Introduction: Specific mutations in the epidermal growth factor receptor (EGFR) characterize a subgroup of nonsmall cell lung cancer (NSCLC) patients that may be highly responsive to receptor inhibitor therapy. 18F-FDG PET/CT scans can map the glucose metabolism and treatment response of NSCLC. Therefore, we aimed to assess the pattern of metabolic response and outcome of inoperable NSCLC treated with epidermal growth factor receptor (EGFR) inhibitors, using 18F-FDG PET/CT scan. Methods: A retrospective study of inoperable NSCLC patients on EGFR inhibitor treatment that were referred for wholebody18F-FDG PET/CT scans was conducted based on cases scanned from January 2011 to June 2014. Comparison was made among serial attenuation-corrected fused PET/CT images for all study patients throughout the course of their treatment. Comparison based on PERCIST criteria was categorized into 4 levels ie. complete response (CMR), partial response (PMR), stable disease (SMD), progressive metabolic disease (PMD). Results: Overall, there were 5 patients identified, mean age: 57.4 years old +/- 2.9 years; The median survival time from initiation of EGFR inhibitor treatment to death was 17 months. Two patients showed initial partial metabolic response (PMR), two had progressive metabolic disease (PMD) and one had complete metabolic response (CMR) after the initiation of treatment. The patient with initial CMR had relapse and PMD 5 months later. Majority of patients eventually succumbed to their illness. Conclusions: Wholebody18F-FDG PET/CT is able to assess metabolic treatment response of NSCLC towards EGFR inhibitor treatment.
Lung Neoplasms ; Carcinoma, Non-Small-Cell Lung

Many clinical trials of molecular target drugs have been done against advanced lung cancer, however, majority did not meet the primary endpoint. Positive studies of EGFR-TKI such as BR21 and Interest used unselected populations of non-small cell lung cancer. It was quite difficult to explain why they were positive. In the present review, the difficulties of clinical trial design in molecular target drugs were discussed based on the differences of the magnitude of antitumor activity and the target tumor cell population between cytotoxic drugs and molecular target therapy
Carcinoma, Non-Small-Cell Lung ; Lung ; Lung Neoplasms

Superior sulcus or pancoast tumor refers to any primary lung cancer locating in thoracic inlet and causing pain in the periscapular region or arm. These originate in peripheral, and involve the extrapulmonary structures more than arenchyma of the lung. We experienced 1 case of superior sulcus tumor radically resected via anterior transcervical approach, which provided more safe exposure of cervical structures of thoracic inlet than classic posterolateral thoracotomy. Therefore we report this case with review of literature.
Arm ; Bays ; Lung ; Lung Neoplasms ; Pancoast Syndrome ; Thoracotomy

BACKGROUND: Lung cancer in younger patients seems to be a more aggressive disease and their prognosis may be worse than that of older patients. Abnormal p53 expression in primary lung cancer may be an independent prognostic factor for poor prognosis. This study was conducted to determine the difference of abnormal p53 mutation in patients with primary non-small cell lung cancer (NSCLC) under 45 years of age and 55 years old or greater. METHOD: The present study was performed to compare the clinical and pathological features of primary NSCLC between patients younger than 45 years old and older than 55 years old and to evaluate the difference of abnormal p53 mutation between two groups. Immunohistochemical detection of abnormal p53 mutation was assessed in all primary NSCLC specimens by pathologist. RESULTS: Positive nuclear staining of p53 mutation was found in 76.0% of younger patients and in 76.9% of older patients with variable intensity of staining. And there was no significant coorelation between abnormal p53 mutation according to the disease stage or histologic subtype. CONCLUSION: In this investigation, these were no difference in p53 mutation between two groups.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms ; Middle Aged ; Prognosis ; Small Cell Lung Carcinoma*

BACKGROUND: Lung cancer in younger patients seems to be a more aggressive disease and their prognosis may be worse than that of older patients. Abnormal p53 expression in primary lung cancer may be an independent prognostic factor for poor prognosis. This study was conducted to determine the difference of abnormal p53 mutation in patients with primary non-small cell lung cancer (NSCLC) under 45 years of age and 55 years old or greater. METHOD: The present study was performed to compare the clinical and pathological features of primary NSCLC between patients younger than 45 years old and older than 55 years old and to evaluate the difference of abnormal p53 mutation between two groups. Immunohistochemical detection of abnormal p53 mutation was assessed in all primary NSCLC specimens by pathologist. RESULTS: Positive nuclear staining of p53 mutation was found in 76.0% of younger patients and in 76.9% of older patients with variable intensity of staining. And there was no significant coorelation between abnormal p53 mutation according to the disease stage or histologic subtype. CONCLUSION: In this investigation, these were no difference in p53 mutation between two groups.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms ; Middle Aged ; Prognosis ; Small Cell Lung Carcinoma*

