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Kaneko M, Kusumoto M, Kobayashi T, Moriyama N, Naruke T, Ohmatsu H, Kakinuma R, Eguchi K, Nishiyama H, Matsui E. Computed tomography screening for lung carcinoma in Japan. Cancer 2000; 89:2485-8. [PMID: 11147632 DOI: 10.1002/1097-0142(20001201)89:11+<2485::aid-cncr28>3.3.co;2-k] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Japan, lung carcinoma is the leading cause of cancer-related deaths. Adenocarcinoma accounts for roughly half of all lung carcinomas. Earlier detection of lung carcinoma is expected to reduce mortality rates. Computed tomography (CT) provides higher contrast resolution and greater visualization of chest compartments that are difficult to view with chest radiography, such as the mediastinum. CT further permits the detection of minute peripheral nodules. At present, several institutions and research groups are evaluating the utility of low dose spiral CT for lung carcinoma screening. METHODS From September 1993 to December 1998, 1669 individuals underwent a biannual screening program for lung carcinoma. The program included posteroanterior radiograph, sputum cytology, and low dose spiral CT at a for-profit organization: The Anti-Lung Cancer Association (ALCA). A total of 9993 examinations were carried out. The low dose spiral CT parameters used were 120 kvP, 50 mA, 10-mm collimation, and 2:1 pitch. RESULTS Peripheral lung carcinoma was detected in 31 of 9993 examinations (0.3%). Of the 31 cases, 24 tumors (77%) were detected by low dose spiral CT but were not visible on standard chest radiography. Twenty-two of the 24 tumors were Stage IA (T1N0M0, according to staging system revised in 1997). CONCLUSIONS Low dose spiral CT shows promise for lung carcinoma screening. The effectiveness of the technique for the detection of minute lung lesions remains to be established. Routine use of the technique will require resolution of several issues. These issues include the establishment of CT diagnostic criteria, the development of a diagnostic support system, the establishment of methods for definite diagnosis, and assessments of efficacy.
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Niho S, Kubota K, Moriyama E, Hosomi Y, Uramoto H, Nomura M, Goto K, Ohmatsu H, Matsumoto T, Kakinuma R, Shinkai T, Nishiwaki Y. Does chemotherapy duration impact on survival in patients with stage IV non-small cell lung cancer? Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sekine I, Nishiwaki Y, Kakinuma R, Kubota K, Hojo F, Matsumoto T, Ohmatsu H, Goto K, Kodama T, Eguchi K, Shinkai T, Tamura T, Ohe Y, Kunitoh H, Yoshimura K, Saijo N. Dose intensity of irinotecan (CPT) combined with weekly cisplatin (DDP) and etoposide (ETOP) in patients (pts) with metastatic lung cancer (LC): Phase I/II study JCOG 9507. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kakinuma R, Ohmatsu H, Kaneko M, Kusumoto M, Kenji E, Nishiyuma H, Nagai K, Nishiwaki Y, Moriyama N, Kawata Y, Kiki N. Computer-aided diagnosis of lung cancer by helical CT screening: Retrospective analysis. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yoshida J, Nagai K, Nishimura M, Takahashi K, Kakinuma R, Nishiwaki Y, Yokose T. Secretion of hCG/beta-hCG by squamous cell carcinoma of the lung in a 31-year-old female smoker. Jpn J Clin Oncol 2000; 30:163-6. [PMID: 10798545 DOI: 10.1093/jjco/hyd028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe a rare case of pulmonary squamous cell carcinoma secreting human chorionic gonadotropin (hCG) and its beta-subunit (beta-hCG) in a young female smoker. A 31-year-old mother of one child had been suffering from dysfunctional uterine bleeding for about 1 year. Pelvic examinations and abdominal ultrasonography yielded no abnormal findings and no signs of pregnancy. She developed a pain in the right chest and a huge (12x10 cm) squamous cell carcinoma was diagnosed in the right lower lobe. The serum hCG and beta-hCG levels were high: hCG 5611 mlU/ml (normal upper limit 0.7 mIU/ml), beta-hCG 12 238 mIU/ml (normal upper limit 0.5 mIU/ml). The patient underwent right lower lobectomy and systematic lymph node dissection. Microscopic study showed a poorly differentiated squamous cell carcinoma. The pathological stage was T2N0M0, stage IB. Immunohistochemical staining of the tumor was strongly positive for hCG. The serum hCG level returned to normal 1 month after the operation, while an additional 2 months were necessary for the beta-hCG level to normalize. Dysfunctional uterine bleeding disappeared and the patient is doing well, with no signs of recurrence, 9 months after the resection.
