrotum. Lung tumors were found 20 months after resection of the origin. Systemic chemotherapy with new anti-cancer agents (Paclitaxel and Gemcitabine) was performed. The main tumor was reduced to 56% in its diameter after 6 courses of chemotherapy. Exclusion of the right middle and lower pulmonary lobe was performed. The final pathological diagnosis of the lung tumor was metastatic liposarcoma.
Hinyokika kiyo. Acta urologica Japonica 10/2006; 52(9):737-40.
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Shuji Ichinose,
Jitsuo Usuda,
Takeshi Hirata,
Tatsuya Inoue,
Keishi Ohtani,
Sachio Maehara,
Mitsuhiro Kubota,
Kentarou Imai,
Yoshihiko Tsunoda,
Yukari Kuroiwa,
Kimito Yamada,
Hidemitsu Tsutsui, Kinya Furukawa,
Tetsuya Okunaka,
Nancy L Oleinick,
Harubumi Kato
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ABSTRACT: ATX-s10 is a novel and second-generation photosensitizer for photodynamic therapy (PDT). In order to conduct clinical trials of ATX-s10-PDT and/or extend its clinical applications, it is very important to elucidate the mechanisms of the action of ATX-s10-PDT. We examined the apoptic response against ATX-s10-PDT using a Bcl-2 or Bcl-2 mutant overexpressing cells. Using fluorescent microscopy, ATX-s10 localized not only to mitochondria but also to lysosomes and possibly other intracellular organelles, but not to the plasma membrane or the nucleus. These results suggest that ATX-s10-PDT can damage mitochondria and lysosomes. By Western blot analysis, ATX-s10-PDT damaged Bcl-2, which localized preferentially at mitochondrial membranes, and caused Bcl-2 to cross-link immediately after laser irradiation. However, ATX-s10-PDT was not able to rapidly induce morphologically typical apoptosis (i.e. chromatin condensation and fragmentation) as PDT using mitochondria targeted photosensitizers, such as phthalocyanine 4 (Pc 4). Pharmacological inhibitions of lysosomal cytokine protease cathepsins, such as cathepsin B and D, protected MCF-7c3 cells (human breast cancer cells expressing stably transfected procaspase-3) from apoptosis caused by ATX-s10-PDT. Overexpression of wild-type Bcl-2 or Bcl-2Delta33-54 resulted in relative resistance of cells to ATX-s10-PDT, as assessed by the degree of morphological apoptosis or loss of clonogenicity. We conclude that lysosomal damage by ATX-s10-PDT can initiate apoptotic response and this apoptotic pathway can be regulated by photodamage to Bcl-2 via mitochondrial damage.
International Journal of Oncology 09/2006; 29(2):349-55. · 2.40 Impact Factor
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Jitsuo Usuda,
Harubumi Kato,
Tetsuya Okunaka, Kinya Furukawa,
Hidemitsu Tsutsui,
Kimito Yamada,
Yasuhiro Suga,
Hidetoshi Honda,
Yoshitaka Nagatsuka,
Tatsuo Ohira,
Masahiro Tsuboi,
Takashi Hirano
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ABSTRACT: Photodynamic therapy (PDT), a treatment for cancer, uses a photosensitizer and laser irradiation to produce reactive oxygen in cells. In Japan, the United States, and many other countries, PDT is a treatment option for stage 0 (TisN0M0) and stage I (T1N0M0) centrally located early stage lung cancer. PDT can preserve lung function, can be repeated, and can be combined with other therapeutic modalities such as chemotherapy. Recently, mono-l-aspartyl chlorine e6 (NPe6, Laserphyrin), a second-generation photosensitizer with lower photosensitivity than Photofrin (porfimer sodium), was approved by the Japanese government and a phase II clinical study using NPe6 with a new diode laser demonstrated an excellent antitumor effect and low skin photosensitivity. We expect PDT to be widely employed in many fields and the applications of PDT to be extended because of the decreasing cost of laser equipment and lower systemic photosensitivity induced by the photosensitizer. The purpose of this review is to introduce not only recent clinical trials of PDT for centrally located early lung cancer, but also new applications of PDT for cases of peripheral-type, early-stage lung cancers. We also discuss the applications of PDT for advanced lung cancer and combined therapy using PDT and other treatments for lung cancer.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 07/2006; 1(5):489-93. · 4.55 Impact Factor
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ABSTRACT: It is well known that central-type early stage lung cancer < 1.0 cm in diameter shows almost 100% complete response (CR) to photodynamic therapy (PDT). However, we have encountered cases of local recurrence after CR of tumors with a surface diameter < 1.0 cm.
