[en] Treatment results of 49 patients (25, limited disease, LD, 24, extensive disease, ED) with small cell lung cancer were retrospectively analyzed. Fifteen patients received chemotherapy with Cyclophosphamide (CPM) and Vincristine (VCR) following thoracic radiotherapy (RT). Twenty-two patients were given induction chemotherapy with CPM, Adriamycin (ADM), and VCR and were followed by thoracic RT. Other chemotherapy consisted of CPM, VCR, Methotrexate, and ADM in 2 patients, 5-FU, CPM, Mitomycin C, and Toyomycin in 1 patient. The remaining 9 patients (2, LD, 7, ED) were treated with RT alone. The response rate was 80 % (64 % CR; 16 % PR) for LD patients and 33 % (4 % CR; 29 % PR) for ED patients (P < 0.001). The three-year survival (Kaplan-Meier's product) of all patients was 14 %, with a median survival time (MST) of 8 months. For patients with LD, the 3-year survival was 27 % (MST 15 months). Survival of patients with ED was 14 % at 1 year, 0 % at 2 year (MST 5.5 months). The difference between these figures was statistically significant (P < 0.0003). The 3-year survival and relapse-free survival for complete responders with LD were 43 % (MST 21 months) and 36 % (median CR duration, 11.5 months) respectively. Six of 16 complete responders with LD are alive and well at over 2 years. Local recurrence rate of the complete responders with LD was 28.8 %. None of the 7 complete responders given more than 48 Gy relapsed within the radiation field. We believe that the addition of thoracic RT to patients with LD is necessary for the control of the primary tumors and for long-term disease-free survival. (author)

[en] Tumor scintigraphy with ²⁰¹Tl chloride was studied in 153 cases with primary lung cancer, the findings were compared with these of various other respiratory diseases, and some attempts to improve scintigraphic diagnosis were made. Positive results were obtained in not only malignant conditions such as primary lung cancer, metastatic lung tumor and malignant mediastinal tumor, but also benign conditions such as benign thymoma, pneumonia, pulmonary tuberculosis and so on. In primary lung cancer, 139 of 153 cases (90.8 %) had positive results, demonstrating the presence of a primary focus in cases of pleural effusion or atelectasis, and metastatic foci in the hilum and mediastinum. The ratio of the maximal count in primary focus to the upper mediastinum ranged from 0.5 to 4.2 with a mean value ± S.D. of 1.8 ± 0.6, and the ratio of total counts of the primary focus to the administered dose of ²⁰¹Tl (uptake ratio) ranged from 0.02 % to 0.98 % with a mean value ± S.D. of 0.27 ± 0.18 %. The degree of ²⁰¹Tl uptake in primary focus correlated with bronchial blood flow and it was higher in cases of T2 and T3 than T1, but no correlation with histological type was found. Joint use of ²⁰¹Tl scintigraphy and perfusion lung scintigraphy was valuable to improve the anatomical orientation of the image and to assess the significance of the distribution of both radiotracers. Radionuclide angiocardiography with ²⁰¹Tl contributed to demonstrate vena cava superior syndrome and impairment of the pulmonary perfusion, and to calculate the uptake ratio of ²⁰¹Tl in various regions including tumor. ²⁰¹Tl scintigraphy seems to be useful in detecting right ventricular hypertrophy, pericardial effusion, bleomycin pneumonitis and other cardio-pulmonary complications as well as the presence and extent of primary lung cancer. (author)

[en] In order to analyze radiographic findings of small peripheral adenocarcinoma of the lung, diagnostic xerotomograms of 43 cases of primary adenocarcinoma and 12 cases of non neoplastic lesions, which were less than 2 cm in diameter, were retrospectively examined. Small solitary peripheral mass densities on xerotomogram were classified into three groups; 1) solid type with well-defined margin, and moderate or high density 2) infiltrative type with ill-defined margin, and low density 3) mixed type consisting of the solid type and infiltrative type. In this study concerning small peripheral adenocarcinomas which were less than 2 cm in diameter, the characteristics of peripheral adenocarcinoma on radiograms, spicula, notch lobulation, involvement of surrounding bronchi or vessels, and involvement of more than two subsegments were distinctly demonstrated on xerotomograms, which had excellent edge enhancement and tolerance. Based on findings of spicula plus lobulation, it was possible to differentiate adenocarcinoma appearing as a small solid type solitary mass density from non neoplastic lesions. Furthermore, a new scoring system was presented based on the findings of the margin of the lesion, vascular and pleural involvements. There was a difference in the scores of adenocarcinoma and non-neoplastic lesions. To obtain more precise differential diagnosis of small solitary peripheral mass densities, it is necessary to accumulate more knowledge concerning radiologic-pathologic correlation and to obtain better quality of images. (author)

[en] The authors evaluated the CT diagnosis of mediastinal lymph node metastasis in four sections of the mediastinum (58 cases, 151 parts). The reliability of CT diagnosis was as follows; Sesitivity 61.9 %, specificity 86.9 %, and accuracy 82.8 %. CT often resulted in underestimation in adenocarcinoma, and the true positive rate was lower in the upper section of the superior mediastinum than in other parts. We analyzed the lymph node size, number and range of metastasis. The length of the lymph node was shorter than 10 mm in many cases; 90.3 % in metastasis-negative, 52.2 % in metastasispositive. In lymph node metastasis, the length and also the range of cancer varied from section to section. Each part contained not only positive metastasis but also metastasis-negative lymph node. We, therefore, suggest that these factors influence the diagnosis even in true positive cases. (author)