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Niho S, Nishiwaki Y, Goto K, Ohmatsu H, Matsumoto T, Hojo F, Ohe Y, Kakinuma R, Kodama T. Significance of serum pro-gastrin-releasing peptide as a predictor of relapse of small cell lung cancer: comparative evaluation with neuron-specific enolase and carcinoembryonic antigen. Lung Cancer 2000; 27:159-67. [PMID: 10699689 DOI: 10.1016/s0169-5002(99)00100-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) have been reported to be useful markers for staging, monitoring treatment, and predicting relapse in patients with small cell lung cancer (SCLC). Recently, pro-gastrin-releasing peptide (Pro-GRP) became available as a sensitive, specific, and reliable tumor marker for patients with SCLC. The aim of this study is to determine the most useful tumor marker to detect the relapse of SCLC. Furthermore, we analyzed the relationship between tumor markers at relapse and survival from relapse or response to salvage chemotherapy. Medical records were reviewed to obtain serum levels of Pro-GRP, NSE, and CEA before and after the initial chemotherapy, and at relapse. Consecutive 66 patients with SCLC, with an objective response and confirmed relapse treated at the National Cancer Center Hospital East, were analyzed in this study. The percentages of patients whose tumor marker level were elevated before treatment, decreased after the treatment, and increased again at relapse were 67% (95% CI, 55-78) for Pro-GRP, 20% (10-29) for NSE, and 38% (26-50) for CEA. Multivariate analysis indicated that poor performance status before initial treatment and elevated serum levels of lactate dehydrogenase at relapse were poor prognostic factors for patients with recurrent SCLC (P<0.005). None of the serum levels of Pro-GRP, NSE, and CEA at relapse was a significant prognostic factor and associated with an objective response to salvage chemotherapy. The present study demonstrated that serum levels of Pro-GRP reflect the disease course of patients with SCLC most accurately.
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Tanaka K, Shima Y, Kakinuma R, Kubota K, Ohe Y, Hojo F, Matsumoto T, Ohmatsu H, Goto K, Nagai K, Nishiwaki Y. Effect of nebulized morphine in cancer patients with dyspnea: a pilot study. Jpn J Clin Oncol 1999; 29:600-3. [PMID: 10721941 DOI: 10.1093/jjco/29.12.600] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is known that opioids may decrease subjective dyspnea. The recent finding that opioid binding sites are present in the peripheral bronchus supports the possibility of a local action of opioids. However, the clinical benefit of nebulized morphine is controversial. The purpose of this study was to confirm the feasibility of nebulized morphine and to evaluate its clinical benefits. PATIENTS AND METHODS Fifteen cancer patients with dyspnea in the Thoracic Oncology Division and Palliative Care Unit in the National Cancer Center Hospital East were given 20 mg of morphine hydrochloride dissolved in 5 ml of normal saline through an ultranebulizer. The subjective effects were evaluated using a visual analog scale (VAS) immediately before and 60 min after inhalation. Respiratory rate (RR), hemoglobin oxygen saturation (SpO2) and blood pressure also were measured twice at these two time points. A questionnaire about adverse reactions was included. RESULTS No major adverse reactions such as respiratory depression, sleepiness, nausea or vomiting were observed. VAS was significantly decreased after nebulization (p = 0.005) without any significant change in RR or SpO2. In eight of 15 patients, dyspnea was improved as measured by a decrease in VAS of more than 10%. This correlated with the desire of the patients to continue its use. CONCLUSION Our preliminary data confirmed the feasibility of nebulized morphine and suggested its possible clinical benefit for dyspneic patients. A randomized controlled study is warranted to exclude a placebo effect and to compare the clinical benefits of nebulized morphine with those of other methods of treatment.
