The 12th World Conference on Lung Cancer(WCLC) opened in September 2-6,2007 in South Korea.More than 4 500 representatives attended the conference all over the world,WCLC received 1 500 papers.Dozens of fields specialized conference opened.The hot topics of lung cancer filed have carried on wide-ranging discuss in this meeting.The progress in three aspects is especially noticeable: First,new TNM stage of lung cancer is introduced based on analysis 100 869 lung cancer cases.Second,Individuation treatment will be main therapy tool for enhancing!the lung cancer treatment effects.Third,target therapy was started to combine lung cancer treatment(including adjuvant therapy,first line,second line,maintenance and consolidation treatment,et al).This article reviewed issues mentioned above.

After many targeted drugs have entered into the treatment guideline or all stage clinical trial of non-small-cell lung cancer (NSCLC), many researchers undertake deep investigation on the role of molecular gene marker in targeted therapy of NSCLC. It is a good outset that mutation detection of epidermal growth factor receptor (EGFR) gene direct the selection of EFGR tyrosine kinase inhibitors (EGFR-TKI). To choose individualized therapy regimens according to molecular gene marker will be the important research direction, but also be the critical measure to improve the management level of NSCLC and prolong patient"s survival. Accompanied with deep investigation of targeted therapy, there will be more molecular gene markers to direct the formulation of individualized therapy regimens.

Background and purpose: Brain metastases are common occurrences in patients with non-small cell lung cancer (NSCLC). Gefitinib is a specific inhibitor of epidermal growth factor receptor-associated tyrosine kinase, which has been commonly used in the treatment for advanced NSCLC. The aim of this study was to evaluate the antitumor efficacy of gefitinib in NSCLC patients with brain metastases. Methods: Fifty NSCLC patients with brain metastases were reviewed retrospectively. All of them were treated with gefitinib, given orally at a daily dose of 250 mg. These patients discontinued administration of gefitinib when disease progression, death or intolerable side effects appeared. X~2 test was applied in response analysis. Survival analysis was compared with Kaplan-Meier method and Log-rank test respectively. The multivariate analysis was perfonned with Cox's proportion risk model. Statistical significance was defined as P<0.05. Results: In terms of intracranial lesions, partial response (PR) was observed in 5 patients (10%), stable disease (SD) in 37 patients (74%) and progressive disease (PD) in 8 patients (16%), objective response rate (ORR) and disease control rate (DCR) were 10% and 84%, respectively. As for systemic disease, PR was observed in 5 patients (10%), SD in 30 patients (60%) and PD in 15 patients (30%), overall ORR and DCR were 10% and 70%, respectively. Overall DCR was related to the patients' PS score and the number of brain metastases (P=0.004, P=0.022), but there was no statistical difference in overall DCR among different subtypes of age, gender, smoking history, histology, the onset of brain metastases, chemotherapy, brain radiotherapy and side effects (P>0.05). The median time to disease progression (MTTP) was 7.0 months, which was related to the patients' PS score and smoking history (P=0.000, P=0.045). The median survival time (MST) was 10.8 months, and 1-and 2-year survival rates were 44% and 6% respectively. The univariate analysis showed that the survival time was related to the patients' PS score. smoking history and the number of brain metastases (P=0.011, P=0.028, P=0.044). The multivariate analysis indicated that both the patients' PS score and smoking history were two independent prognostic factors (P=0.005, P=0.006) and the relationship of the survival time and the number of brain metastases was near to statistical significance (P=0.075). Conclusion: The patients with non-smoking history and favorable performance status(PS 0-1) may have better survival benefit and those with single brain metastasis have a trend to survive longer. Gefitinib may be effective on brain metastases in NSCLC patients and appears to be a possible new treatment option.

Small cell lung cancer(SCLC)is regarded as one of the most chemotherapy and radiotherapy sensitive malignant solid tumors.With regimens based on platinum-etoposide,which is still the standard of first-line treatment in extensive-stage SCLC,objective responses are seen in 50% to 70% of cases.With combined chemoradiotherapy,the probability of attaining a complete response increases to 40% to 50%.The majority of patients with SCLC will eventually develop a tumor relapse.For the patients with relapse,so far only single-agent topotecan represents a most effective therapeutic option.Integration of chest radiotherapy with standard chemotherapy,optimization of timing and fractionation of radiation therapy,and the introduction of prophylactic cranial radiation have led to an obvious improvement in 3-year survival.

