Thoracic Oncology

　Introduction

　　The Thoracic Oncology Group consists of thirteen doctors including a chief, a head, four staff doctors, a chief resident and six residents. The clinical activities include both treatments of patients and diagnosis of thoracic disease using bronchoscopic, fluoroscopic and fluoroscopic-CT guided needle lung biopsies. Treatments using chemotherapy for patients with lung cancer are performed at inpatient and outpatient clinics. Most patients have primary lung cancer and a few have mediastinal and pleural malignancies. To support our patients with multidisciplinary care, we work in close cooperation 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 doctors are open from Monday to Friday to examine all new patients referred to the Thoracic Oncology Group, as well as, to follow-up 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. 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 use approximately 80 beds, working with the thoracic surgeons, for patient management.
　　Case conferences with thoracic surgeons to discuss operative indications, and with radiation oncologist and pharmacists to discuss treatments for inoperable cases, are held Tuesday and Wednesday evenings, respectively. We have a conference with nursing staff and pharmacists to discuss newly admitted patients 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 study. Some studies are collaborations with other divisions of our hospital such as, Thoracic Surgery Division, Radiation Oncology Division, Developmental Drug Therapy Division, Psycho-oncology Division, Palliative Care Unit and Pharmacy Division. We also contribute to multicenter trials conducted by Japan Clinical Oncology Group (JCOG) and pharmaceutical companies. Our division is one of the opinion leaders in the JCOG lung cancer study group.
　　Research activities of the Thoracic Oncology Group are as follows:
1.　Clinical trials to develop new and effective treatment modalities for lung cancer.
2.　Clinical trials to develop effective supportive care for patients with lung cancer.
3.　Detection and diagnosis of small peripheral type lung cancers that are not visible on plain chest X-rays.
4.　Basic collaborative studies with the National Cancer Center Research Institute East.
5.　Mental status of patients with lung cancer.

　New Developments

　　We started chemotherapy for patients with lung cancer in outpatient clinic using weekly cisplatin and docetaxel or docetaxel alone. A phase I study of weekly cisplatin and docetaxel to develop a chemotherapy in outpatient clinic and for elderly patients is almost completed. We will conduct a phase II trial of weekly cisplatin and docetaxel for patients with metastatic non-small cell lung cancer. Another phase I study of cisplatin, docetaxel and mitomycin was completed, however, we decided not to conduct a phase II study because of toxicity. The efficacy of nebulized morphine in cancer patients with dyspnea was demonstrated by a pilot study and as a result, a double blind controlled study is being conducted with the Pharmacy Division and Palliative Care Unit. We established a scale for evaluation of dyspnea in cancer patients.

　Statistics

Specification of Inpatients Treated among 1992 and 1998
　 1992 1993 1994 1995 1996 1997 1998
Total No. of lung
cancer patients 　
110　　
269　　
295　　
301　　
363　　
402　　
385　
Stage of disease
　I 20　 85　 88　 101　 139　 128　 141　
　II 5　 18　 11　 12　 8　 21　 18　
　IIIA 15　 42　 45　 53　 49　 46　 30　
　IIIB 26　 51　 49　 44　 72　 69　 64　
　IV 44　 73　 102　 91　 95　 138　 132　
Histology
　Adenocarcinoma 56　 166　 165　 169　 220　 238　 228　
　Squamous cell ca. 30　 57　 68　 76　 88　 90　 90　
　Small cell ca. 17　 36　 39　 37　 35　 50　 48　
　Large cell ca. 6　 8　 19　 10　 13　 21　 9　
　Others 1　 2　 4　 9　 7　 3　 10　
Treatment
　Chemo+surgery 7　 9　 5　 4　 8　 3　 0　
　Surgery 26　 106　 113　 133　 150　 162　 168　
　Chemotherapy 53　 106　 117　 112　 124　 145　 145　
　Radiotherapy 8　 13　 13　 23　 29　 23　 19　
　Laser therapy 0　 0　 2　 0　 4　 1　 0　
　Palliative care 16　 35　 45　 29　 48　 68　 53　

Specification of Inpatients Treated among 1992 and 1998
	1992	1993	1994	1995	1996	1997	1998
Total No. of lung cancer patients	110	269	295	301	363	402	385
Stage of disease
I	20	85	88	101	139	128	141
II	5	18	11	12	8	21	18
IIIA	15	42	45	53	49	46	30
IIIB	26	51	49	44	72	69	64
IV	44	73	102	91	95	138	132
Histology
Adenocarcinoma	56	166	165	169	220	238	228
Squamous cell ca.	30	57	68	76	88	90	90
Small cell ca.	17	36	39	37	35	50	48
Large cell ca.	6	8	19	10	13	21	9
Others	1	2	4	9	7	3	10
Treatment
Chemo+surgery	7	9	5	4	8	3	0
Surgery	26	106	113	133	150	162	168
Chemotherapy	53	106	117	112	124	145	145
Radiotherapy	8	13	13	23	29	23	19
Laser therapy	0	0	2	0	4	1	0
Palliative care	16	35	45	29	48	68	53

(Y. Ohe)　

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