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Hosomi Y, Ohe Y, Mito K, Uramoto H, Moriyama E, Tanaka K, Kodama K, Niho S, Goto K, Ohmatsu H, Matsumoto T, Hojo F, Kakinuma R, Nishiwaki Y. Phase I study of cisplatin and docetaxel plus mitomycin C in patients with metastatic non-small cell lung cancer. Jpn J Clin Oncol 1999; 29:546-9. [PMID: 10678557 DOI: 10.1093/jjco/29.11.546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Docetaxel, cisplatin and mitomycin C are some of the active drugs used in the treatment of patients with metastatic non-small cell lung cancer (NSCLC). The purpose of this study was to determine the maximum tolerated dose (MTD) and recommended dose of the three drugs in combination for such patients. METHODS Chemotherapy-native patients with metastatic NSCLC were enrolled in this study. The doses of docetaxel and cisplatin were fixed at 60 and 80 mg/m2, respectively. It was planned to increase the dose of mitomycin C from 4 to 6 and 8 mg/m2. All drugs were administered on day 1 and repeated every 3-4 weeks. RESULTS All six patients received 60 mg/m2 of docetaxel and 80 mg/m2 of cisplatin, three of them with 4 mg/m2 of mitomycin C (level 1) and the other three with 6 mg/m2 of mitomycin C (level 2). Two of the three level 2 patients experienced dose-limiting toxicities (DLTs) in first cycle: febrile neutropenia and grade 3 hyponatremia. Based on these data, the MTD was concluded to be 60 mg/m2 for docetaxel, 80 mg/m2 for cisplatin and 6 mg/m2 for mitomycin C. Evaluation of the data from all of the cycles, however, showed that four of the six patients experienced DLTs. CONCLUSIONS The addition of mitomycin C to docetaxel and cisplatin resulted in relatively high toxicities. It was impossible to use a high enough dose of mitomycin C to improve the survival of NSCLC patients. We therefore concluded that further evaluation of this combination is unwarranted.
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Kakinuma R, Ohmatsu H, Kaneko M, Eguchi K, Naruke T, Nagai K, Nishiwaki Y, Suzuki A, Moriyama N. Detection failures in spiral CT screening for lung cancer: analysis of CT findings. Radiology 1999; 212:61-6. [PMID: 10405721 DOI: 10.1148/radiology.212.1.r99jn1461] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To clarify the computed tomographic (CT) findings and the progression of minute lung cancers that were missed at initial spiral CT screening but were later detected. MATERIALS AND METHODS The findings from seven patients with lung cancer that was missed at the initial spiral CT screening were reviewed. Retrospective CT findings, time to detection, cell type, and pathologic stage were evaluated. RESULTS Minute lung cancers missed at early spiral CT included a nodule among the shadows of old tuberculosis (n = 2), a faint nodule with high attenuation in the center of the nodule (n = 1), an increase in attenuation just adjacent to an axial peripheral pulmonary vessel (n = 1) and adjacent to a craniocaudal peripheral pulmonary vessel (n = 1), and a minute faint nodule (n = 2). The time to detection ranged from 6 to 18 months. At pathologic examination, six cancers were stage I, and one was stage II. CONCLUSION Minute nodules of lung cancer that are near the threshold of detectability may be missed at spiral CT screening. It is important to examine noncalcified nodules with thin-section CT even when lesions from prior disease, such as those from old tuberculosis, exist and to evaluate the shadows of pulmonary vessels carefully. A follow-up examination is highly recommended.
