[A case of rapidly growing recurrent thyroid carcinoma performed tracheobronchial expandable metallic stent (EMS) therapy].

The case is a 60-year-old female who underwent an operation as a right lobectomy of the thyroid and the resection of neck enlarged cystic lymph nodes in 2006. Pathological results were adenomatous goiter and the metastatic lymph nodes of papillary thyroid carcinoma. The primary lesion of thyroid carcinoma was not found. In four years after the operation, the local recurrence with anaplastic formation of the tumor occurred and tracheobronchial expandable metallic stent( EMS) therapy was performed to the tracheal stenosis. But she died of rapidly enlargement of the anaplastic thyroid carcinoma in two months after stent therapy. It was necessary to observe this case severely after the first operation because the primary lesion of the thyroid carcinoma was not resected. The tracheobronchial EMS therapy was effective to the respiratory failure for a short-term caused by the tracheal stenosis of the thyroid anaplastic carcinoma.

Does postoperative serum interleukin-6 influence early recurrence after curative pulmonary resection of lung cancer?

PURPOSE: We examined the influence of inflammatory cytokine levels on postoperative early recurrence in patients who underwent curative lung cancer surgery. METHODS: In 107 patients who underwent curative pulmonary resections for non-small cell lung cancer (NSCLC) from November 2007 to June 2008, we measured serum interleukin-6 (IL-6) levels preoperatively, and on postoperative day (POD) 0, 1, and 2. Between July 2009 and August 2009, 1 year after the date of enrollment of the last patient, we investigated survival status of each patient and identified a group with recurrence. RESULTS: Among 107 patients, 29 patients developed recurrence with a mean follow-up of 18.1 months (range 14 to 21). P-stage was significantly more advanced in the recurrence group than in the non-recurrence group (p = 0.005). Serum IL-6 levels on POD 1 were significantly higher in the recurrence group than in the non-recurrence group (p = 0.007). In Cox's proportional hazards regression, P-stage and serum IL-6 levels on POD 1 were significant independent predicting factors for postoperative early recurrence (p = 0.006, p = 0.003). CONCLUSIONS: The higher the serum IL-6 levels on POD 1, the higher the risk of early postoperative recurrence, even when curative pulmonary resection can be accomplished in lung cancer patients.

Japanese Lung Cancer Registry Study: first prospective enrollment of a large number of surgical and nonsurgical cases in 2002.

PURPOSE: To investigate prognoses of lung cancer patients prospectively enrolled in the Japan Lung Cancer Registry Study. METHODS: Patients newly diagnosed as having lung cancer exclusively in 2002 were enrolled. Follow-up surveys were performed twice, in 2004 and 2009, and the final follow-up data with prognoses were analyzed for 14,695 patients (79%). Clinical stages were defined according to the sixth edition of the International Union Against Cancer--tumor, node, metastasis classification (2002). RESULTS: The mean age was 67.1 years (range, 18-89 years), and there were 10,194 men (69.3%) and 4315 women (29.7%). The most frequent histology was adenocarcinoma (n = 8325, 56.7%), followed by squamous cell carcinoma (n = 3778, 26%) and small cell carcinoma (n = 1345, 9.2%). The distribution of clinical stages was as follows: IA, 4245 cases (29.3%); IB, 2248 (14.5%); IIA, 208 (1.4%); IIB, 918 (6.3%); IIIA, 1700 (11.8%); IIIB, 2110 (16.3%); and IV, 3037 (21.0%). The 5-year survival rates were 44.3% for all patients, 46.8% for those with non-small cell lung cancer, and 14.7% for those with small cell lung cancer. According to the clinical stage of non-small cell lung cancer and small cell lung cancer, the 5-year survival rates were 79.4 and 52.7% for stage IA, 56.9 and 39.3% for IB, 49.0 and 31.7% for IIA, 42.3 and 29.9% for IIB, 30.9 and 17.2% for IIIA, 16.7 and 12.4% for IIIB, and 5.8 and 3.8% for IV, respectively. CONCLUSION: Analysis of a large cohort in the Japanese registry study found that stage-specific prognosis was within a range similar to other reports. The data presented should provide an important reference for future clinical trials in Japan.

