Long-term survival after an aggressive surgical resection and chemotherapy for stage IV pulmonary giant cell carcinoma

BACKGROUND: Pulmonary giant cell carcinoma is one of the rare histological subtypes with pleomorphic, sarcomatoid or sarcomatous elements. The prognosis of patients with this tumor tends to be poor, because surgery, irradiation and chemotherapy are not usually effective. CASE PRESENTATION: We herein report a patient with pulmonary giant cell carcinoma with stage IV disease in whom aggressive multi-modality therapy resulted in a long-term survival. A 51-year-old male underwent an emergent operation with a partial resection of small intestinal metastases due to bleeding from the tumor. The patient also underwent a left pneumonectomy due to hemothorax as a result of the rapid growth of the primary tumor. Thereafter, two different regimens of chemotherapy and a partial resection for other site of small intestinal metastases and a splenectomy for splenic metastases were performed. The patient is presently doing well without any evidence of recurrence for 3 years after the initial operation. CONCLUSION: This is a first report of a rare case with stage IV pulmonary giant cell carcinoma who has survived long-term after undergoing aggressive surgical treatment and chemotherapy

Malignant schwannoma of the upper mediastinum originating from the vagus nerve

BACKGROUND: Malignant schwannoma of the upper mediastinum originating from the vagus nerve is extremely rare. CASE PRESENTATION: A 46-year-old female was admitted for a left cervical mass which was associated with both hoarseness and Horner's syndrome. Chest computed tomography showed a mass extending from the left upper mediastinum to the left supraclavicular area. A fine needle aspiration cytological examination suggested primary lung cancer stage IIIB large cell carcinoma. After administering induction chemo-radiotherapy, a complete surgical resection was performed. The tumor was found to involve both the left vagus nerve and the left sympathetic nerve. Histological examination of the resected specimen revealed the tumor to be malignant schwannoma. CONCLUSION: Despite incorrect preoperative diagnosis, the multimodality treatment administered in this case, including induction chemo-radiotherapy and surgery, proved to be effective

Multimodal treatment for resectable epithelial type malignant pleural mesothelioma

BACKGROUND: Malignant pleural mesothelioma is a rare malignancy. The outcome remains poor despite complete surgical resection. PATIENTS AND METHODS: Eleven patients with histologicaly proven epithelial type malignant pleural mesothelioma undergoing extrapleural pneumonectomy with systemic chemotherapy and/or radiotherapy before and after surgical resection were retrospectively reviewed. RESULTS: Ten out of 11 patients underwent complete surgical resection, of these 7 patients had stage I disease. Of these 7 patients, 5 are alive without any recurrence, a 2-year survival rate of 80% was observed in this group. There was no operative mortality or morbidity. CONCLUSION: Extrapleural pneumonectomy with perioperative adjuvant treatment is safe and effective procedure for epithelial type malignant pleural mesothelioma

Prognostic value of visceral pleural invasion in resected non–small cell lung cancer diagnosed by using a jet stream of saline solution

AbstractObjectiveVisceral pleural invasion caused by non–small cell lung cancer is a factor in the poor prognosis of patients with that disease. We investigated the relationship between the diagnosis of visceral pleural invasion by using a jet stream of saline solution, which was previously reported as a new cytologic method to more accurately detect the presence of visceral pleural invasion, and prognosis.MethodsFrom January 1992 through December 1998, 143 consecutive patients with peripheral non–small cell lung cancer that appeared to reach the visceral pleura underwent a surgical resection at the Department of Thoracic Oncology, National Kyushu Cancer Center. The surface of the visceral pleura in patients undergoing lung cancer resection was irrigated with a jet stream of saline solution. The diagnosis of visceral pleural invasion was determined by means of either a pathologic examination or by means of a jet stream of saline solution. In addition, a cytologic examination of the pleural lavage fluid obtained immediately after a thoracotomy was evaluated.ResultsForty-nine (34%) resected tumors were identified as having visceral pleural invasion. The diagnosis of visceral pleural invasion in 31, 6, and 12 patients was determined by using a jet stream of saline solution alone, pathologic examination alone, or both, respectively. The visceral pleural invasion and positive findings of intrapleural lavage cytology were linked. Although there was no significant difference between the incidence of distant metastases in the patients with visceral pleural invasion and those without visceral pleural invasion, the incidence of local recurrence, especially regarding carcinomatous pleuritis (malignant pleural effusion, pleural dissemination, or both), in the patients with visceral pleural invasion was significantly higher than in those without visceral pleural invasion. The recurrence-free survival of patients with visceral pleural invasion was significantly shorter than that of patients without visceral pleural invasion (P = .004), even patients with stage I disease (P = .02). There was also a significant difference between the patients with or without visceral pleural invasion in the overall survival (P = .02). Visceral pleural invasion was independently associated with a poor recurrence-free survival on the basis of multivariate analyses (P = .03), as were sex (P = .03), age (P = 002), and the stage of the disease (P < .0001).ConclusionsThis study confirmed that the jet stream of saline solution method in addition to ordinary pathologic examination was useful for detecting visceral pleural invasion, which is considered to be one of the causes of local recurrence, especially in carcinomatous pleuritis

Tegafur-Uracil Plus Gemcitabine Combination Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer Previously Treated with Platinum