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Ogawa Y, Shimizu H, Itakura Y, Ohama Y, Arakawa H, Amizuka T, Obata M, Kakinuma R. Functional pulmonary surfactant deficiency and neonatal respiratory disorders. Pediatr Pulmonol Suppl 1999; 18:175-7. [PMID: 10093135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The pathophysiology of functional deficiency of pulmonary surfactant in the neonatal respiratory disorders represented by MAS, hemorrhagic lung edema and ARDS was discussed. The removal of inhibitor(s) is the cardinal procedure for MAS and the lavage with surfactant solution seems to be promising. In case of replacement therapy, we should consider using a different dose compared to the one used in RDS due to lung immaturity, in order to optimize results.
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Goto K, Kodama T, Hojo F, Kubota K, Kakinuma R, Matsumoto T, Ohmatsu H, Sekine I, Nagai K, Nishiwaki Y. Clinicopathologic characteristics of patients with nonsmall cell lung carcinoma with elevated serum progastrin-releasing peptide levels. Cancer 1998; 82:1056-61. [PMID: 9506349 DOI: 10.1002/(sici)1097-0142(19980315)82:6<1056::aid-cncr7>3.0.co;2-c] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Progastrin-releasing peptide (proGRP) is a specific tumor marker in patients with small cell lung carcinoma (SCLC). It has been reported that serum proGRP levels rarely are elevated in patients with nonsmall cell lung carcinoma (NSCLC); the reported frequency is <3%. The purpose of this study was to examine the clinicopathologic features of NSCLC patients with high serum proGRP levels. METHODS The authors measured serum proGRP levels with a TND-4 kit, a newly developed enzyme-linked immunoadsorbent assay, in 544 NSCLC and 206 SCLC patients. Pathologic features were examined using conventional hematoxylin and eosin staining and histochemical and immunohistochemical staining using polyclonal antibodies to proGRP, chromogranin A, calcitonin, and monoclonal antibody to the neural cell adhesion molecule (NCC-Lu-243). RESULTS The serum proGRP levels were elevated in 140 SCLC patients (68.0%) and in 23 NSCLC patients (4.2%). Seven of these 23 NSCLC patients had serum proGRP levels > or = 100 pg/mL. They included two patients with renal dysfunction, one patient diagnosed cytologically with adenocarcinoma without undergoing precise pathologic examination, two patients diagnosed histologically with squamous cell carcinoma with foci of small cell elements, and two patients diagnosed with large cell neuroendocrine carcinoma and poorly differentiated adenocarcinoma, respectively, which showed neuroendocrine differentiation on immunohistologic analysis. The remaining 16 NSCLC patients had serum proGRP levels < 70 pg/mL. CONCLUSIONS Nearly all NSCLC patients had serum proGRP levels < 100 pg/mL. However, if an NSCLC patient presents with a proGRP level > or = 100 pg/mL, the clinicopathologic features must be examined with regard to the small cell component, neuroendocrine differentiation, and renal dysfunction.
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Kanazawa K, Kawata Y, Niki N, Satoh H, Ohmatsu H, Kakinuma R, Kaneko M, Moriyama N, Eguchi K. Computer-aided diagnosis for pulmonary nodules based on helical CT images. Comput Med Imaging Graph 1998; 22:157-67. [PMID: 9719856 DOI: 10.1016/s0895-6111(98)00017-2] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this paper, we present a computer-assisted automatic diagnostic system for lung cancer that detects nodule candidates at an early stage from helical CT images of the thorax. Our diagnostic system consists of analytical and diagnostic procedures. In the analytical procedure, first we extract the lung and the pulmonary blood vessel regions using the fuzzy clustering algorithm, then we analyze the features of these regions using image-processing techniques. In the diagnostic procedure, we define diagnostic rules utilizing the extracted features which support the determination of the candidate nodule locations. We show the effectiveness of our system by giving the results from its application to image data for mass screening of 450 patients.