[A Japanese lung cancer registry study at 2002].

OBJECTIVES: To publicize clinical results of Japanese lung cancer patients registered in 2002. Study design. In 2002, The Japanese Joint Committee for Lung Cancer Registration conducted a prospective observational study for lung cancer patients registered at starting treatments with follow-ups in 2004 and 2009. At first, 18,552 cases were registered from 358 institutes, while we analyzed 14,695 samples whose living periods could be identified. RESULTS: There were two times males as many as females with a mean age of 67.1 years. The most frequent histology was adenocarcinoma in 56.7%, following squamous cell carcinoma in 25.7% and small cell carcinoma in 9.2%. Clinical stage was IA in 29.3%, IB in 15.3%, IIA in 1.4%, IIB in 6.2%, IIIA in 11.8%, IIIB in 14.6% and IV in 21.0%. Surgery was performed in 8454 cases (57.5%). Five-year survival rate was 44.3% for all patients, 14.7% for cases of small cell carcinoma, 46.8% for non-small cell carcinoma, 59.6% for surgery cases, 8.5% for no surgery cases, 37.7% for males and 59.0% for females. The rates in clinical stage settings in cases of small cell carcinoma and non small cell carcinoma, was 52.7% and 79.4% for IA, 39.3% and 56.7% for IB, 31.7% and 49.0% for IIA, 29.9% and 42.3% for IIB, 17.2% and 30.9% for IIIA, 12.4% and 16.7% for IIIB and 3.8% and 5.8% for IV, respectively. CONCLUSION: An analysis of Japanese lung cancer patients registered in 2002 revealed that the most frequent histology type was adenocarcinoma following squamous cell carcinoma and small cell carcinoma. Prognosis in 5 years was superior in cases of female, non small cell lung cancer and surgery to those of male, small cell lung cancer and no surgery, respectively. Further investigation is needed with respect to dependences of those survival differences.

[Two resected cases of pulmonary adenocarcinoma with intralober metastasis diagnosed by the pathological diagnosis during the operation].

We described two resected cases of pulmonary adenocarcinomas with intralober pulmonary metastasis diagnosed by the frozen section diagnosis. The first case was a 61-year-old female who underwent an operation as a left S4 pulmonary adenocarcinoma which was 2 cm in size, and a left S3 pulmonary nodule which was 3 mm in size, was suspected pulmonary metastasis by CT scan. In September 2007, a partial resection of the left lung S3 was performed at first and the result of the frozen section diagnosis of this tumor was adenocarcinoma. The segmentectomy of the left lung S4, a partial resection of the left lung S6 and S3, and dissection of the lymphnodes (#6, 11) were performed. The final pathological diagnosis was pulmonary adenocarcinoma pT3N0M0=Stage IIB, pm1. The new metastasis of the right lung occurred in 2009, a partial resection of the right lung and systemic chemotherapy were performed. The second case was a 60-year-old female who underwent an operation as a right S10, S6, S2 pulmonary ground grass opacity (GGO) nodules which were 0.5 to 1 cm in size, was suspected pulmonary adenocarcinoma by CT scan. In June 2009, a partial resection of the right lung S10 was performed at first and the result of the frozen section diagnosis of this tumor was adenocarcinoma. Following this diagnosis, a partial resection of the right lung S6, and dissection of the lymphnodes (#7, 10) were performed and these results of the frozen section diagnosis were lung S6 tumor: adenocarcinoma, and the lymphnodes: no malignancy. The additional resection of the right lung S2, S8 was performed, the final pathological diagnosis was pulmonary adenocarcinoma pT-3N0M0=Stage IIB, pm1. After the operation, a systemic chemotherapy was performed.

[Two resected cases of pulmonary metastasis from post operative colorectal cancer after preoperative chemotherapy with FOLFOX].

