Thoracic Oncology

Introduction
The Division of Thoracic Oncology cares for patients with lung cancer both primary and metastatic,mediastinal tumors and pleural tumors. To help our patients in the multidisciplinary care, we work closely withcomedicals, thoracic surgeons, radiation oncologists and psychiatrists who have special expertise in these areas.We also conduct clinical research to understand more about these malignant tumors and to develop new andmore effective diagnoses and treatments. Residents and trainees from domestic and foreign institutions have joined the Thoracic Oncology Program.

Routine Activities　
An Outpatient Clinic conducted by staff members is open from Monday to Friday to examine all new patients referred to the Thoracic Oncology Division and to see returning patients. We also examine the patients who are candidate of surgical resection. The staff of the Thoracic Oncology Division are responsible for the reading of chest X-rays and chest CTs in the hospital. Bronchoscopy for diagnosis and treatment is done from Monday to Thursday afternoon. Fluoroscopic-CT guided needle lung biopsy and fluoroscopic guided needle biopsy are done on the same day as bronchoscopy is performed. We use approximately 80 beds in conjunction with the Thoracic Surgery Division for patient management.
Case conferences with thoracic surgery, medical oncology and nursing staff are scheduled on Tuesday evenings, Wednesday evenings and Friday afternoons, respectively. The staff members and residents join the journal club on Wednesday mornings with members of thoracic surgery. In monthly meeting with physicians in private practices, we present case reports and research results for subspecialty education.

Research Activities
Our research activities are concentrated in four areas: (1) detection and diagnosis of peripheral-type minute lung cancer that are not visible on plain chest X-ray; (2) Positron emission tomography (PET) trials for diagnosis and staging: (3) development of new and effective treatment modalities; (4) performing a basic collaborative study with the Research Institute East; correlation between gene abnormality and clinical characteristics, study of precancerous lesions; atypical adenomatous hyperplasia. (5) Mental status of patients with lung cancer.

New Developments
PET trials for diagnosis and accurate staging have been started. The non-invasive modality would help patient management more efficient. Based on the data of minute peripheral type lung cancer, we developed a teaching software for detection. The software contains teaching files showing lung cancers of between 0.5 cm and 2 cm in size. These modalities would help lung cancer screening more effective. An accrual goal for the four-arm trial comparing cisplatin plus irinotecan with cisplatin plus gemcitabine, cisplatin plus vinorelbine and carboplatin plus paclitaxel for advanced non-small-cell lung cancer will been met soon. The study would define a standard treatment for disseminated non-small cell lung cancer (NSCLC). Encouraging survival data has been shown with a pilot study of cisplatin plus vinorelbine followed by thrice daily thoracic radiotherapy. Based on the pilot study of cisplatin and etoposide plus concurrent thoracic radiotherapy followed by cisplatin and irinotecan for limited small-cell lung cancer (LD-SCLC), we will start a phase III trial to evaluate the efficacy of irinotecan and cisplatin in LD-SCLC. A phase II study of ZD 1839 (Iressa) demonstrated more than 20% response rate for platinum-refractory or relapsed NSCLC. This is the first study that itarget-based therapyi alone makes significant tumor shrinkage in NSCLC.

K. KUBOTA

Table of Contents