Ryosuke Ono

Hematoporphyrin derivative photodynamic therapy in roentgenographically occult carcinoma of the tracheobronchial tree

From July 1981 to July 1987, hematoporphyrin derivative photodynamic therapy (HpD‐PDT) was administered to 36 patients admitted to the National Cancer Center Hospital with roentgenographically occult lung cancer in whom biopsy showed 39 malignant lesions of the trachea and bronchus, although all the lesions could not be localized by the plain chest radiography and computed tomography scanning. The patients received an injection of HpD (2.5 mg/kg body weight) intravenously 72 hours before laser photoirradiation, and all patients underwent at least one session of PDT through a fiberoptic bronchoscope. Among the 39 malignant lesions of the trachea and bronchus, apparent complete responses were obtained in 11 patients with 12 lesions and less than complete responses in 27 lesions. Those with less than complete responses subsequently were treated with surgical or radiation therapy. Of the 36 patients, 16 patients are alive 37 to 109 months after therapy (mean, 65.1 months) with no apparent recurrence or metastasis, and 20 patients have died. Five of the 20 patients died of recurrent lung cancer, and the other 15 died of secondary causes. Regarding treatment complications, only a small amount of excessive airway secretions were observed, and there was no abscess formation in any patient.

Late toxicities and complications in three-year survivors of small cell lung cancer

123 patients with small cell lung cancer (SCLC) presented to the National Cancer Center Hospital (Tokyo) between 1978 and 1986. 22 of 71 patients with limited stage disease (LD) and none of 52 patients with extensive disease (ED) survived for 3 years. 15 of the 22 three year survivors had significant late complications. All patients received chemotherapy and either thoracic irradiation, resection or both. No prophylactic cranial irradiation was given. 4 patients developed cardiac failure, 2 with a dilated cardiomyopathy, despite the fact that no patient received over 420 mg/m2 of doxorubicin. 12 patients of the 17 who received thoracic irradiation developed radiation pneumonitis and 3 required hospitalisation for severe haemoptysis (2) or cavity formation (1). 1 patient who received nimustine developed a fatal myelodysplastic syndrome and 2 additional patients developed second primary tumours in the oesophagus (1) and stomach (1). Mild peripheral neuropathy (WHO grade 1) was persistent in 3 patients and asymptomatic azotemia (WHO grade 1) in 7. Despite advances in the treatment of SCLC there are very few asymptomatic long-term survivors.

Roentgenographically Occult Small-Cell Lung Cancer: Case Report and Review of the Literature

This report describes a rare case of roentgenographically occult small-cell lung cancer in a 73-year-old man with hemoptysis. Fiberoptic bronchoscopy disclosed a 5-mm dome-shaped lesion; a biopsy established the diagnosis of small-cell lung cancer. The patient received a combination of chemotherapy and radiotherapy. More than 10 years later, he is still alive without recurrent disease. A review of the literature of roentgenographically occult small-cell lung cancer revealed the following: (1) a history of heavy smoking was common; (2) double primary bronchogenic carcinoma was noted; (3) hemoptysis or bloody sputum was an initial common symptom; (4) the sensitivity of sputum cytologic analysis was relatively low; (5) the tumor, which was shiny, smooth, and covered with bronchial epithelium, was often located at the bifurcation; and (6) lymph node metastatic involvement occurred.

Clinical features and the results of treatment of brain metastases in small cell lung cancer.

1984年以降国立がんセンター内科でプロトコールスタディにエントリーされた肺小細胞癌は142例で, 初診時あるいは経過中にCTscanにより脳転移を確認された症例は58例 (41%) であった. 治療的全脳照射により94%の症例で自覚症状の改善が得られ, CT像では85%の奏効率 (CR rate: 38%) であった. しかしCRを得た20症例のうち30%に局所再発が認められた. 脳転移治療開始時からのMSTは治療的全脳照射完遂例で7カ月であった. 脳転移が直接死因になるものは少なく, 死亡した43例中11例 (26%) のみであり, 半数以上の症例は原発巣の増悪もしくは他臓器転移が直接の死因となった.

Comparative Study between the Macroscopic Pathological Findings and Bronchoscopical Findings and Difficulties in Detection of the Sites of Early-Stage Lung Cancer

The recent rapid increase in cases of lung cancer has necessitated the early detection and correct diagnosis of incipient lung cancer in the hilar region of the lung. Bronchial fiberscopy is very valuable for definitive diagnosis, in particular for the diagnosis of the site of the cancer in so-called occult lung cancer cases. Therefore, the authors carried out clinical and pathological studies in our 16 cases of early lung cancer at the hilum region of the lung.

Significance of Peripheral Bronchography on Coin Lesion

The findings peculiar to lung cancer can be obtained by the sufficiently precise and selective bronchography of the peripheral bronchus. These findings are especially important in lung cancer of the lung field type. For this purpose, the authors developed a flexible bronchial catheter.

Treatment for the post-surgical collapse of the lung using Flexible Bronchofiberscopy

最近, 抗生物質の進歩により, 術後肺合併症のうちで重要なる気管支炎および肺炎は, はなはだしく減少せるも, 術後急性肺虚脱は依然として減少せず, 術後肺合併症として重要性が増した. 術後胸廓換気運動の障害が急性肺虚脱発生の主因と考えられる. 肺虚脱が発生すると頻脈, 不整脈が出現し, 過剰換気のために換気血流の不均等性がより一層, つよまる. 以上の病態を改善する目的で, 33症例に気管支ファイバースコープを使用し, 積極的に気道分泌物を排除する治療法を実施し, 治療効果を検討した.1) 臨床的に呼吸数の増加, 脈搏頻数, チアノーゼ等の換気循環障害を認めた症例に対して, Therapeutic bronchofiberscopeを行い, 気道内の分泌物を吸引排除すると, 換気循環障害が改善された.2) 胸部X線写真上では33例中31例に無気肺陰影の消腿が認められた3) 気管支ファイバースコープで気道内の分泌物を吸引除去すると, 機械的に気管, 気管支に刺激を加えるために, 咳反射が回復し, 肺換気機能が亢進することによって, hypoxiaの改善をもたらした.4) 気道内の分泌物が膿性の場合には蛋白分解酵素, N-Acetyl-L-Cysteine等の粘液溶解剤を注入したのちに吸引することが良い.5) 術後急性期の患者に対して, 全く危険がないこと, 苦痛が少ないことである.