UNLABELLED: We described two resected cases of pulmonary metastasis from postoperative colorectal cancer after preoperative FOLFOX chemotherapy. Pathologic histology inspection of the tumor was judged to be effective prior to resection. The first case is a 68-year-old male who underwent a sigmoidectomy as a stage III A sigmoid colon cancer in March 2003. Afterwards, distant metastases had occurred to the liver, the left lung and neck lymph nodes from 2003 to 2006. Three operations and systemic chemotherapy were performed. A new metastasis of the right lung occurred in November 2006. The FOLFOX chemotherapy was performed 7 times, the tumor was not changed in the image, and the effect judgment was SD. After the chemotherapy, a partial resection of the right lung was performed in November 2007. Half of the tumor resulted in necrosis on the specimen (Grade 1b). The second case is a 63-year-old female who underwent an anterior resection of the rectum as a stage II rectal cancer in January 2000, a partial resection of the right lung as a metachronous right pulmonary metastasis in March 2003, and post operative chemotherapy (IFL) were performed. A new metastasis of the right lung occurred in September 2005. The FOLFOX chemotherapy was performed 4 times, the tumor was not changed in the image, and the effect judgment was SD. After the chemotherapy, a partial resection of the right lung was performed in April 2006. One third of the tumor resulted in necrosis on the specimen (Grade 1a). COMMENT: It was thought that FOLFOX chemotherapy can be a promising candidate for neoadjuvant treatment of pulmonary metastasis from postoperative colorectal cancer.

Improvements in surgical results for lung cancer from 1989 to 1999 in Japan.

BACKGROUND: In 1986, Japanese Association for Thoracic Surgery started a nationwide survey of the number of primary lung cancer undergoing resection and this survey was continued annually. Thereafter, investigations of lung cancer surgical results have been conducted three times. The postoperative overall 5-year survival rate was 47.8% in resected cases in 1989, 52.3% in 1994, and 62.0% in 1999, showing improvement over the decade (p < 0.01). OBJECTIVE: To clarify the factors influencing survival improvements retrospectively. PATIENTS AND METHODS: The subjects of the investigation are the patients who underwent resection for primary lung cancers in 1989, 1994, and 1999. Postoperatively, after 5 years, surveys of surgical results were sent to institutes where lung cancer resection had been performed. The subjects undergoing resection who provided 10 items (age, sex, pathologic T factor, pathologic N factor, pathologic M factor, date of resection, histology, curability, prognosis, and survival time) numbered 3004 in 1989, 6895 in 1994, and 12,235 in 1999. They were classified according to the Union International Contre le Cancer 1997 revised tumor, node, and metastasis classification. Differences in age, gender, histology, pathologic stage, curability, and operative death rates were analyzed for each survey year. RESULTS: According to the changes in proportions, the cases over 70 years of age, women, and pathologic stage I increased significantly (p < 0.001), whereas in cases with small cell lung cancer, incomplete resection and operative death decreased significantly over time (p < 0.001). CONCLUSION: The postoperative 5-year survival rate in Japan improved between 1989 and 1999. The main cause of this improvement was the increase in early stage lung cancer, especially cases with tumors 2 cm or less in size.

Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer: prognostic factors for overall survival and risk factors for postoperative complications.

