Clinical outcomes of image-guided proton therapy for histologically confirmed stage I non-small cell lung cancer.

BACKGROUND: Two prospective phase II trials were designed to assess the efficacy and safety of image-guided proton therapy (IGPT) for either medically inoperable or operable stage I non-small cell lung cancer (NSCLC). The present study reports the interim results of these trials. METHODS: Fifty-five patients with histologically confirmed stage I NSCLC (IA in 33 patients and IB in 22 patients; inoperable in 21 patients and operable in 34 patients) who received IGPT between July 2013 and February 2017 were analyzed. The median patient age was 71 years (range: 48-88 years). IGPT with fiducial metallic marker matching was performed for suitable patients, and a respiratory gating method for motion management was used for all treatments. Peripherally located tumors were treated with 66 Gy relative biological effectiveness equivalents (Gy(RBE)) in 10 fractions (n = 49) and centrally located tumors were treated with 72.6 Gy(RBE) in 22 fractions (n = 6). Treatment associated toxicities were evaluated using Common Toxicity Criteria for Adverse Events (v.4.0). RESULTS: Median follow-up was 35 months (range: 12-54 months) for survivors. For all patients, the 3-year overall survival, progression-free survival, and local control rates were 87% (95% confidence interval: 73-94%), 74% (58-85%), and 96% (83-99%), respectively. Fiducial marker matching was used in 39 patients (71%). Grade 2 toxicities observed were radiation pneumonitis in 5 patients (9%), rib fracture in 2 (4%), and chest wall pain in 5 (9%). There were no grade 3 or higher acute or late toxicities. CONCLUSIONS: IGPT appears to be effective and well tolerated for all patients with stage I NSCLC. TRIAL REGISTRATION: Lung-001, 13-02-09 (9), registered 11 June 2013 and Lung-002, 13-02-10 (10), registered 11 June 2013.

The relationship between the expression of thymidylate synthase, dihydropyrimidine dehydrogenase, orotate phosphoribosyltransferase, excision repair cross-complementation group 1 and class III ß-tubulin, and the therapeutic effect of S-1 or carboplatin plus paclitaxel in non-small-cell lung cancer.

Previous studies have reported that the expressions of specific proteins may predict the efficacy of chemotherapy agents for non-small cell lung cancer (NSCLC) patients. The present study evaluated the expression of proteins hypothesized to be associated with the effect of chemotherapeutic agents in 38 NSCLC patients with pathological stage II and IIIA. The subjects received carboplatin plus paclitaxel (CP) or S-1 as adjuvant chemotherapy following complete resection. The protein expressions evaluated were those of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phsphoribosyltransferase (OPRT), which were suspected to be associated with the effect of S-1 agents, excision repair cross-complementation group 1 (ERCC1), which was suspected to be associated with the effect of platinum-based agents, and class III ß-tubulin (TUBB3), which was suspected to be associated with the effect of taxane-based agents. The positive rate of TS was 55.3% (n=21/38), DPD was 57.9% (n=22/38), OPRT was 42.1% (n=16/38), ERCC1 was 47.4% (n=18/38) and TUBB3 was 44.7% (n=17/38). Among the patients who received S-1 adjuvant chemotherapy, TS-negative cases demonstrated a significantly better disease-free survival than positive cases. Thus, TS protein expression may have been a factor that predicted the effect of S-1 agent as adjuvant chemotherapy.

S-1 vs. paclitaxel plus carboplatin as adjuvant chemotherapy for completely resected stage II/IIIA non-small-cell lung cancer.

The majority of patients with completely resected stage II or IIIA non-small-cell lung cancer (NSCLC) require adjuvant chemotherapy to improve survival following surgery. In the present trial, the 2-year disease-free survival (DFS), and the feasibility and safety of S-1 as an adjuvant chemotherapy for advanced lung cancer were evaluated. A total of 40 patients with completely resected stage II or IIIA NSCLC were enrolled and randomized to receive postoperative chemotherapy with either up to 4 cycles of paclitaxel plus carboplatin (arm A) or with up to 1 year of S-1 (arm B). The primary endpoint was 2-year DFS. The secondary endpoints were feasibility and toxicity. A total of 40 patients were enrolled, but 3 were excluded in accordance with the exclusion criteria. The remaining 37 patients were analyzed. The 2-year DFS rate was 54.2% in arm A and 84.2% in arm B. Overall, 15/18 (83.3%) patients completed 4 cycles of paclitaxel plus carboplatin and 13/19 (68.4%) completed 1-year of S-1adjuvant chemotherapy. Of the 18 (16.7%) patients in arm A, 3 experienced grade 3 or 4 adverse events, while none in arm B experienced such events. Therefore, S-1 chemotherapy for patients with completely resected stage II or IIIA NSCLC was a feasible and safe regimen, and it may therefore be considered as a potential adjuvant chemotherapy option for advanced NSCLC.