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Miyamoto T, Ohmatsu H, Kakinuma R, Kodama T, Nishiwaki Y, Nagai K, Moriyama N. 848 CT fluoroscopically guided transthoracic needle biopsy. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)80226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goto K, Kodama T, Kakinuma R, Kubota K, Hojo F, Matsumoto T, Ohmatsu H, Sekine I, Nishiwaki Y. 879 Monitoring serum KL-6: A useful indicator for interstitial pneumonia due to radiotherapy and chemotherapy in patients with lung cancer. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)80260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nishiyama H, Tadera M, Suzuki S, Tuchiya S, Yamaguchi T, Hayashi N, Kato S, Suzuki A, Sobue T, Ohmatsu H, Kakinuma R, Moriyama N, Eguchi K, Kaneko M, Naruke T. 762 Usefulness of helical CT scan for early detection of lung cancer our experience at the anti-lung cancer association (ALCA). Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)80140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sekine I, Nishiwaki Y, Kakinuma R, Kubota K, Hojo F, Ogino H, Yokoyama A, Saito M, Mori K, Tsukiyama I, Tsuchiya S, Hayakawa K, Saijo N. 303 Phase II study of alternating radiotherapy (RT) and chemotherapy (CT) for locally advanced non-small-cell lung cancer (NSCLC). JCOG study 9306. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)89687-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kakinuma R, Ohmatsu H, Kaneko M, Eguchi K, Naruke T, Nagai K, Nishiwaki Y, Kodama T, Moriyama N. 829 Lung cancer detected by helical CT screening: Review of retrospectively visible cases. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)80211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ebi N, Kubota K, Nishiwaki Y, Hojo F, Matsumoto T, Kakinuma R, Ohmatsu H, Sekine I, Yokosaki M, Gotoh K, Yamamoto H, Kodama T. Second-line chemotherapy for relapsed small cell lung cancer. Jpn J Clin Oncol 1997; 27:166-9. [PMID: 9255271 DOI: 10.1093/jjco/27.3.166] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Between January 1985 and August 1991, 159 patients with small cell lung cancer received first-line chemotherapy and 123 (77%) were responders. Of these, 88 relapsed, the remainder having died of other or unknown diseases or being alive without carrying cancer. The relapsed patients were examined to evaluate the outcome of the treatment for relapsed small cell lung cancer and to identify the factors that would contribute to the response rates and the survival durations. Forty-eight of 88 relapsed patients received second-line chemotherapy. Of the 48, 3 were evaluated as showing a complete response, 13 as partial response, 9 as no change, 15 as progressive disease and 8 as not evaluable. The response rate was 33% (95% confidence interval 20.4-48.4%). The median survival time was 146 days. The duration and rate of response in first-line chemotherapy affected the response rates of the second-line chemotherapy, but without statistical significance (P = 0.058 and 0.067 respectively). Increased response duration, time off chemotherapy and previous response to first-line chemotherapy all had a positive effect on the survival times (P < 0.01). Relapsed small cell lung cancer still shows a response to second-line chemotherapy without lessening survival time, and thus clinical trials of new drugs or combination chemotherapeutic regimens for relapsed small cell lung cancer cases would be reasonably justified. Randomized comparative studies are warranted for determining the benefits of second-line chemotherapy for relapsed small cell lung cancer cases.