INTRODUCTION: This retrospective study was designed to identify the predictors of long-term survival and the risk factors for complications after surgery in patients aged 80 years or older with clinical (c)-stage I non-small cell lung cancer. METHODS: The Japanese Joint Committee of Lung Cancer Registry collated the clinicopathological profiles and outcomes of 13,344 patients who underwent pulmonary resection for primary lung cancer in 1999. The data of 367 patients aged 80 years or older with c-stage I non-small cell lung cancer were analyzed for prognostic factors and risk factors for postoperative complications. RESULTS: The median age was 82 years (range, 80-90 years). Of the total patient number, 102 (27.8%) had some form of comorbidity diagnosed preoperatively. Thirty-one (8.4%) patients presented with postoperative complications, and the operative mortality was 1.4%. The 5-year survival rates were 55.7% for c-stage I patients, 62.0% for c-stage IA, and 47.2% for c-stage IB. Advanced pathologic stage and comorbidity were significant independent predictors of shortened survival (p < 0.0001 and p = 0.032, respectively). Comorbidity and mediastinal lymph node dissection were identified as factors that increased the risk of postoperative complications (p < 0.0001 and p = 0.036, respectively). Survival rates were independent of the extent of pulmonary resection (lobectomy or limited resection). CONCLUSIONS: Octogenarian patients with c-stage I lung cancer in this study had a satisfactory long-term outcome and low-mortality rate. Comorbidity is a factor associated with both prognosis and operative risks. A selection of the patients who would be curable without mediastinal lymph node dissection after an accurate preoperative staging is beneficial to decrease the postoperative complications because this procedure is a risk factor.

Visceral pleura invasion impact on non-small cell lung cancer patient survival: its implications for the forthcoming TNM staging based on a large-scale nation-wide database.

INTRODUCTION: No analyses have been reported on the impact of visceral pleura invasion (VPI) on staging, in relation with the International Association for the Study of Lung Cancer proposals for the 7th edition of the tumor, node, metastasis (TNM) classification of the International Union Against Cancer staging system. The purpose of this study was to evaluate the impact of VPI on survival and propose a method of incorporating VPI status into the TNM classification. METHODS: We reviewed the data on 9758 non-small cell lung cancer patients, who underwent anatomic surgical resection in 1999, accumulated by the Japanese Joint Committee for Lung Cancer Registration, to gain insight into their clinicopathologic characteristics and outcomes. VPI was defined as tumor extension beyond the elastic layer of the visceral pleura. Patients were divided into nine groups according to VPI status and tumor diameter, in accordance with the International Association for the Study of Lung Cancer proposals. RESULTS: On the basis of survival, the nine groups were divided into the following five levels: tumors < or =2 cm without VPI; tumors < or =2 cm with VPI and tumors 2.1 to 3 cm without VPI; tumors 2.1 to 3 cm with VPI and tumors 3.1 to 5 cm without VPI; tumors 3.1 to 5 cm with VPI and tumors 5.1 to 7 cm without VPI; and tumors 5.1 to 7 cm with VPI and tumors >7 cm without VPI or T3 tumors. CONCLUSIONS: The T status of tumors, 7 cm or less, with VPI should be upgraded to the next T level in the future edition of the TNM classification of International Union Against Cancer staging system.

A Japanese Lung Cancer Registry study: prognosis of 13,010 resected lung cancers.

PURPOSE: The validation of tumor, node, metastasis staging system in terms of prognosis is an indispensable part of establishing a better staging system in lung cancer. METHODS: In 2005, 387 Japanese institutions submitted information regarding the prognosis and clinicopathologic profiles of patients who underwent pulmonary resections for primary lung neoplasms in 1999 to the Japanese Joint Committee of Lung Cancer Registry. The data of 13,010 patients with only lung carcinoma histology (97.6%) were analyzed in terms of prognosis and clinicopathologic characteristics. RESULTS: The 5-year survival rate of the entire group was 61.4%. For the small cell histology (n = 390), the 5-year survival rates according to clinical (c) and pathologic (p) stages were as follows: 58.8% (n = 161) and 58.3% (n = 127) for IA, 58.0% (n = 77) and 60.2% (n = 79) for IB, 47.1% (n = 17) and 40.6% (n = 29) for IIA, 25.3% (n = 38) and 41.1% (n = 29) for IIB, 29.0% (n = 61) and 28.3% (n = 60) for IIIA, 36.3% (n = 19) and 34.6% (n = 40) for IIIB, and 27.8% (n = 12) and 30.8% for IV (n = 13). For the non-small cell histology (n = 12,620), the 5-year survival rates according to c-stage and p-stage were as follows: 77.3% (n = 5642) and 83.9% (n = 4772) for IA, 59.8% (n = 3081) and 66.3% (n = 2629) for IB, 54.1% (n = 205) and 61.0% (n = 361) for IIA, 43.9% (n = 1227) and 47.4% (n = 1330) for IIB, 38.3% (n = 1628) and 32.8% (n = 1862) for IIIA, 32.6% (n = 526) and 29.6% (n = 1108) for IIIB, and 26.5% (n = 198) and 23.1% (n = 375) for IV. Adenocarcinoma, female gender, and age less than 50 years were significant favorable prognostic factors. CONCLUSION: This large registry study provides benchmark prognostic statistics for lung cancer. The prognostic difference between stages IB and IIA was small despite different stages. Otherwise, the present tumor, node, metastasis staging system well characterizes the stage-specific prognoses.