New technique of percutaneous CT fluoroscopy-guided marking before video-assisted thoracoscopic surgery for small lung lesions: feasibility of using a 25-gauge needle without local anaesthesia.

OBJECTIVE: To retrospectively evaluate the feasibility of CT fluoroscopy-guided percutaneous marking using a 25-gauge needle and indigo carmine before video-assisted thoracoscopic surgery (VATS) for small lung lesions. METHODS: 21 patients, 14 males and 7 females, with a median age of 69 years (range, 40-79), underwent CT fluoroscopy-guided percutaneous VATS marking using a 25-gauge, 70-mm needle and 1.5-ml indigo carmine. The mean diameter of the lung lesions was 14 mm (range, 6-27). We evaluated the technical success rate, surgical success rate and complications related to this procedure by reviewing medical records and images. Technical success was defined as completion of this procedure. Surgical success was defined as resection of the target lesion with negative margins on pathological examination after VATS. Complications that required advanced levels of care were classified as major complications, and the remaining complications were considered minor. RESULTS: The technical success rate was 100%. In all cases, VATS was successfully performed as planned, and the target lesion was resected with negative margins on pathological examination after VATS. Thus, the surgical success rate was 100%. Mild pneumothorax was found in two cases, but further treatment was not required. The minor complication rate was 9.5% (2/21), and major complication rate was 0%. Only two patients (9.5%) complained of slight pain upon puncture, but local anaesthesia was not required. CONCLUSION: Percutaneous CT fluoroscopy-guided VATS marking using a 25-gauge needle without local anaesthesia appears feasible and safe. Advances in knowledge: This technique expands a possibility of the CT-guided marking.

[Hemorrhage from the subclavian artery after lung cancer resection treated by stent graft placement].

We present a case of a 79-year-old man with right apical invasive lung cancer which was treated by induction radiotherapy followed by right upper lobectomy with chest wall resection. Four days after the operation, hemorrhage from the funicular structure in the cupula of the parietal pleura was observed, and hemostasis was achieved by ligation and fibrin sheet pasting. At the time, we were not able to detect the hemorrhage from the subclavian artery. Two days after the 1st hemostasis, hemorrhage reccurred. Hemorrhage from the inferior border of the subclavian artery was observed, and hemostasis was achieved by direct suture and fibrin sheet pasting. One day after the 2nd hemostasis, re-recurrent hemorrhage occurred. Stent graft placement was performed under local anesthesia. No hemorrhage occurred after the stent graft placement.

[An operative case of thymic cyst with thymoma;report of a case].

Thymic cyst with thymoma is a rare disease. A 67-year-old woman was referred to our hospital for right chest pain and cough. Mass shadow in the right hilum was detected in the chest radiograph. Chest computed tomography( CT) revealed a cystic mass with partially thickened wall suggesting solid tumor at the anterior mediastinum. The tumor was resected by median sternotomy. Histopathological finding was a multilocular thymic cyst with thymoma of spindle cell type.

Adverse events of stapling in thoracic surgery: relations between an incidence of adverse events and a stapling volume.

PURPOSE: The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, sometimes adverse events (AEs) of stapling are experienced. The aim of the present study was to retrospectively analyze AEs of stapling in thoracic surgery. METHODS: A retrospective multi-institutional review was conducted by the 27 institutions of the Central Japan Lung Cancer Surgery Study Group. Between January 2009 and December 2010, 4495 patients underwent thoracic surgery using mechanical stapling. RESULTS: Stapling of various tissues was performed 16403 times. Total number of AEs related to stapling was 126 (0.77%). One hundred and nine events occurred intraoperative and 17 events occurred postoperative. The AE rates ranged from 0% to 1.8%. No relationship was seen between the incidence of AE and a stapling volume of thoracic surgery. CONCLUSION: We have investigated intraoperative and postoperative AEs of stapling. Generally, stapling in thoracic surgery was safe. An AE rate of stapling in thoracic surgery is not influenced by the numbers of stapling in institutions.

[Repair of Morgagni's hernia by thoracoscopic surgery; report of a case].

An 84-year-old woman visited a local clinic with the complaint of upper abdominal pain and was referred to our hospital because of a suspected mediastinal tumor. Chest and abdominal computed tomography (CT) scanning were performed and Morgagni's hernia that contained omentum was identified on multiplanar reconstruction (MPR) images. Repair surgery was performed via mini-thoracotomy with thoracoscopy. The omentum witch was adherent to the hernial sac in the thorax was carefully dissected and was replaced in the abdomen. The diaphragmatic defect was closed and was reinforced with an expanded proline mesh patch. The thoracoscopic surgery with mini-thoracotomy can be a safe and effective method for repairing a Morgagni's hernia of which contents are thought to be omentum and when intrathoracic adhesions in the hernial sac are suspected.