Tetsuji Kado

Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer.

PURPOSE To clarify whether the percentage of pulmonary volume irradiated to >20 Gy (V20) is related to the incidence and grade of radiation pneumonitis (RP) in cases of lung cancer treated with concurrent chemoradiation. METHODS AND MATERIALS The subjects comprised 71 patients with lung cancer who were treated with conventionally fractionated definitive concurrent chemoradiation. The chemotherapy agents were carboplatin or cisplatin combined with taxane for most patients. Radiotherapy was delivered at 1.8-2.0 Gy fractions once daily to a total of 48-66 Gy (median 60). We analyzed the relation between RP grade and V20. Univariate and multivariate analyses were performed to assess patient- and treatment-related factors, including age, gender, smoking history, pulmonary function (forced expiratory volume in 1 s), tumor location (upper lobe vs. middle/lower lobe), chemotherapy regimen (platinum + taxane vs. other), total dose, overall radiation periods in addition to V20. RESULTS With a median follow-up of 7.5 months, an RP grade of 0, 1, 2, 3, and 5 was observed in 16, 35, 17, 1, and 2 patients, respectively; the corresponding mean V20 values were 20.1%, 22.0%, 26.3%, 27.0%, and 34.5%. The 6-month cumulative incidence of RP greater than Grade 2 was 8.7%, 18.3%, 51%, and 85% in patients with a V20 of <or=20%, 21-25%, 26-30%, and >or=31%, respectively (p <0.0001). According to both univariate and multivariate analyses, V20 was the only factor associated with RP of Grade 2 or greater. CONCLUSION The incidence and grade of RP are significantly related to the V20 value. Thus, V20 appears to be a factor that can be used to predict RP after concurrent chemoradiation for lung cancer.

Dosimetric predictors of radiation esophagitis in patients treated for non-small-cell lung cancer with carboplatin/paclitaxel/radiotherapy

PURPOSE To establish dosimetric predictors of radiation esophagitis (RE) in patients treated with a combination of carboplatin, paclitaxel, and radiotherapy. METHODS AND MATERIALS Three-dimensional radiotherapy plans of 26 patients with non-small-cell lung cancer who received 50-60 Gy of radiotherapy concurrently with weekly administration of carboplatin (AUC 2) and paclitaxel (40-45 mg/m(2)) were reviewed in conjunction with RE. The factors analyzed included the following: percentages of organ volumes receiving >40 Gy (V40), >45 Gy (V45), >50 Gy (V50), and >55 Gy (V55); the length of esophagus (total circumference) treated with >40 Gy (LETT40), >45 Gy (LETT45), >50 Gy (LETT50), and >55 Gy (LETT55); the maximum dose in the esophagus (Dmax); and the mean dose in the esophagus (Dmean). Data were obtained on the basis of superposition algorithm. RESULTS All factors except Dmax showed statistical correlation with RE. Good correlations were shown between RE and LETT45 (rho = 0.714) and V45 (rho = 0.686). CONCLUSIONS LETT45 and V45 appear to be useful dosimetric predictors of RE. It is also suggested that Dmax does not predict RE.

Mixed connective tissue disease with fatal pulmonary hypertension and a review of literature

The paper presents an autopsy case of mixed connective tissue disease (MCTD) with pulmonary hypertension (PH) and a review of literature. A 33-year-old woman with Raynauds phenomenon and dyspnea of one year duration was diagnosed as having MCTD on the basis of a higher titer (1:163,840) of serum antibodies to the ribonucleoprotein (RNP). Cardiac catheterization showed complicating PH, confirmed an autopsy by the findings of concentric intimal cellular proliferation and typical plexiform lesions in the small arteries and arterioles of the lung, suggesting primary PH. Fatal PH with MCTD has been reported only 6 cases in literature including our case. All were young females, with histopathological findings consistent with plexogenic pulmonary arteriopathy in 5 cases and with recurrent pulmonary thromboembolism in the other. The aetiology of PH is still unknown, but it may be due to vasoconstriction evoked by the hyper-reactivity of the vessels.