Bronchoscopy is a minimally invasive method for obtaining peripheral pulmonary lesions (PPL). Traditional bronchoscopy-guided transbronchial lung biopsy (TBLB) is performed under X-ray guidance, and diagnostic rate is relatively low. A new, real-time electromagnetic navigation bronchoscopy (ENB) is a minimally invasive diagnostic technique which appeared in recent years. Studies suggest ENB is a feasible and safe method for diagnosis of PPL which shows higher diagnostic yields than traditional TBLB, and its potential application in localization and treatment of PPL. This article reviews the clinical application of the technique.

Background and purpose:Brain is one of the most common sites for distant metastasis in patients with non-small cell lung cancer,and the prognosis of patients with brain metastasis is usually dismal.The purpose of this retrospective study is to document the relationship between the prognosis of lung cancer patients with brain metastasis and the expressions of p53,nm23 and VEGF in resected lung cancer tissues.Methods:Ninety-two patients who were definitively treated with surgery for non-small cell lung cancer but lately developed brain metastasis between 1997 and 2005 were identified in our institution.Their clinical data were retrieved and retrospectively reviewed.All pathological specimens of their resected lung cancer were examined for the expressions of p53,nm23 and VEGF by immunohistochemical staining.The association between the treatment outcome and the expression of the above mentioned biomarkers were analyzed.Results:The median survival time(MST) of patients with p53(+) versus p53(-) was 11.0 versus 11.9 month,respectively.The 1,2,and 3-year overall survival rates were 45.71%,22.86%,and 18.29% respectively for p53(+) patients,and 49.55%,16.12%,and 8.89% respectively for p53(-) patients(P=0.5179);The MST of patients with nm23(+) versus nm23(-) was 13.0 versus 10.1 month,respectively.The 1,2,and 3-year overall survival rates were 54.20%,21.51%,and 16.45% respectively for nm23(+) patients,and 32.0%,12.0%,and 4.0% respectively for nm23(-) patients(P=0.1075);The MST of patients with VEGF(+) versus VEGF(-) was 10.5 versus 12.2 months,respectively.The 1,2,and 3 year overall survival rates were 42.20%,0,and 0 respectively for VEGF(+) patients,and 50.0%,25.41%,and 16.57% respectively for VEGF(-) patients(P=0.0231).Conclusions:VEGF was a significant adverse prognostic factor for patients with non-small cell lung cancer who developed brain metastasis.Lung cancer patients whose tumor tissue demonstrated positive VEGF expression had reduced overall survival rates at 1,2,and 3 years after surgery.The expression of p53 and nm23 are not significantly associated to the prognosis of this group of patients.

Objective To explore the clinical features and diagnosis of pulmonary sarcoidosis.Methods The data of 60 cases of pulmonary sarcoidosis confirmed by pathology was reviewed to determine the clinical features and the value in the diagnosis of sarcoidosis.Results The main clinical manifestations of sarcoidosis included bilateral hilar and mediastinal lymphadenopathy.The results of lung function tests showed that these patients had restrictive ventilating obstacles with decreased DLCO.The diagnosis was confirmed in 80% of the bronchial mucosa biopsies and 77.8% of the transbranchial lung biopsies through fiberotic bronchoscopy,87% of the biopsies of peripheral lymphnodes and 87.5% of the subskin nodes biopsies.Conclusion Nonspecific constitutional symptoms may occur in the cases of sarcoidosis.To the diagnosis of intrathoracic sarcoidosis,peripheral lymph nodes biopsies,the bronchical mucosa biopsies and TBLB are the convenient methods with highly definite diagnosis rate and microinvasion in clinical practice.

Background and purpose: The overall survival time of extensive-stage small cell lung cancer is not satisfactory. No chemotherapy schemes more effective than etoposide combined with cisplatin, and other optimum combinations should be under evaluation. The aim of this study was to investigate the survival advantage of IEP followed by EP chemotherapy in the treatment of extensive-stage small cell lung cancer compared with EP chemotherapy alone. Methods: From Jan 2004 to Sep 2007, 68 extensive-stage small cell lung cancer patients were enrolled in this project and were randomly divided into research group and control group in the ratio of 1:1. In the research group, 34 patients accepted IEP chemotherapy at least two times followed by EP chemotherapy maintenance therapy. 34 patients as control group accepted EP chemotherapy only. Statistical significance was defined as P<0.05. Results: The median overall survival time of the research group was 15.32 months and the control group was 9.30 months. There were no significant differences between the two groups (P=0.0787). The median time to progression of the research group was 7.83 months and 6.92 months for the control group, respectively. There were no significant differences between the two groups (P=0.0164). It is suggested that IEP followed by EP chemotherapy in treatment of extensive-stage small cell lung cancer could get a better progression free survival, but the overall survival time has not been improved. Conclusion: We conclude that those patients with extensive-stage small cell lung cancer could get better progression free survival by accepting IEP chemotherapy.