Ninety-three patients with 114 lesions were followed up, and cases of recurrence after CR has been obtained with initial tumors that had a diameter < 1.0 cm were examined. We compared the cytologic findings of local recurrence after CR to the cytologic findings before PDT. The relationship between the cell features and the depth of bronchial tumor invasion before PDT and on recurrence was evaluated.
The CR and 5-year survival rates of patients with lesions < 1.0 cm were 92.8% (77 of 83 patients) and 57.9%, respectively; meanwhile, in the group of patients with lesions > or = 1.0 cm, CR and 5-year survival rates were 58.1% (18 of 31 patients) and 59.3%. There was a significant difference in efficacy between the two groups (p < 0.001). Recurrences after CR were recognized in 9 of 77 lesions (11.7%) < 1.0 cm. When the recurrent tumor cells showed type I-II (low-to-moderate atypia) at the same site initially treated, CR could be obtained by a second PDT. Type III cells (high-grade atypia) showed the characteristics of tumor cells from deeper layers of the bronchial wall. Local recurrence at the same site may be caused by residual tumor cells from deep layers because of inadequate laser irradiation and penetration.
To reduce the recurrence rate, it is essential to accurately grasp the tumor extent and the depth of the bronchogenic carcinoma before performing PDT. Analysis of cell features of recurrent lesions after CR appears to be a useful source of information as to the depth of cancer invasion in the bronchial wall.
Chest 11/2005; 128(5):3269-75. · 5.25 Impact Factor
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ABSTRACT: New modalities for local treatments that destroy tumor effectively but which are less invasive and less damaging to normal lung tissue must be developed for patients who are unable to undergo even video-assisted thoracic surgery (VATS) due to poor cardiopulmonary function, severe adhesion, or advanced age, etc. We evaluated the use of microwave coagulation therapy (MCT), which has been used successfully for coagulation of hepatic tumors, in normal canine lung tissue to evaluate its efficacy and safety.
Measurements of thermal response and coagulation area and histological examinations after microwave coagulation were performed in normal canine lung tissue.
The temperature in normal canine lung tissue increased to 90-100 degrees C at 5 mm from the electrode after 60 s and 70-80 degrees C at 10 mm after 90 s at 40 or 60 W. The coagulation area was approximately 20 mm in diameter at 40 W and 60 W. Histological analysis demonstrated thickening of collagen fiber shortly after coagulation, stromal edema and granulation tissue after 3 months, and, finally, scar tissue was seen after 6 months.
Microwave coagulation therapy (MCT) is a useful modality for minimally invasive therapy in peripheral lung tumors.
Journal of Surgical Research 03/2005; 123(2):245-50. · 2.25 Impact Factor
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ABSTRACT: We conducted combination chemotherapy with gemcitabine (GEM) and paclitaxel (TXL) for stage III non-small cell lung cancer. The chemotherapy schedule consisted of GEM 800 mg/m2 and TXL 70 mg/m2 once a week for 6 consecutive weeks. The patients were 7 males and 3 females with a median age of 66 years. There were 5 adenocarcinomas and 5 squamous cell carcinomas, 7 stage IIIA and 3 IIIB. Eight patients completed 6 cycles of planned administration. Of 9 patients who were evaluable for response, 6 patients achieved PR (66.7%), 2 patients had SD, and 1 patient had PD. The cancers were resectable in 7 out of 9 patients, and were resected completely in 5 patients. Grade 3 anemia and leucopenia were observed in 1 patient and 2 patients, respectively, but they were mild. In our experience, a non-platinum weekly regimen with GEM and TXL is well tolerated and effective, which suggests the possibility of induction chemotherapy and outpatient treatment.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2003; 30(12):1923-6.
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Harubumi Kato, Kinya Furukawa,
Masami Sato,
Tetsuya Okunaka,
Yohko Kusunoki,
Masaaki Kawahara,
Masahiro Fukuoka,
Teruomi Miyazawa,
Takashi Yana,
Kaoru Matsui,
Takeshi Shiraishi,
Hirohisa Horinouchi
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ABSTRACT: Photofrin is the most commonly used photosensitizer for photodynamic therapy (PDT). The major side effect of Photofrin is cutaneous photosensitivity. A second generation photosensitizer, mono-L-aspartyl chlorin e6 (NPe6) has shown anti-tumor efficacy and rapid clearance from skin. Therefore, we conducted a phase II clinical study to investigate the anti-tumor effects and safety of NPe6 in patients with early superficial squamous cell carcinoma of the lung. Enrollment criteria consisted of endoscopically evaluated early stage lung cancer with normal chest X-ray and CT images, no lymph node or distant metastasis. Tumors were located no more peripherally than subsegmental bronchi, the peripheral margin had to visible, and the tumor size had to not more than 2 cm in diameter. The histologic type of the tumor had to squamous cell carcinoma. Laser irradiation (100 J/cm2) using a diode laser was performed at 4 h after administration of NPe6 (40 mg/m2). Among 41 patients with 46 lesions, 40 with 45 lesions were eligible for safety evaluation, and 35 patients with 39 lesions were judged as eligible for efficacy evaluation. No serious adverse drug reactions were observed. Disappearance of skin photosensitivity was recognized within 2 weeks in 28 of 33 patients (84.8%) and in all the other seven patients first tested at 15-18 days. Complete response (CR) was seen in 84.6% of lesions (82.9% of patients). This study demonstrated excellent anti-tumor effects and safety, especially low skin photosensitivity in patients with early stage lung cancer. PDT using the second generation photosensitizer NPe6 and a diode laser will likely become a standard modality of PDT for central type early superficial squamous cell carcinoma of the lung.