[en] The accuracy of ultrasonography (US) and computed tomography (CT) were compared in the evaluation of the extent to the chest wall and the pleura in 34 cases of primary lung cancer in the vicinity of the chest wall. The percent accuracy of US evaluation of parietal and visceral pleural invasion was 62 % and that of CT for chest wall invasion was 74 %. US and CT both displayed a tendency to overestimate extent. Inaccurate estimation by US included 13 cases, 69.2 % among which had pleural indentation. Most mistakenly estimated as Surgical-P had pleural indentation as well. Overestimation by CT was recognized in 3 cases, 2 of which had atelectasis and the other pleural adhesion. The diagnosis of P-factor by US as well as the findings at surgery were difficult in cases having pleural indentation and evaluation of chest wall invasion by CT was also difficult in cases with atelectasis and pleural adhesion. The sensitivities of US and CT were both 90 %. Both methods were useful in the evaluation of chest wall involvement. US was superior to CT with respect to demonstration of more detailed visceral pleural change and respiratory movement of the tumor mass and the pleura can be observed. Therefore, US and CT should be utilized to assess chest wall and pleural involvement in cases with lung cancer in the vicinity of the chest wall. (author)

[en] Twelve patients with bronchiolo-alveolar carcinoma were analyzed by CT. Abnormal shadows were classified into two groups, either pneumonia-like shadows or nodular shadows. Characteristically lucencies were observed within these abnormal shadows in 9 patients and were classified into two groups, according to the size and the density, as cavity or multiple air-density areas distributed irregularly within the shadows (irregular air-density areas). The lucencies as mentioned above may be specific CT findings of bronchiolo-alveolar carcinoma. (author)

[en] Eleven cases of inoperable non-small cell lung cancer were treated with hyperfractionated radiotherapy combined with chemotherapy. Hyperfractionated radiotherapy consisted of 1.6 Gy per fraction, 2 fractions a day with 6 hours between fractions, 5 days a week for a total of 60.8 Gy. After 38.4 Gy of irradiation to the primary tumor, hilar, and mediastinal lymph nodes, an additional 22.4 Gy was given to primary lesion. Chemotherapy consisted of cisplatin, 80 mg/m² day 1, mitomycin C, 10 mg/m² day 1, and vinblastine, 5 mg/m², days 1 and 15. At least 2 courses were administered. The combination of radiotherapy and chemotherapy was sequential. Of 6 patients in whom hyperfractionated radiotherapy was performed first, 5 achieved partial response (PR). Of 5 patients in whom chemotherapy was performed first, 2 achieved PR. Median survival time was 300 days. Nine of the eleven patients experienced esophagitis, but in all patients this was controlled easily by oral antacids and/or H₂ blockers. In regard to radiation pneumonitis, fibrosis occurred in seven of nine cases, but they did not require corticosteroids. Levels of hematological toxicity were similar to previous reports, but were somewhat severe in cases receiving chemotherapy after irradiation. We conclude that hyperfractionated radiotherapy combined with chemotherapy including cisplatin is safe, but further evaluation to determine optimal dose and combination methods is necessary. (author)

[en] The effectiveness of postoperative radiotherapy (RT) was retrospectively studied in 71 cases of pT3-4 and/or n2-3 NSCLC. We scheduled 50 Gy RT with a portal including the hilum and the upper madiastinum, although some modifications were made in specific cases. RT was performed in 39 cases including 27 curative resection cases, among which a dose of more than 39 Gy was delivered in 30 cases. A total of 37.9% of 34 curative resection cases in stage IIIA and 11.8% of 17 curative cases in stage IIIB survived for three years after the operation, while none (0%) of 13 patients with macroscopic residual tumors survived for three years. Seven cases of intrapulmonary metastasis were excluded from analysis. Analysis of pT4 and/or n2-3 cases which achieved survival for more than 6 months after the curative resection revealed that the 3-year survival rates in 19 RT cases (≥39 Gy) and 15 non-RT cases were 45.6% and 9.8%. The local recurrence rates were 21.1% and 60.0%, while the distant metastasis rates were 36.8% and 53.3%. Local recurrence in the RT group was observed at the supraclavicular fossae which was out of the radiation portal, and metastatic mediastinal lymph nodes were found at two or more sites. The desired dose could not be delivered in the majority of the cases with macroscopic residual tumors. In some cases RT was not undertaken due to the poor post-operative condition of the patients. In conclusion, RT was effective in eradicating local subclinical disease and also in improving the survival rate. Our findings on local recurrence demonstrated that the supraclavicular fossae should also be included in the radiation portal in the cases with two or more metastasized mediastinal lymph node sites for better local control. (author)

[en] Nineteen patients with lung cancer detected by the development of recurrent nerve paralysis were reviewed on the basis of conventional radiography, tomography, and CT. Left recurrent nerve paralysis was caused by AP window masses in 14 of the 19 patients and by preaortic lesions in 3. In one patient, left recurrent nerve paralysis was caused by an aortic aneurysm. Right recurrent nerve paralysis was caused by a paratracheal mass in only one patient. In 10 patients, the paralysis was caused by direct invasion of the primary lung tumor into the nerve, in 8 patients by metastases to the mediastinal lymph nodes, and in one patient by an aortic aneurysm. CT was superior to conventional radiography and tomography in the detection of mediastinal lesions responsible for causing the paralysis. Therefore, CT can play an important role in the assessment of patients with recurrent nerve paralysis. (author)

[en] We evaluated long-term administration of Tegafur, OK-432 and PSK after radiotherapy for non-resectable non-small cell lung cancer. In our hospital 162 patients received radiotherapy between 1979 and 1986. Among those who were discharged after the first admission, 38 were completely followed up by us and 86 were not. These two groups were somewhat different in regard to patient characteristics and survival times. In the former group, we examined the effect of long-term mild chemoimmunotherapy by multivariate analysis using Cox's proportional hazard model. This revealed that those who were given Tegafur and OK-432 showed better prognosis even after adjustment for several factors. (author)