Keigo Tominaga

Utility of low-dose helical CT as a second step after plain chest radiography for mass screening for lung cancer.

We evaluated the usefulness of low-dose helical computed tomography (CT) as a routine second step in patients screened for lung cancer with plain chest radiography (PCR). Of 5,437 people who underwent mass screening for lung cancer by PCR, further work-up was required for 230 because of abnormal findings. Of 221 subjects who had CT as a second step, abnormal shadows were detected in 110 and no abnormal shadows were seen in 111. Screening CT (helical scan; beam collination, 10 mm; pitch of 2:20 mm/s; and tube current, 50 mA) detected 17 lung cancers, 87 benign lesions, and 6 extrapulmonary lesions, with an average diameter of 10 mm (range, 2–35 mm). All lung cancers were peripheral (12 stage I, 4 stage IIIA, and 1 stage IV). In 40% of screened subjects, 37 with benign lesions and 7 with lung cancer (6 stage I), lesions were delineated only by screening CT. In conclusion, low-dose helical CT was found to be useful as a second step in patients who have been screened for lung cancer by PCR and can delineate the early stage of lung cancer.

Invasive thymoma with intracaval growth into the right atrium

We report an unusual case of invasive thymoma with intracaval growth into the right atrium. Computed tomography and venacavography demonstrated this manner of extension of thymoma. The tumor was completely removed by means of cardiopulmonary bypass after four courses of chemotherapy. Multidisciplinary treatment for invasive thymoma with this growth pattern is thought to be useful.

A Case-Control Study of Stomach Cancer and Its Genesis in Relation to Alcohol Consumption, Smoking, and Familial Cancer History

A case‐control study of stomach cancer and its genesis has been conducted in relation to alcohol consumption, cigarette smoking, and familial cancer history. Two hundred and ninety‐four cancer cases, discovered by mass screening and histologically verified after endoscopic examination, have been compared with 588 randomly selected controls, who received the same early detection program and were verified as being free of the disease. No statistically significant association was observed between the development of stomach cancer and alcohol consumption or familial cancer history. However, the development of stomach cancer was found to have a positive correlation with smoking (relative risk for those who smoke less than 19 cigarettes/day, 3.56: 95% confidence interval, 2.39 to 5.31; relative risk for those who smoke more than 20 cigarettes/day, 2.58: 95% confidence interval, 1.60 to 4.17). The results of this study suggest that cigarette smoking appears to have a more harmful effect on the development of stomach cancer than either alcohol consumption or a familial history of cancer. The high relative risk of smoking revealed by this study implies that further research on the effects of smoking in the development of stomach cancer would be desirable.

Helical computed tomography diagnosis of pleural dissemination in lung cancer: comparison of thick-section and thin-section helical computed tomography.

Pleural dissemination in lung cancer was prospectively evaluated by helical computed tomography (CT), and the usefulness of thick-section CT (10-mm collimation; pitch 1) and thin-section CT (2-mm collimation; pitch 1) were compared. The study included 54 patients with pulmonary adenocarcinoma in whom plain chest radiographs showed no evidence of pleural effusion and in whom the primary lesion was seen to be contiguous with the pleural surface on thick-section CT. Thin-section CT was performed for evaluation of the costal, mediastinal, interlobar, and diaphragmatic pleural surfaces. Pathologic examination revealed pleural dissemination in 20 patients (8 resected, 12 nonresected). Pleural dissemination was diagnosed in 12 patients on thick-section CT, and in 20 patients on thin-section CT. False negatives occurred in ten and two patients, respectively. The same two patients were false positives by both methods. Accuracy was 78% for thick-section CT and 93% for thin-section CT, and sensitivity was 50% and 90%, respectively. Thin-section CT provided more useful information than thick-section CT for the evaluation of pleural dissemination in lung cancer.

A phase II study of irinotecan and infusional cisplatin with recombinant human granulocyte colony-stimulating factor support for advanced non-small-cell lung cancer.

Purpose: We administered chemotherapy consisting of a combination of 5-day continuous infusion of cisplatin (20 mg/m2 per day) plus irinotecan (160 mg/m2 per day, as a bolus, on day 1) with recombinant human granulocyte colony-stimulating factor (rG-CSF) support to previously untreated advanced non-small-cell lung cancer (NSCLC) patients, and evaluated the effectiveness and safety of this therapy. Patients: Enrolled in the study were 41 NSCLC patients. Results: Of the 41 patients, 24 achieved a partial response. The response rate was 58.5% (95% confidence interval, 42.2% to 74.8%), with a median response duration of 32.1 weeks. The median survival time was 44.8 weeks and the 1-year survival rate was 44%. A total of 100 courses of therapy were given. The major toxic effects were grade 3 or 4 diarrhea (23%), granulocytopenia (20%), thrombocytopenia (15%) and anemia (15%). There were no treatment-related deaths. Conclusions: Combination chemotherapy with irinotecan plus infusional cisplatin with rG-CSF support was well tolerated and effective in patients with advanced NSCLC.

Tumor lysis syndrome in invasive thymoma with peripheral blood T-cell lymphocytosis

Tumor lysis syndrome has rarely been observed in solid tumors. We report a case of a patient with advanced invasive thymoma associated with peripheral blood T-cell lymphocytosis in whom tumor lysis syndrome developed after chemotherapy. The potential for tumor lysis syndrome should be anticipated when treating extensive thymoma.

