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 with co-medicals, 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 and more effective diagnoses and treatments. Residents and trainees from domestic and foreign institutions have joined the Thoracic Oncology Program.

Routine Activities 
Daily 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 candidates for 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 meetings 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 and accrual goal was met for the study of solitary pulmonary nodules. The non-invasive modality would help make patient management more efficient. Analysis of adenocarcinoma of the lung using microscopic CT has been started. Multi-slice CT is employed for the study of lung cancer screening at the Anti-Lung Cancer Association. Teaching software of helical CT screening for lung cancer was published on the Internet. 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 was met. 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 have started a phase III trial to evaluate the efficacy of irinotecan and cisplatin in LD-SCLC. A phase II study of ZD 1839 (Iressa) for chemotherapy-naive patients was started. The study will form the basis for future development of a combined modality approach with targeted therapy and chemotherapy for the treatment of NSCLC.

K. KUBOTA

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