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Kakinuma R, Imatsu H, Kaneko M, Eguchi K. [Lung cancer: progress in diagnosis and treatment. I. Diagnosis and physiopathology: 2. On the lung screening system--cytodiagnosis and CT examination]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 1997; 86:10-4. [PMID: 9102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ando M, Eguchi K, Shinkai T, Tamura T, Ohe Y, Yamamoto N, Kurata T, Kasai T, Ohmatsu H, Kubota K, Sekine I, Hojo N, Matsumoto T, Kodama T, Kakinuma R, Nishiwaki Y, Saijo N. Phase I study of sequentially administered topoisomerase I inhibitor (irinotecan) and topoisomerase II inhibitor (etoposide) for metastatic non-small-cell lung cancer. Br J Cancer 1997; 76:1494-9. [PMID: 9400948 PMCID: PMC2228187 DOI: 10.1038/bjc.1997.584] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We conducted a phase I study of irinotecan (CPT-11) and etoposide (VP-16) given sequentially to untreated patients with metastatic non-small-cell lung cancer. Arm A: CPT-11 was given over 90 min on days 1-3 and VP-16 was given over 60 min on days 4-6. Arm B: VP-16 was given on days 1-3 and CPT-11 on days 4-6. G-CSF was given to all patients daily on days 7-17. Twenty-seven patients were entered randomly at the two arms. The major dose-limiting toxicities in arms A and B were granulocytopenia and diarrhoea. Transient elevations of transaminases and bilirubin were observed in both arms. The degree of the toxicities did not differ between the two arms. The maximum tolerated doses (MTDs) were 60 mg m-2 CPT-11 and 60 mg m-2 VP-16 in both arms. Of the 13 patients who received more than two cycles, two out of five achieved partial response (PR) at the first level of arm A and one out of four achieved PR at the second level of arm B. We conclude that these schedules of sequential CPT-11 and VP-16 administration were inappropriate because of severe toxicities.
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Kubota K, Nishiwaki Y, Kakinuma R, Hojo F, Matsumoto T, Ohmatsu H, Sekine I, Yokozaki M, Goto K, Ebi N, Kodama T. Dose-intensive weekly chemotherapy for treatment of relapsed small-cell lung cancer. J Clin Oncol 1997; 15:292-6. [PMID: 8996155 DOI: 10.1200/jco.1997.15.1.292] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was undertaken to determine the activity and toxicity of dose-intensive weekly chemotherapy (cisplatin, vincristine, doxorubicin, and etoposide [CODE] regimen) for previous treated, recurrent small-cell lung cancer (SCLC). PATIENTS AND METHODS The 17 patients with relapsed SCLC entered onto the study were to receive intensive weekly chemotherapy with the CODE regimen. All 17 patients had been heavily pretreated with some form of cisplatin-based combination chemotherapy. Six patients had received previous chemotherapy with CODE and one patient with cisplatin and etoposide (PE) as induction therapy. Nine patients had been treated with concurrent or sequential PE plus thoracic irradiation (TRT). The median time off chemotherapy was 6.7 months (range, 3.3 to 72). Patients were treated with 9 weeks of the CODE regimen. Response, survival, and toxicity data were noted. RESULTS All 17 patients were assessable for response, survival, and toxicity. Fifteen of 17 patients (88.2%) had an objective response, with five complete responses (CRs; 29%) and 10 partial responses (PRs; 58.8%). The median durations of response and survival were 156 days and 245 days, respectively. Myelosuppression was significant, with 76% of patients developing grade 4 leukopenia. No treatment-related death was observed. CONCLUSION The CODE regimen is highly active in the treatment of relapsed SCLC with an encouraging survival outcome.
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Sekine I, Nishiwaki Y, Kakinuma R, Kubota K, Hojo F, Matsumoto T, Ohmatsu H, Yokozaki M, Goto K, Miyamoto T, Takafuji J, Kodama T. Phase II study of high-dose dexamethasone-based association in acute and delayed high-dose cisplatin-induced emesis--JCOG study 9413. Br J Cancer 1997; 76:90-2. [PMID: 9218738 PMCID: PMC2223781 DOI: 10.1038/bjc.1997.341] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Thirty-three patients with lung cancer receiving 80 mg m(-2) cisplatin were treated with high-dose dexamethasone (32 mg m(-2) on days 1-3, 16 mg m(-2) on day 4 and 8 mg m(-2) on day 5) combined with granisetron on day 1 and metoclopramide on days 2-5. Twenty-eight (85%) patients had no nausea or vomiting on day 1, and 16 (48%) achieved total control on days 1-5 with acceptable toxicity. High-dose dexamethasone for cisplatin-induced delayed emesis should be further evaluated in a phase III trial.