Radiation therapy for roentogenographically occult lung cancer by external beam irradiation and endobronchial high dose rate brachytherapy.

PURPOSE We investigated the clinical usefulness of radiation therapy by external beam irradiation and endobronchial brachytherapy for the treatment of roentogenographically occult lung cancer. PATIENTS AND METHODS From 1995 to 1996, five patients were treated with radiation therapy. We analyzed their treatment outcomes. The follow-up period varied from 3.0 to 3.8 years or until death. External beam radiation (40 Gy/20 fractions/4 weeks) was delivered to the tumor site alone, and not prophylactically given to the mediastinum. Endobronchial brachytherapy using high dose rate iridium (Ir)-192 was concurrently administered principally to a total dose of 18 Gy on the bronchial mucosa in three weekly fractions of 6 Gy each. RESULTS Complete remission was obtained in all patients. Two patients died of intercurrent diseases at 12 and 21 months without any evidence of recurrence. The disease has been also controlled in the other three cases. With the above doses, three small tumors < 1 cm were controlled without adverse effect. In two tumors, the dose reference points were set 2-7 mm beneath the mucosa, and larger doses were administered by brachytherapy. An applicator acting as a spacer was not used in these cases. The tumors were controlled, although the irradiated bronchi showed severe stenosis in 6 months following the treatment. However, the patients were asymptomatic and did not need further intervention. CONCLUSION External beam irradiation combined with endobronchial brachytherapy was useful for the treatment of roentogenographically occult lung cancer as an alternative to surgery. Further investigation is needed to determine the optimal doses of radiation therapy.

A phase I study of irinotecan and infusional cisplatin for advanced non-small-cell lung cancer

Abstract A phase I study was performed to establish the optimum dose for combination therapy with infusional cisplatin and irinotecan (CPT-11) in non-small-cell lung cancer (NSCLC). The subjects were 20 patients with a performance score of 0–2 with untreated advanced NSCLC. Cisplatin was administered by 5-day continuous intravenous infusion at 20–25 mg/m2 per day. CPT-11 was administered by bolus infusion at a starting dose of 20 mg/m2 on days 1 and 8 or 60 mg/m2 per day on day 1 alone, followed by serial increments of 20 mg/m2. Since grade 4 granulocytopenia was observed in two of the five patients receiving 20 mg/m2 per day cisplatin (days 1–5) and 100 mg/m2 CPT-11 (day 1), and since one of them developed severe pneumonia and sepsis associated with the granulocytopenia, the regimen was considered to be intolerable. In the same patient, grade 4 thrombocytopenia and grade 3 diarrhea were observed. Therefore, the optimum dose appeared to be 20 mg/m2 per day (days 1–5) for cisplatin and 80 mg/m2 (day 1) for CPT-11. The side effects were grade 2 diarrhea in one of three patients, and grade 2 vomiting in three patients, but grade ≥2 hemotoxicity was not observed. This combined regimen resulted in a partial response in 9 out of 19 assessable patients. The dose-limiting factor in this combination therapy was granulocytopenia, and a high efficacy rate was obtained.

Comparison of Survival in Nonresected Well Differentiated and Poorly Differentiated Adenocarcinoma of the Lung

SummaryOne hundred nineteen cases of advanced adenocarcinoma of the lung were divided into well differentiated adenocarcinoma (72 cases) and poorly differentiated adenocarcinoma (47 cases) histologically and/or cytologically. The median survival of 72 cases of well differentiated adenocarcinoma (7.9 months) was significantly (P<0.025) longer than that of poorly differentiated adenocarcinoma (4.9 months) irrespective of stage, difference in treatment regimen, or response to treatment. In 9 evaluable cases, the objective response rate to chemotherapy was 25% (6/24) in poorly differentiated adenocarcinoma and 11.3% (8/71) in well differentiated adenocarcinoma, respectively. In 45 patients who received a combination of chemotherapy and radiotherapy, the median survival of 22 well differntiated adenocarcinomas (11.8 months) was significantly (P<0.05) longer than that of 23 poorly differentiated adenocarcinomas (5.6 months). The same tendency was observed in 74 patients who received chemotherapy alone. Analysis based on the grade of differentiation is essential for the accurate assessment of the efficacy of treatment in adenocarcinomas of the lung.

A phase I study of irinotecan and infusional cisplatin with recombinant human granulocyte colony-stimulating factor support in the treatment of advanced non-small cell lung cancer

We conducted a phase I study to examine whether support with recombinant human granulocyte colony-stimulating factor (rG-CSF) would permit dose intensification of irinotecan (CPT-11) in combination with cisplatin (20 mg/m2 x 5 days) in non-small cell lung cancer (NSCLC) patients. CPT-11 was administered by bolus infusion at a starting dose of 100 mg/m2 on day 1, followed by serial increments at 20 mg/m2, given every 4 weeks. The major toxic effects were granulocytopenia and diarrhoea. The response rate was 55% (11/20). The optimum dose for phase II studies appears to be 20 mg/m2/day (5-day continuous infusion) for cisplatin and 160 mg/m2 (day 1) for CPT-11 with rG-CSF support in NSCLC.