Shin Kawahara

Comparative study of prophylactic cranial irradiation in patients with small cell lung cancer achieving a complete response: a long-term follow-up result

Between 1981 and 1986, a total of 46 patients with small cell lung cancer (SCLC) achieving a complete response by chemotherapy with or without chest irradiation were randomized either to receive prophylactic cranial irradiation (PCI) or not. With a median follow-up time of 8.5 years for both groups, only five of 23 patients (22%) in the PCI group developed brain relapse, while 12 out of 23 (52%) in the no PCI group did so (P < 0.05). The frequency of patients developing a sole brain relapse during their whole clinical course was 4% for the PCI group and 17% for the no PCI group, however, the difference was not statistically significant. Patient survival was better for the PCI group (median survival time of 21 months, and 5-year survival rate of 22%) as compared with the no PCI group (median survival time of 15 months, and 5-year survival rate of 13%), showing a marginal significance (P = 0.097). Late neurologic toxicity was infrequent; only one developed a mild deterioration among seven long-term disease-free survivors in the PCI group. These results appear to warrant further clinical trials to clarify the utility of PCI in patients with SCLC achieving a complete response.

A phase II study of cisplatin and 5-fluorouracil with concurrent hyperfractionated thoracic radiation for locally advanced non-small-cell lung cancer: a preliminary report from the Okayama Lung Cancer Study Group.

A recent meta-analysis and randomized studies have demonstrated that combined chemoradiotherapy is associated with a survival advantage for selected patients with locally advanced unresectable non-small-cell lung cancer (NSCLC). We conducted a phase II study of combined chemoradiotherapy to find a more effective combination of drugs and radiation than those previously reported for such patients. Between January 1994 and November 1996, 50 previously untreated patients with locally advanced unresectable NSCLC (stage IIIA with N2 or IIIB disease) were entered in this study. Patients were required to have Eastern Cooperative Oncology Group performance status ≤ 2, age ≤ 75 years and adequate organ function. Treatment consisted of three cycles of cisplatin (20 mg m−2, days 1–5) and 5-fluorouracil (5-FU) (500 mg m−2, days 1–5) every 4 weeks, and concurrent hyperfractionated thoracic radiation (1.25 Gy twice daily, with a 6-h interfraction interval; total radiation dose, 62.5–70 Gy). Of the 50 patients entered, 37 (74%) responded to this chemoradiotherapy, including two (4%) with complete response. By a median follow-up time of 41.0 months, 35 patiennts had died and 15 were stil alive. The median time to progression for responding patients was 14.1 months (range, 2.6–51.3+ months). The median survival time was 18.7 months, with a survival rate of 66.0% at 1 year, 46.0% at 2 years and 27.6% at 3 years. Survival outcome was strongly affected by the extent of nodal involvement (median survival time, 27.4 months for N0–2 disease (n = 37) vs 10.7 months for N3 disease (n = 13);P = 0.007). The major toxicities of treatment were leukopenia and neutropenia (≥ Grade 3, 58% and 60% respectively). Other toxicities of ≥ Grade 3 included thrombocytopenia (26%), anaemia (26%), nausea/vomiting (16%) and radiation oesophagitis (6%). Treatment-related death occurred for one patient. Our findings suggest that cisplatin and 5-FU in combination with concurrent hyperfractionated thoracic radiation is effective and feasible for the treatment of locally advanced unresectable NSCLC. The short-term survival in this study appeared to be more encouraging than those of similar chemoradiation trials. A randomized trial will be needed to compare the combination of cisplatin and 5-FU with other platinum-based regimens together with concurrent hyperfractionated thoracic radiation. In addition, in future studies, inclusion criteria for N3 disease with or without supraclavicular involvement should be reconsidered to correctly evaluate the effect of combined chemoradiotherapy for locally advanced unresectable NSCLC.

Serum Soluble Interleukin-2 Receptor in Patients with Lung Cancer.

未治療の肺癌患者54症例を対象に血清可溶性インターロイキン2受容体 (sIL-2R) を測定し, その臨床的意義について検討した.肺癌患者の血清sIL-2Rの測定値は751±432U/mlであり, 37例 (69%) が530U/ml (健常人の平均値+2S.D.) 以上であった. 血清sIL-2Rは病期III/IV期では病期I/II期に比して有意に高値であった. 小細胞癌では同じ病期の非小細胞癌に比較して血清sIL-2Rは低値であった. 血清sIL-2Rと血清アルブミンおよび血清choline esteraseとの問には有意な負の相関関係, 血清sIL-2Rと血清CRPとの問には有意な正の相関関係が認められた. 非小細胞癌においては血清sIL-2R高値 (600U/ml以上) のものは予後不良の傾向が認められた.以上より, 血清sIL-2Rは肺癌患者, 特に非小細胞肺癌患者の腫瘍量の有用な指標であり, 予後因子となりうる可能性が示唆された.

Coexistence of Lung Cancer and Active Pulmonary Mycobacterial Disease.

過去10年間に当院で経験した肺癌と活動性肺抗酸菌症の合併例15例について臨床的検討を行った. 肺癌の組織型は, 扁平上皮癌9例, 腺癌4例, 小細胞癌2例, 抗酸菌種は, M. tuberculosis12例, M. avium complex3例であった. 9例は同一肺葉に肺癌病巣と抗酸菌病巣が認められた. 肺癌の経過中に肺抗酸菌症が発症した症例は6例であった. 肺抗酸菌症が先に発見され, その治療中に肺癌が診断された症例は9例であった. その9例について, 過去のレントゲン写真の検討を行ったが, 9例全例, 肺抗酸菌症治療の入院時には肺癌は存在しており, そのうち6例は, 肺癌の発生は肺抗酸菌症の発症よりも先行していたものと考えられた. 以上より, 肺抗酸菌症に肺癌が潜在している可能性を念頭に置いて診療に当たる重要性が示唆された.

Two cases of small cell carcinoma of the lung associated with carcinomatous leptomeningitis.

肺小細胞癌69例の治療経過中に2例の癌性髄膜症を経験した.症例1は, 化学療法により完全寛解を得た後, 癌性髄膜症で再発し, 発症後7週間で死亡した.剖検時, 腫瘍細胞は髄膜のみに認められ, 癌性髄膜症の発症がなければさらに長期の生存が可能と思われた.症例2は, 化学療法による部分寛解中に癌性髄膜症を発症し, 脳脊髄への放射線照射と抗癌剤髄腔内投与が著効を示し, 発症後9ヶ月間の長期にわたり癌性髄膜症を管理し得た.