Thoracic Oncology and Surgery
Our research activities are focused on 4 areas:
(1) detection, diagnosis, and treatment of peripheral-type minute lung cancers that are not visible on plain chest X-rays; (2) development of new and effective diagnostic and treatment modalities; (3) performing a basic collaborative study with the Research Center for Innovative Oncology regarding the correlation between gene abnormalities and clinical characteristics and a study on precancerous lesions and atypical adenomatous hyperplasia; and (4) imparting communications skills training to physicians who care for cancer patients to provide them a better understanding of the mental status of lung cancer patients.
To establish a standard for the management of minute pulmonary nodules that are revealed on chest CT, a prospective observational study is in progress. A trial of limited resection for small pulmonary ground-glass opacity lesions is also currently in progress. Although surgical resection is the standard regimen for patients with stage II non-small-cell lung cancer (NSCLC), the accuracy of establishing a diagnosis of clinical N1 cancer is unsatisfactory, and a high rate of unexpected pN2 disease was observed. To avoid futile surgery and arrive at a proper decision regarding the treatment, modalities such as additional node biopsy or FDG-PET scan should be considered (64, 65). T4 tumors are generally regarded as inoperable; however, a subgroup of patients with intrapulmonary metastases may benefit from surgery (66, 67). Postoperative respiratory infections remain a significant problem in lung cancer surgery (68, 69), although their incidence is lower than that of infections after salvage esophagectomy following definitive chemoradiotherapy (70). Advanced age, low FEV1%, advanced pathological stage, or induction therapy is a risk factor for infections after lung cancer surgery (68). Annual abdominal ultrasonographic examination after complete NSCLC resection failed to demonstrate clinical benefit in such situations (71). Further studies are needed to establish the optimal follow-up strategy.
Chemotherapy is the standard treatment of patients with completely resected stage IB–IIIA NSCLC. To define the optimal chemotherapeutic regimen, a randomized phase II study of docetaxel plus cisplatin or paclitaxel plus carboplatin (PC) is on in progress. A phase II study of S-1 + cisplatin and concurrent radiotherapy for stage III non-small-cell lung cancer is also in progress. S-1 + cisplatin has also been evaluated in patients with stage IV NSCLC, and a randomized phase III trial comparing S-1 + cisplatin with docetaxel + cisplatin for advanced NSCLC was initiated. A combination of a platinum-based drug and third-generation agents, including vinorelbine, paclitaxel, docetaxel, gemcitabine, or irinotecan, is the standard first-line regimen for patients with advanced NSCLC (72). To control the local venous toxicity of vinorelbine, a randomized trial of drip infusion versus bolus injection of vinorelbine was conducted. There was no difference between a 6-min infusion and a 1-min bolus injection of vinorelbine (73). A pan-Asian randomized trial comparing gefitinib with platinum-based chemotherapy as the first-line chemotherapy in NSCLC patients with no or minimal history of smoking met the accrual goal. The standard second- or third-line chemotherapy is single-agent cytotoxic chemotherapy or therapy with epidermal growth factor receptor tyrosine kinase inhibitors. A phase II trial of PC in NSCLC patients previously treated with chemotherapy demonstrated a response rate of 37% and a median survival time of 9.9 months (74). PC could be a treatment of choice in such a setting.
A phase III trial comparing single-agent chemotherapy with topotecan with a weekly 3-drug combination regimen including cisplatin, irinotecan, and etoposide for relapsed SCLC was initiated. A phase II study of cisplatin plus irinotecan for large-cell neuroendocrine carcinoma is also currently in progress.
● K. Kubota ●
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