BackgroundAn open-label, single-arm prospective study was conducted to evaluate the efficacy and toxicity of the combination of gemcitabine and tegafur-uracil (UFT) in patients with advanced nonsmall-cell lung cancer (NSCLC) after the failure of previous platinum-containing regimens.Patients and MethodsPatients with advanced NSCLC received 200 mg/m2 of UFT twice daily from day 1 through 14 plus 900 mg/m2 of gemcitabine per day via intravenous injection on days 8 and 15. This regimen was repeated every 3 or 4 weeks.ResultsA total of 40 patients were enrolled. Eleven patients (28%; 95% confidence interval [CI], 15–44%) achieved a partial response. The median progression-free survival, median overall survival, and 1-year survival rate were 4.0 months (95% CI, 3.3–6.7 months), 12.6 months (95% CI, 7.0–22.3 months), and 51% (95% CI, 33–66%), respectively. The most common grade 3 or 4 toxicity was neutropenia (38%; 95% CI, 23–54%) and the rate of grade 3 or 4 nonhematologic toxicity remained at less than 5%. A multivariate Cox model showed that adenocarcinoma, nonsmoking history, and good performance status predicted better survival.ConclusionsCombination chemotherapy with UFT and gemcitabine showed a promising effectiveness and acceptable toxicity for patients with platinum-resistant NSCLC

S-1 Plus Cisplatin with Concurrent Radiotherapy for Locally Advanced Non-small Cell Lung Cancer: A Multi-Institutional Phase II Trial (West Japan Thoracic Oncology Group 3706)

Purpose:To evaluate the combination chemotherapy using oral antimetabolite S-1 plus cisplatin (SP) with concurrent thoracic radiotherapy (RT) followed by the consolidation SP for locally advanced non-small cell lung cancer.Patients and Methods:Patients with stage III non-small cell lung cancer, 20 to 74 years of age, and Eastern Cooperative Oncology Group performance status 0 to 1 were eligible. The concurrent phase consisted of full dose S-1 (orally at 40 mg/m2/dose twice daily, on days 1–14) and cisplatin (60 mg/m2 on day 1) repeated every 4 weeks for two cycles with RT delivered beginning on day 1 (60 Gy/30 fractions over 6 weeks). After SP-RT, patients received an additional two cycles of SP as the consolidation phase.Results:Fifty-five patients were registered between November 2006 and December 2007. Of the 50 patients for efficacy analysis, the median age was 64 years; male/female 40/10; Eastern Cooperative Oncology Group performance status 0/1, 21/29; clinical stage IIIA/IIIB 18/32; and adenocarcinoma/others 20/30. There were 42 clinical responses including one complete response with an objective response rate of 84% (95% confidence interval [CI], 71–93%). The 1- and 2-year overall survival rates were 88% (95% CI, 75–94%) and 70% (95% CI, 55–81%), respectively. The median progression-free survival was 20 months. Of the 54 patients for safety analysis, common toxicities in the concurrent phase included grade 3/4 neutropenia (26%), thrombocytopenia (9%), and grade 3 esophagitis (9%) and febrile neutropenia (9%). In one patient, grade 3 pneumonitis was observed in the consolidation phase. There were two treatment-related deaths caused by infection in the concurrent phase.Conclusions:SP-RT showed a promising efficacy against locally advanced NCSLC with acceptable toxicity

Clinical Evaluation of Immune Response in Patients with Cancer

Immune response was clinically evaluated in 25 patients with carcinoma compared with 26 of non cancer patients by means of lymphocyte transformation against PHA which was shown as stimulation index. In patients with cancer, stimulation index showed apparently as low as an average of 38 compared with 82 of non-cancer patients. Furthermore, the level of stimulation index was a corresponding correlation to age in which low activation was presented in the elderly. According to diseased organs, the weak response of stimulation index against PHA were observed in patients with the carcinoma of the esophagus and the lung. The response of skin test for PPD, PHA, SK-SD and candida were inhibited in patients with advanced cancer of stage III and IV compared with that of stage I and II. These responses were also suppressed in postoperative course until at least 6 months after surgery. From these results, it was noted that operative procedures provoked the induced weakness against host defense immunologically. However, it was certified that the use of immunopotentiator faciliated the activity of immune response during postoperative period for the patients with no severely advanced lung cancer of stage I and II despite of little effects for patients with advanced lung cancer of stage III and IV. It was concluded that immune response of patients with cancer was inhibited by advancing carcinoma and by operative procedures but the use of immunopotentiator was beneficial to promote the host defense during postoperative period

A Functional Evaluation of Bronchial Reconstructed Lung with Special Reference to Denervation

Bronchoplastic procedures for lung cancer were suitable operative method to reserve pulmonary function and to enlarge the resected area. However, functional evaluation is not necessarily achieved in bronchial reconstructed lung, especially with reference to denervation. In this study the influence of denervation was investigated experimentally by pulmonary perfused wedge method in which vascular tonus was directly illustrated and by measurement of oxygen saturation (Sao2) of pulmonary venous blood in which the ability of oxygen uptake was elucidated. When comparing the results of denervation with regard to operative procedures of bronchoplasty, bronchoplasty with sleeve anastomosis of pulmonary artery and autotransplantation respectively, the deteriorate effects related to bronchoplasty were not observed as compared to autotransplantation