Thoracic Oncology

Introduction
The Thoracic Oncology Division consists of 14 doctors including a chief, a head, four staff doctors, a chief resident and seven residents. The clinical activities include not only the care of inpatients and outpatients but also the diagnosis of thoracic disease using bronchoscopic, fluoroscopic and fluoroscopic-CT guided needle lung biopsies. Most inpatients have primary lung cancer and a few have mediastinal and pleural tumors. To support our patients with multidisciplinary care, we work in close co-operation with thoracic surgeons, radiation oncologists, psychiatrists and pharmacists. We also conduct clinical research to develop new and more effective treatments and diagnostic methods for lung cancer. Residents and trainees from domestic and foreign institutions have joined the Thoracic Oncology Program.

Routine Activities
The outpatient clinics conducted by staff physicians are open from Monday to Friday and examine all new patients referred to the Thoracic Oncology Group as well as following up our returning patients. We also examine patients who are candidates for surgical resection. Bronchoscopic and fluoroscopic needle lung biopsy for diagnosis are done from Monday to Thursday afternoon. The newly developed fluoroscopic-CT guided needle lung biopsy for diagnosis of very small lung nodules is done on Tuesday afternoon. Our activities include the reading of chest X-rays and chest CTs in the hospital. We utilize approximately 100 beds, working with thoracic surgeons, for patient management.
Case conferences with thoracic surgeons, to discuss operative indications, and with radiation oncologists, psychiatrists and pharmacists, to discuss treatments for inoperable cases, are held Tuesday and Wednesday evenings, respectively. We have a conference with the nursing staff and pharmacists to discuss cases in litigation every Friday afternoon. We also attend a conference on resected cases with pathologists and surgeons on Friday mornings. A journal club is conducted with members of the thoracic surgery team on Wednesday mornings. At a monthly meeting with physicians in private practice, we present case reports and research results for subspecialty education.

Research Activities
Every Friday evening we have a work conference to discuss clinical research, especially protocol studies, as well as basic research.
Research activities of the Thoracic Oncology Group are as follows:
1. Clinical trials to develop new and effective treatment modalities for lung cancer.
2. Detection and diagnosis of peripheral type small lung cancer that is not visible on plain chest X-ray.
3. Basic collaborative studies with the Research Institute East.
4. Mental status of patients with lung cancer.

New Developments
Fluoroscopic CT-guided needle lung biopsy has become established as a routine examination for small lung nodules. A phase I study of weekly chemotherapy with cisplatin, etoposide and irinotecan was completed and the recommended dose of irinotecan with cisplatin and etoposide was decided. This weekly chemotherapy regimen will proceed to a phase II study for patients with relapsed small cell lung cancer. The efficacy of high-dose dexamethasone treatment for cisplatin-induced emesis was demonstrated in a phase II trial.

Statistics

Background of Inpatients Treated between 1992 and 1997

1992 1993 1994 1995 1996 1997

Total no. of lung
cancer patients 110 269 295 301 363 402

Stage of disease

I 20 8 88 101 139 128

II 5 18 11 12 8 21

IIIA 15 42 45 53 49 46

IIIB 26 51 49 44 72 69

IV 44 73 102 91 95 138

Histology

Adenocarcinoma 56 166 165 169 220 238

Squamous cell ca. 30 57 68 76 88 90

Small cell ca. 17 36 39 37 35 50

Large cell ca. 6 8 19 10 13 21

Others 1 2 4 9 7 3

Treatment

Chemo+surgery 7 9 5 4 8 3

Surgery 26 106 113 133 150 162

Chemotherapy 53 106 117 112 124 145

Radiotherapy 8 13 13 23 29 23

Laser therapy - - 2 - 4 1

Palliative care 16 35 45 29 48 68

Background of Inpatients Treated between 1992 and 1997
	1992	1993	1994	1995	1996	1997
Total no. of lung cancer patients	110	269	295	301	363	402
Stage of disease
I	20	8	88	101	139	128
II	5	18	11	12	8	21
IIIA	15	42	45	53	49	46
IIIB	26	51	49	44	72	69
IV	44	73	102	91	95	138
Histology
Adenocarcinoma	56	166	165	169	220	238
Squamous cell ca.	30	57	68	76	88	90
Small cell ca.	17	36	39	37	35	50
Large cell ca.	6	8	19	10	13	21
Others	1	2	4	9	7	3
Treatment
Chemo+surgery	7	9	5	4	8	3
Surgery	26	106	113	133	150	162
Chemotherapy	53	106	117	112	124	145
Radiotherapy	8	13	13	23	29	23
Laser therapy	-	-	2	-	4	1
Palliative care	16	35	45	29	48	68

(Y. Ohe)

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