Lung Cancer 11/2003; 42(1):103-11. · 3.43 Impact Factor
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ABSTRACT: Objective evaluation of the performance of autofluorescence bronchoscopy based on analysis of thin sections of the bronchus of resected lungs was performed and compared with the results of preoperative autofluorescence bronchoscopy. Conventional bronchoscopy and autofluorescence bronchoscopy were performed prior to surgery for lung cancer. Thin sections of the bronchus were obtained from the resected specimens. The thin sections were pathologically analyzed and the diagnostic accuracy of endoscopy was calculated. The subjects were 30 consecutive operable lung cancer cases who received white light and autofluorescence bronchoscopy before operation. A total of 163 thin sections of the bronchi in the resected lungs were made. The sensitivity of white light bronchoscopy for cancer was 90 and 31% for dysplasia. The respective figures for autofluorescence bronchoscopy were 97 and 50% for cancer and dysplasia. The specificity of white light and autofluorescence was 88 and 84%, respectively. The diagnostic accuracy of autofluorescence bronchoscopy was objectively confirmed. Autofluorescence examination showed better sensitivity for cancerous/precancerous lesions and the evaluation of the extent of cancer invasion was accurate.
Lung Cancer 10/2003; 41(3):303-9. · 3.43 Impact Factor
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Journal of Bronchology & Interventional Pulmonology. 12/2002; 10(1):64-69.
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ABSTRACT: We report our experience in the diagnosis and surgical treatment of central type lung cancer (CTLC) and discuss the prognostic significance of clinicopathological factors including the T factor.
Subjects were 151 patients with CTLC undergoing surgery from 1984 to 1999. Surgical procedures include lobectomy in 111, pneumonectomy in 35, and segmentectomy in 5. Bronchoplasty was done in 44, including sleeve lobectomy in 33, carinal resection in 8, and bronchoplasty without resection of pulmonary parenchyma in 3. Data on CTLC was compared to that on peripheral lung cancer during the same period.
Compared to peripheral tumors, central lung tumors showed a higher ratio in male gender, pN1 in pN factors, squamous cell carcinoma in histology, and pneumonectomy and bronchoplasty in surgery. No statistical differences were seen between groups in surgical outcome, mean age, distribution pattern in pT factors, and extended surgery. The positive predictive cT factor has improved. No significant difference was seen in 5-year survival based on 8 factors--period, cT factors, tumor histology, bronchoplasty, extended surgery, cellular atypia, additional chemotherapy, and radiotherapy. Five-year survival differed significantly for 12 other factors--pT, cN, and pN factors; surgical method; number of resected organs in extended surgery; curability (complete/incomplete); tumor size; N1 and N2 station metastasis; p factor, and blood vessel and lymphatic invasion. Multivariable analysis indicated only 2 independent prognostic factors--cN and p factor.
CTLC appears to belong to a subgroup other than peripheral tumors, requiring a more accurate diagnosis of cT factors, particularly in the proximal bronchus, because cT and cN factors are the only 2 used preoperatively.
The Japanese Journal of Thoracic and Cardiovascular Surgery 11/2002; 50(10):413-7.
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ABSTRACT: A 39-year-old man was admitted to our hospital for further evaluation of a consolidated shadow and clarification of the cause of serum tumor marker elevation (CA19-9 496.2 U/ml, CA125 160.6 U/ml). Chest computed tomography revealed a well-defined homogeneous nodule in the left S(10). Angiography showed one aberrant artery, branching from the ascending aorta. Intralobar pulmonary sequestration was diagnosed and the sequestrated lung was resected. Microscopic findings of the sequestrated lung showed a mucus-containing cystically dilated bronchus, which was covered with ciliated cylindrical epithelium. Immunohistochemical staining showed positive staining for CA19-9 and CA125 in both the ciliated cylindrical epithelium and mucus. Serum values of tumor markers returned to their normal range after surgery.
Internal Medicine 11/2002; 41(10):875-8. · 0.94 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 06/2002; 60 Suppl 5:414-8.
