Lung Cancer and Lung Transplantation: A Review

With the increase in the number of lung transplants, it is expected that there will be a corresponding increase in the number of lung cancers reported in these patients. Longevity of the transplant recipients, lung transplantation for chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis, a history of smoking, and the increasing age of the lung donors make lung cancer more likely. Nodules and masses seen in chest imaging in lung transplant patients call for work up until a final diagnosis is achieved because there is a high likelihood of a serious infection or malignancy. The presence of a native lung is a major risk factor for lung cancer occurring in the transplant setting. Lung cancer of donor origin is rare. Bronchioloalveolar carcinoma confined to one lung can potentially be treated by transplanting the affected lung. Treatment for patients with lung cancer in the lung transplant setting has to be individualized because of the complexity of their medical problems and multiple medications. Attention needs to be focused on detecting lung cancer early in these patients to achieve a favorable outcome.     

Lung carcinoma

Chemotherapy for patients with advanced lung carcinoma at an early period of diseases contributes to prolonged survival. However, since survivals are limited to around 1 year, it is critical for patients to stay at home and continue their social activities under chemotherapy. As active agents such as paclitaxel, docetaxel, gemcitabine, vinorelbine and irinotecan were introduced into clinical practice, and new techniques for preventing side effects such as emesis and neutropenia were developed, chemotherapy for outpatients become feasible also in Japan. In addition, the outpatient chemotherapy, preventing oncologic emergency and early starting of palliative care are also very important for patients'quality of life (QOL) at home. This review summarizes the present status of taking care for outpatients with lung cancer.     

Lung cancer

Although surgery offers the best chance of cure for patients with early stage (I-resectable III A) non-small cell lung cancer (NSCLC), the overall 5-year survival rate is modest, and systematic improvements are needed. In the 1990s, two small prospective randomized phase III trials demonstrated striking results with neo-adjuvant chemotherapy and therefore several randomized trials were performed. However, there was no statistical significant trial among them. The recent systematic meta-analysis based on 8 trials revealed hazard ratio was 0.88 (95%CI: 0.76-1.01), although these data suggested a 12% relative benefit with the neoadjuvant chemotherapy, equivalent to an absolute improvement in survival of 5% at 5 years. For patients with stage N2-III A NSCLC, US intergroup trial (INT0139) also demonstrated there was no statistical difference between chemoradiotherapy following surgery and chemoradiotherapy on overall survival. At present, there is no scientific evidence of the neoadjuvant strategy for early stage NSCLC in practice. This invasive treatment is still investigational and should be done as the clinical trial base.     

Lung cancer

The number of lung cancer deaths in Japan has been continuously increasing for decades, mainly because of the growing size of the elderly population. In contrast, age-specific lung cancer death rates for those aged under 79 years plateaued recently, reflecting the decreasing smoking rates since 1966. However, the smoking rate for males (54% in 1999) is still extraordinarily high in Japan compared to other developed countries, so it is necessary to further promote anti-smoking activities. It is reported that the relative risk for lung cancer due to cigarette smoking increases 4-5 fold (current smokers versus non-smokers) for males and 2-3 fold for females, and that the population attributable risk is 70% for males and 15-25% for females in Japan, which indicates that cigarette smoking is the most influential risk factor for lung cancer. However, the magnitude of the relative risk and population attributable risk is not as high as those observed in other developed countries. In order to clarify the reasons for this, it is necessary to further accumulate findings from actual epidemiological studies in Japan. In addition to cigarette smoking, occupational exposures, dietary habits (low intake of vegetables and fruits), atmospheric air pollution, environmental tobacco smoke, cooking and heating fuels, indoor radon and previous lung diseases are reported to increase the risk of lung cancer.     

Lung cancer

Aging society is coming now, the ratio of elderly patients among all lung cancer patients has currently been increasing. It is necessary for elderly patients who are under-represented in clinical trials to study their suitable regimen. Thus, phase II and III clinical trials have been performed specifically for elderly non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients all over the world. As for single agent chemotherapy, there is a strong rationale for docetaxel and vinorelbine in elderly patients with advanced NSCLC. Recently, there are phase I and II clinical trial for CPT-11 monotherapy, and gefitinib and TS-1 are reasonable options for elderly patients. Alimta is tolerable for elderly, and subset analysis is performed for the elderly with recurrent NSCLC. As platinum-based chemotherapy, there are several elderly subset analyses and JCOG 0207, which is a phase III trial now in progress comparing weekly cisplatin+weekly docetaxel and weekly docetaxel. In SCLC, there is no evidence of single agent chemotherapy but combination chemotherapy such as carboplatin+etoposide is recommended. A phase III study of carboplatin+etoposide versus amrubicin under way. These studies should aim to optimize several agents for elderly patients and prolong survival, palliative care.     