Abnormalities of epidermal growth factor receptor in lung squamous-cell carcinomas, adenosquamous carcinomas, and large-cell carcinomas: tyrosine kinase domain mutations are not rare in tumors with an adenocarcinoma component.

BACKGROUND: Tyrosine kinase domain (TKD) gene mutations of the epidermal growth factor receptor gene (EGFR) have proven to be clinically significant in nonsmall-cell lung cancer (NSCLC), particularly in adenocarcinoma. However, TKD mutations together with deletion mutations in the extracellular domain of EGFR (EGFRvIII) have not been fully investigated in NSCLC except for adenocarcinoma. The present study sought to gain further insight into the significance of EGFR mutations in NSCLC by focusing on nonadenocarcinoma NSCLC. METHODS: EGFR TKD mutations were investigated using direct sequencing and mutation-specific polymerase chain reaction (PCR), and EGFRvIII mutations were examined using reverse transcriptase-PCR in samples from 42 NSCLC patients and 6 NSCLC cell lines excluding adenocarcinoma. RESULTS: EGFR TKD mutations were detected in 1 of 7 (14%) squamous-cell carcinomas with an adenocarcinoma component and 2 of 4 (50%) adenosquamous carcinomas. In contrast, EGFR TKD mutations were not identified in 24 pure squamous-cell carcinomas without any adenocarcinoma component, 7 large-cell carcinomas, or 6 cell lines. EGFRvIII was detected solely in 1 of 7 large-cell carcinomas (14%), but not in 31 squamous-cell carcinomas, 4 adenosquamous carcinomas, or 6 cell lines. CONCLUSIONS: These results suggest that EGFR TKD mutations are found in NSCLCs with an adenocarcinoma element. Patients with such lesions are thus considered candidates for molecular therapies targeting EGFR.

[Evaluation of bronchial arterial infusion (BAI) for lung cancer with carcinomatous pleuritis].

MATERIALS AND METHODS: Six high-risk patients of lung cancer with carcinomatous pleuritis to which BAI was done were examined. BAI was performed using CDDP (40-50 mg/m2) + CPT-11 (40-50 mg/m2). The therapeutic effects, side effects, a reduction of the symptoms and prognosis were examined. RESULTS: All cases were revealed as stable disease according to the rule of the RECIST. The side effect of appetite loss for over grade 2 was found in one case. The reduction of respiratory symptoms (cough, dyspnea at the movement in 3, chest pain in 1 and loss of the movement in 1) was recognized by four out of five cases. Five patients died in three to seven months after the treatment of BAI. The causes of death were the recurrence of carcinomatous pleuritis and the primary lesion or the metastasis lesion of the lung in 4 cases and the recurrence of the primary lesion in 1 case. The recurrence of the malignant pleural effusion was recognized in 1 case without intra-thoracic infusion. COMMENT: BAI was effective as a reduction of the respiratory symptoms in the high-risk patients of lung cancer with carcinomatous pleuritis. It appeared that a long-term survival was probable with the combination of BAI, intra-thoracic infusion and systemic chemotherapy.

[Carboplatin and CPT-11 chemotherapy in a hemodialysis patient with small-cell lung cancer].