Surgical resection is the treatement of choice for early stage lung cancer. However, it is hazardous for patients with poor pulmonary function, multifocal endobronchial lesions, a previous history of major lung resection, or an important comorbidity. Under such circumstances, bronchoscopic photodynamic therapy could be considered as a treatment option for patients whose tumors are centrally located and bronchoscopically visible and accessible. We present a patient with radiologically occult synchronous non-small cell lung cancer accompanied by esophageal cancer. The esophageal cancer and a tumor in the right lower lobe were surgically removed, and a carcinoma in situ in the left upper lobe was treated with bronchoscopic photodynamic therapy. Nine months later, another tumor was detected in the right middle lobe by narrow-band imaging. The tumor was treated by photodynamic therapy again. In this case, narrow-band imaging played a crucial role in the diagnosis, and photodynamic therapy ensured complete application of the treatment.
Bronchoscopy ; Carcinoma in Situ ; Carcinoma, Non-Small-Cell Lung ; Comorbidity ; Esophageal Neoplasms ; Humans ; Lung ; Lung Neoplasms ; Photochemotherapy

Papillary thyroid carcinoma and primary lung cancer have vastly different treatment approaches and prognosis. If lung mass is found in patients with papillary thyroid carcinoma, we have to be aware of the possibility of primary lung cancer especially when the lesion is not iodine-avid, or is not typical to metastatic thyroid carcinoma, or serum thyroglobulin is not elevated. Here we present two cases of non-small cell lung cancer masquerading as metastatic papillary thyroid carcinoma and think of the approach of the lung mass which is found in patients with papillary thyroid carcinoma.
Carcinoma ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung ; Lung Neoplasms ; Prognosis ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.
Bronchial Fistula ; Carcinoma, Non-Small-Cell Lung ; Fistula ; Humans ; Lung Neoplasms ; Lymph Nodes ; Lymphatic Diseases ; Male ; Pneumonia ; Thoracic Cavity ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

Knowledge of molecular pathogenesis of non-small cell lung cancer has increased remarkably and changed the principles of treatment, especially during the past decade. These advancements have been limited mainly to adenocarcinoma of the lung. Recently, genetic alterations in squamous cell lung cancer (SQCLC) have been detailed and positive results of clinical trials using agents targeting these changes have indicated the potential for improved treatment outcomes for SQCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Lung Neoplasms* ; Lung*

OBJECTIVE: Patients with lung cancer have a relative high risk of developing secondary primary lung cancers. This study examined the additional value of autofluorescence bronchoscopy (AFB) for diagnosing synchronous lung cancers and premalignant lesions. METHODS: Patients diagnosed with lung cancer from January 2005 to December 2005 were enrolled in this study. The patients underwent a lung cancer evaluation, which included white light bronchoscopy (WLB), followed by AFB. In addition to the primary lesions, any abnormal or suspicious lesions detected during WLB and AFB were biopsied. RESULTS: Seventy-six patients had non-small cell lung cancer (NSCLC) and 23 had small cell lung cancer (SCLC). In addition to the primary lesions, 84 endobronchial biopsies were performed in 46 patients. Five definite synchronous cancerous lesions were detected in three patients with initial unresectable NSCLC and in one with SCLC. The secondary malignant lesions found in two patients were considered metastatic because of the presence of mediastinal nodes or systemic involvement. One patient with an unresectable NSCLC, two with a resectable NSCLC, and one with SCLC had severe dysplasia. The detection rate for cancerous lesions by the clinician was 6.0% (6/99) including AFB compared with 3.0% (3/99) with WLB alone. The prevalence of definite synchronized cancer was 4.0% (4/99) after using AFB compared with 2.0% (2/99) before, and the staging-up effect was 1.0% (1/99) after AFB. Since the majority of patients were diagnosed with advanced disease, the subjects with newly detected cancerous lesions did not have their treatment plans altered, except for one patient with a stage-up IV NSCLC who did not undergo radiotherapy. CONCLUSIONS: Additional AFB is effective in detecting early secondary cancerous lesions and is a more precise tool in the staging workup of patients with primary lung cancer than with WLB alone.
Biopsy ; Bronchoscopy* ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Prevalence ; Radiotherapy ; Small Cell Lung Carcinoma