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Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suemasu K, Moriyama N. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996; 201:798-802. [PMID: 8939234 DOI: 10.1148/radiology.201.3.8939234] [Citation(s) in RCA: 644] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare low-dose spiral computed tomography (CT) with radiography of the chest for the screening and detection of small peripheral lung cancers in a high-risk population. MATERIALS AND METHODS Posteroanterior and lateral radiographs and low-dose spiral CT scans were obtained twice a year from September 1993 to April 1995 in 1,369 individuals (a total of 3,457 examinations) who were at high risk for lung cancer. Low-dose spiral CT parameters were 120 kvP, 50 mA, 10-mm collimation, and 2:1 pitch. RESULTS Peripheral lung cancer was detected in 15 of 3,457 examinations (0.3%). Among the 15 cases, the results of chest radiography were negative in 11 (73%), and the tumors were detected only at low-dose spiral CT. The detection rates of low-dose spiral CT and chest radiography were 0.43% (15 of 3,457 examinations), respectively. Fourteen (93%) of the 15 (exclusion of one pulmonary lung cancer) tumors were stage I. CONCLUSION Low-dose spiral CT was superior to chest radiography in the screening and detection of peripheral lung cancer in high-risk individuals. Further large-scale studies are warranted, however, to clarify the efficacy and cost-effectiveness of low-dose spiral CT in a randomized, controlled population.
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Sekine I, Nishiwaki Y, Kakinuma R, Kubota K, Hojo F, Matsumoto T, Ohmatsu H, Yokozaki M, Goto K, Kodama T. Late recurrence of small-cell lung cancer: treatment and outcome. Oncology 1996; 53:318-21. [PMID: 8692537 DOI: 10.1159/000227580] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The 2-year survival of patients with small-cell lung cancer (SCLC) with limited disease is about 25% and the survival curve continues to decline after 2 years. We reviewed 34 cases of survivors of SCLC who had been free of disease for 2 years and who constituted 12.2% of the 278 patients with SCLC newly diagnosed at our institution from 1977 to 1991. The cancer had recurred in 13 patients, 10 of whom were treated with chemotherapy and/or radiotherapy, and 1 complete and 1 partial response were obtained. Three patients received only supportive care because of poor performance status. The median survival after recurrence in the 13 patients was 7.4 months (range 0-39 months). A second primary cancer was noted in 5 patients, but 3 of them died from recurrence of SCLC. The prognosis of patients with late recurrence of SCLC was relatively good, and it seems that adequate treatment in such cases may lead to long-term survival.
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Sekine I, Nishiwaki Y, Kakinuma R, Kubota K, Hojo F, Matsumoto T, Ohmatsu H, Yokozaki M, Kodama T. A randomized cross-over trial of granisetron and dexamethasone versus granisetron alone: the role of dexamethasone on day 1 in the control of cisplatin-induced delayed emesis. Jpn J Clin Oncol 1996; 26:164-8. [PMID: 8656557 DOI: 10.1093/oxfordjournals.jjco.a023201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We studied the role of dexamethasone (DEX) administered on day 1 in controlling cisplatin-induced delayed emesis. Forty patients were randomly allocated to receive either granisetron (GRN) and DEX on day 1, or the same dose of GRN alone. On days 2-5, all the patients received metoclopramide and DEX. They were crossed over to the other antiemetic regimen with their second course of chemotherapy. Thirty-one patients were evaluable for efficacy. The mean visual analogue scale scores for nausea on days 1 and 2 were 9.1 and 18.8 mm for GRN and DEX, and 16.3 and 28.5 mm for GRN alone, respectively (P<0.05 on day 2). The mean numbers of emetic episodes on days 1-3 were 0.036, 0.46 and 0.36 for GRN and DEX, and 0.39, 0.89 and 0.57 for GRN alone, respectively (P<0.01 on day 1). Hiccups and restlessness were noted in 38% and 33% of cycles, respectively. Addition of DEX to GRN on day 1 thus enhanced the control of delayed emesis.
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