We administered a dose-down chemotherapy, which was a combination of carboplatin 100 mg/body (AUC 3.0, day 1) and CPT-11 30 mg/m2 (day 1, day 15) to the patient with a poor performance status of extensive small-cell lung cancer with renal failure. Hemodialysis was performed two hours after the chemotherapy. We measured plasma levels of total-platinum and CPT-11 and metabolic products (SN-38) after the hemodialysis. The results of pharmacokinetic study showed a high level collection of total-platinum caused by carboplatin and SN-38, and that was caused by CPT-11 in the blood. Although the grade 3 of granulocytopenia was found, the decrease in tumor marker and an improvement of the ADL were confirmed. It thought that this chemotherapeutic regimen was effective for small-cell lung cancer with renal failure undergoing hemodialysis. Further study is needed for a selection of suitable chemotherapeutic regimens, an optimal dosage of each drug and timing of hemodialysis.

How should the TNM staging system for lung cancer be revised? A simulation based on the Japanese Lung Cancer Registry populations.

OBJECTIVE: The 1997 version of the TNM staging system for lung cancer has several prognostic problems. Among these, the overlapping survival of stages IB and IIA is the most serious. We performed this retrospective study to test a revised TNM staging system for lung cancer. METHODS: We revised the T1 descriptor definition and stage grouping for testing as follows. According to the greatest tumor diameter, T1 tumors were divided into T1a tumors (< or =2.0 cm) and T1b tumors (2.1-3.0 cm). With these descriptors, new IA, IB, and IIA stages were defined as T1a N0 M0, T1b N0 M0, and T2 N0 M0 + T1 N1 M0, respectively. For 6644 patients with histologically non-small cell lung cancers resected in 1994 and reported in the Japanese Lung Cancer Registry Study, the survivals and prognostic difference between neighboring stages were studied. RESULTS: The 5-year survival of the entire population was 52.6%. In the clinical setting, the 5-year survivals of the new IA, new IB, new IIA, IIB, IIIA, IIIB, and IV stages were 77.5%, 69.3%, 49.8%, 40.6%, 35.8%, 28.0%, and 20.8%, respectively. In the pathologic setting, they were 83.7%, 76.0%, 60.0%, 42.2%, 29.8%, 19.3%, and 20.0%, respectively. For both clinical and pathologic settings, differences between all neighboring stages were statistically significant, except for that between IIIB and IV. CONCLUSION: Subcategorization of T1 and minor changes in stage grouping results in a system with significant differences in prognosis between neighboring stages. The unification of stages IB and IIA, especially, improves the discriminatory power of the staging system.

[Evaluation of bronchial arterial infusion (BAI) for lung cancer with brain metastasis].

MATERIALS AND METHODS: Seven high risk patients of lung cancer with brain metastasis to which BAI was done were examined. The standard systemic chemotherapy was not indicated in these cases due to the patients' systemic condition. BAI was performed using CDDP (40-80 mg/m2)+CPT-11 (40-60 mg/m2). The therapeutic effects, side effects, quality of life (QOL) and prognosis were examined. RESULTS: All cases revealed a stable disease according to the rule of the RECIST. Side effects over grade 2 were not recognized. QOL was improved because clinical effects were recognized in all seven cases with respiratory symptoms (cough in 6, dyspnea at movement in 5 and hemosputum in 1). Six patients died three-thirty months after the treatment of brain metastasis, and the median survival was twelve months. The causes of death were recurrence of brain tumor in 3, increase of primary lesion in 1, recurrence of brain tumor and increase of primary lesion in 2. The prognosis of the patient who had progressing T and N factors was bad. COMMENT: BAI was effective in keeping the quality of life for a lung cancer patient with brain metastasis. It was thought that BAI should be performed positively in the high risk patient who did not have progressing T and N factors.

Clinico-pathological and biological significance of tyrosine kinase domain gene mutations and overexpression of epidermal growth factor receptor for lung adenocarcinoma.