Changes in Responses to Questionnaires Concerning Informing Lung Cancer Patients of Their Diseases Between 1996 and 2001

目的.肺がん患者の病名告知に対する意識の, 最近の5年間の変化を知ることを目的とした. 方法. 1996年と2001年の初診時病名告知アンケート調査の比較検討を行った. 1996年および2001年に兵庫県立成人病センター呼吸器科に初診受診し, 肺がんの確定診断のついた患者のうちアンケートに回答した1996年176名 (回答率71.3%), 2001年246名 (回答率89.5%) を対象とした. 結果. 全体的には, 病状や治療法の説明を詳細に受けたい患者は, 1996年は46.0%が2001年には69.5%へ増加し, 本当の病名を知りたい患者は65.9%から91.1%へ有意に増加した. またこれまで告知率が低いとされていた高齢患者や進行期の患者においても, 同様の増加を認めた. 結論. 我々のアンケート調査から, この5年問で病名告知など真実を知りたいと希望する肺がん患者が確実に増加してきたことが明らかとなった.

Bronchial hyperresponsiveness in patients with squamous cell lung cancer

Objective: The aim of this study was to examine the relationship between bronchial hyperresponsiveness, both in vivo and in vitro, and the type of lung cancer (squamous cell or adenocarcinoma).

Interstitial Pneumonitis Observed in Patients With Combined Chemotherapy Using Gemcitabine and Docetaxel.

平成11年8月より平成13年4月までに非小細胞肺癌に対しGemcitabme (GEM) (800-1000mg/m2, day 1, 8), Docetaxel (TXT) (50～60mg/m2, day 8), 3週毎投与の併用化学療法を施行し, 25例中5例に間質性肺炎の有害事象を認めた. 5例共にほぼ同時期 (2コ-ス目day 15～18) に発症し, 発熱, 低酸素血症, LDH上昇と胸部X線上の間質性陰影を認めた. 5例中3例には皮膚症状 (皮疹, 掻痒) が先行していた. 間質性肺炎はステロイド治療で全例回復した. GEMと他剤との併用療法は同期間中に30例, TXTと他剤との併用療法は同期間中に46例施行しているが, 肺毒性は認めなかった. GEM, TXT併用療法による肺毒性の報告は少なく, 今後このような症例の集積や, 発症時期・機序等の検討が必要と考えられた

A Case of Metastatic Lung Tumor from Uterine Leiomyosarcoma Showing Reduction in Size after Hysterectomy and Bilateral Oophorectomy.

症例は53歳の女性で, 平成5年9月に他院にて子宮筋腫の診断のもとに単純子宮全摘術, 両側卵巣摘除術を受けた. その時の胸部単純写真にて右上肺野に斑状影が認められ, 胸部CTでは上葉に境界明瞭辺縁平滑な腫瘤を認めた. 気管支ファイバースコープにても確定診断には至らなかった. 4ヵ月後の胸部単純写真では腫瘤影は明らかに縮小したがその5ヵ月後には再増大を認め, 当院にて右上葉切除術を受けた. 切除標本では紡錘形の細胞が束状となり, 縦横に交錯して増殖しており核の形は不整形で, 大小不同がみられmitosisも多発していたことから, 平滑筋肉腫と考えられた. 他院での子宮摘除標本の再検索でも同様の所見であったことから, 子宮平滑筋肉腫の肺転移と診断した. また, 摘出組織のエストロゲンリセプターは陽性であり, 子宮平滑筋肉腫においてもホルモン調節機構が腫瘍の増殖の過程に影響する症例が存在し, ホルモン療法の可能性が示唆された.

Cytologic examination of pleural lavage before and after pulmonary resection for primary lung cancer.

原発性肺癌の切除前後に術中胸腔内洗浄液の細胞診を行い, 病期, 組織型, 及び手術操作の影響を検討した.当センターで3年半の間に治癒切除が行われた144例のうち, 手術操作前後に胸腔内洗浄液細胞診の行い得た102例を対象とした.手術操作前の洗浄液細胞診陽性例は腺癌で, T2N0とT2N2の各1例の計2例 (2%), 手術操作後の5例 (4.9%) も腺癌でN1症例が2例, N2症例が3例であった.尚この5例の操作前の細胞診はすべて陰性であった.