Lung cancer

Based on several landmark studies and meta-analyses, the standard of care for stage II - III A NSCLC patients has been adjuvant cisplatin-based doublet chemotherapy performed after appropriate surgical resection. The benefit of this therapy for patients with stage I B NSCLC is less apparent, likely because of the heterogeneity of this population. In Japan, however, many randomized clinical studies have assessed the effectiveness of postoperative adjuvant chemotherapy with tegafur-uracil (UFT)in patients with completely resected NSCLC. Based on these studies and a meta-analysis, UFT is used as the standard postoperative adjuvant chemotherapy for stage I NSCLC patients with a tumor larger than 2 cm. It is necessary to re-evaluate adjuvant chemotherapy strategies according to the new seventh edition of the tumor-nodemetastasis classification system. The role of postoperative radiotherapy(PORT)is also explored there. Recently, several tumor markers such as ERCC1 may have had a predictive value for selecting patients who will benefit from adjuvant platin-based chemotherapy. Targeted agents and vaccine therapy are also being evaluated as adjuvant treatments for use after the resection of NSCLC. Randomized studies are ongoing. If these results are confirmed, we will enter an era of personalized care for resected NSCLC.     

Lung cancer

Tumor markers are defined as substances which are produced by cancer cells or non-cancer cells reactive to cancer cells, and reflect the cancer status, such as its presence, characteristics, and volume. Clinically, many tumor markers are useful not only to assess the presence/absence of cancer, the primary site, histology, stage, and recurrence, but also to monitor the anti-cancer therapy. Tumor markers for lung cancer play only supporting roles because of their limited sensitivity and specificity, but they are clinically essential to daily medical oncology. This review addresses 6 important tumor markers for lung cancer, namely, CEA, SLX, CYFRA, SCC, ProGRP, and NSE.     

Lung carcinosarcoma

Lung carcinosarcoma is a neoplasm of high grade composed of epithelial and mesenchymal cells. It is exceptional; and usually affects men who are smokers, between the fifth and eighth decades of life. Medical treatment, chemotherapy and radiotherapy are not active in this kind of tumour, so surgery is the treatment of choice. Prognosis is poor with survival rates at 6 months around 27%. We describe the diagnostic process and the clinical outcome of a patient with lung carcinosarcoma with several paraneoplastic syndromes.     

经支气管镜肺活检对周围型肺癌的诊断价值

背景与目的 肺癌是现今全世界发病率和死亡率最高的恶性肿瘤.由于部位特殊和检查方法的局限,周围型肺癌诊断较困难,应用经支气管镜肺活检(TBLB)技术,旨在评价TBLB对周围型肺癌的诊断价值.方法 78例周围型肺癌,经支气管镜常规检查无法观察到病变,采用TBLB证实42例.对于未获得诊断的36例周围型肺癌患者,其中22例通过CT引导下经皮肺活检(PNLB)证实,另外14例患者依次经外科手术、淋巴结活检、胸膜活检、胸水细胞学检查等获取标本,经病理学或细胞学检查证实.结果 已经病理学或细胞学确诊为肺癌78例,经支气管镜肺活检、刷检的阳性率分别为53.8%、8.9%,联合后总阳性率为57.7%;两种取材方法中,以TBLB的阳性率最高,与刷检相比,差异有统计学意义(P<0.01);随着病灶逐渐增大,活检阳性率逐渐增高;右肺活检阳性率高于左肺,两下叶活检阳性率高于上叶;病例越靠近肺内带和肺门,TBLB的活检阳性率越高;PNLB并发症发生率高于TBLB.结论 经支气管镜肺活检检查是确诊周围型肺癌的重要手段之一,联合应用多种取材方法和技术可提高周围型肺癌的诊断准确率.     

Lung cancer screening

Lung cancer is the primary cause of cancer mortality in developed countries. First diagnosis only when disease has already reached the metastatic phase is the main reason for failure in treatment. To this regard, although low-dose spiral computed tomography (CT) has proven to be effective in the early detection of lung cancer (providing both higher resectability and higher long-term survival rates), the capacity of annual CT screening to reduce lung cancer mortality in heavy smokers has yet to be demonstrated. Numerous ongoing large-scale randomised trials are under way in high-risk individuals with different study designs. The initial results should be available within the next 2 years.