INTRODUCTION: Mutations in the tyrosine kinase domain (TKD) of the epidermal growth factor receptor (EGFR) gene have proven to be clinically significant in non-small cell lung cancer. However, relationships between these mutations and EGFR expression or deletion mutations in the extracellular domain of EGFR (EGFRvIII) remain unclear. The purpose of this study was to gain further insight into the clinical significance of these molecular abnormalities in lung adenocarcinoma. METHODS: We investigated EGFR TKD mutations using direct sequencing, EGFR protein expression using Western blotting, and EGFRvIII using reverse transcriptase-polymerase chain reaction in samples from 48 adenocarcinoma patients. Correlations with various clinico-pathological features were analyzed. RESULTS: EGFR TKD mutations were detected in 25 of 48 adenocarcinomas (52.1%), and overexpression of EGFR protein was identified in 19 patients (39.6%). Presence of EGFR TKD mutations was significantly correlated with EGFR overexpression (p = 0.021). EGFR TKD mutations were significantly correlated with never-smoker status (p = 0.043), absence of emphysematous or fibrotic appearance on computed tomography (p = 0.001), papillary subtype (p = 0.041), and bronchioloalveolar carcinoma features (p = 0.045). EGFRvIII was not detected in any adenocarcinomas. Retrospective analysis revealed that patients with EGFR TKD mutations displayed better postoperative prognosis than patients with wild-type EGFR (p = 0.033). CONCLUSIONS: These results suggest that EGFR TKD mutation is associated with EGFR overexpression, representing an important factor for consideration when investigating the clinical significance, including susceptibility to chemotherapy, of EGFR TKD mutations in adenocarcinoma. EGFRvIII does not seem to play a major role in the development of lung adenocarcinoma.

[Evaluation of bronchial arterial infusion (BAI) for metastatic lung tumor from colorectal cancer].

Three cases of metastatic lung tumor from colorectal cancer with an ineffectual systemic chemotherapy were examined based on the therapeutic effectiveness and safety of bronchial infusion (BAI) as a symptomatic therapy. Two out of three cases were rectal cancer and the third case being ascending colon cancer. After the operations, each of the three cases showed a multiple lung metastases recurrence at the primary and metastatic lesions of the lung. The lung metastases became large in size and thoracic symptoms (severe cough, chest pain) appeared in spite of the systemic chemotherapy of CPT-11, 5-FU and CDDP. A low dosage of BAI was administered by using CPT-11 (40 mg/m2) + CDDP (40 mg/m2) as one shot, and was repeated (three and six times respectively) for the two cases. When the low dosage of BAI was administered, there were light side effects and no complications were observed. The average hospital stay was 7.8 days. All three patients were stable and showed improvement in the condition of the disease. The prognoses from the first BAI were 3, 6, and 9 months in all three cases, respectively. BAI using low dosage of anti-cancer agents was effective, as means of improving the chest condition and quality of life in patients with metastatic lung tumor from colorectal cancer, with an ineffectual systemic chemotherapy.

[Radiation recall pneumonitis induced by Gefitinib (Iressa): a case report].

Gefitinib is a newly developed molecular-target drug with selective inhibitory activity for tyrosine kinase of the epidermal growth factor receptor and has an encouraging effect on non-small cell lung cancer in an advanced stage. The adverse drug reactions including diarrhea, skin eruptions and liver dysfunction have been considered mild. However, cases of severe acute lung injuries were reported after approval of the drug in Japan in July, 2002. We report a case of recurrent large cell carcinoma of the lung in a 73-year-old man who suffered from radiation recall pneumonitis induced by Gefitinib. Two months after radiation therapy to the mediastinal and right hilar lesions was completed, he started to take Gefitinib at a dose of 250 mg/day. Six weeks later, he complained acutely of a dry cough, slight fever and effort dyspnea, and his chest CT demonstrated ground-glass opacity corresponding to the previous radiation field. In administering Gefitinib, as well as other cytotoxic drugs, meticulous monitoring for acute lung injury and radiation recall reaction is required.