PURPOSE : Since the combination of cisplatin plus gemcitabine (CG) had a significant survival advantage for the treatment of patients with chemotherapynaive advanced or metastatic non-small cell lung cancer (NSCLC), CG combination have been evaluated with different schedules. However, the best schedule is still unclear. We designed to compare the efficacy and toxicity of CG combination chemotherapy in two different doses of gemcitabine (1,000 or 1,250 mg/m2 3-weekly). MATERIALS AND METHODS : We randomized patients with stage III or IV NSCLC into either gemcitabine 1,250 mg/m2 or gemcitabine 1,000 mg/m2. Patients received cisplatin 60 mg/m2 intravenously on day1 of each 3-week cycle. Gemcitabine was administered intravenously on days 1 and 8 of each 3-week cycle. RESULTS : From April 2002 until July 2004, 125 patients were enrolled from four university hospitals (55 patients in the gemcitabine 1,000 mg/m2 arm and 70 patients in the gemcitabine 1,250 mg/m2 arm). Response rates were not significantly different in both arms (56.4% vs. 55.7%). However, grade 3 neutropenia was significantly lower in gemcitabine 1,000 mg/m2 arm compared to gemcitabine 1,250 mg/m2 arm (11.0% vs. 15.8%). No differences in non-haematologic toxicities in both arms except anorexia were observed. The median survival was 13.4 months for gemcitabine 1,000 mg group compared with 15.8 months for gemcitabine 1,250 mg group. There were no statistically significant differences in survival between the groups. CONCLUSION : For stage III or IV non-small cell lung cancer, combination chemotherapy with gemcitabine 1,000 mg/m2 showed equivalent response rate with lesser neutropenia and anorexia compared to treatment with gemcitabine 1,250 mg/m2
Anorexia ; Appointments and Schedules ; Arm ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Drug Therapy, Combination ; Hospitals, University ; Humans ; Neutropenia

Recurrent lung cancer with endobronchial obstruction after surgical resection due to lung cancer may lead to severe dyspnea, respiratory insufficiency and sudden death. Many palliative modalities including partial excision of endobronchial tumor, insertion of stent, and evaporation with laser, have been used for endobronchial obstruction due to recurrent endobronchial lung cancer. In photodynamic therapy (PDT), photosensitizer named photofrin, is infused intravenously at 48 hours before PDT, and diode laser of an appropriate wavelength is applied to induce destruction of tumor mass with 200~250 J/cm2. We report 2 cases of treatment using PDT for endobronchial obstruction due to recurrent endobronchial lung cancer after surgical resection.
Death, Sudden ; Dihematoporphyrin Ether ; Dyspnea ; Lasers, Semiconductor ; Lung Neoplasms* ; Lung* ; Photochemotherapy* ; Respiratory Insufficiency ; Stents

PURPOSE : We propose the measurement method of tumor movement for respiratory gated therapy in lung cancer patient for stereotactic radiosurgery, contouring method of tumor for radiation treatment planning using measured tumor movement. And through phantom study, we ascertain that the tumor movement is properly reflected in determination of PTV, and the tumor is properly and safely treated in full respiration phases and respiratory gated therapy. MATERIALS AND METHODS : Lung cancer phantom and 1-dimensional moving phantom were made to evaluate respiratory gated radiation therapy for lung SRS. 4D CT scan was performed using these phantoms and 10 sets of CT images and post-processed MIP (Maximum Intensity Projection) images were used to measure the tumor movement. The measured tumor movement in 4D CT images and MIP images were compared. Also, during radiation exposure in full respiration phases and respiratory gated phases, tumor movement included in radiation exposure was measured using EPID image and compared with measured data in 4D CT images and MIP images. RESULTS : The tumor movement measured in full respiration phases was 28.8mm and 29.1 mm in 4D CT images and MIP images respectively, and in respiratory gated phases, 30~70% phases, was 12 mm and 12.2 mm respectively. The tumor contoured in each phase images and MIP images was well agreed in full respiration phases and respiratory gated phases. The tumor movement included in radiation exposure was 29.3 mm and 8.4 mm in full respiration phases and respiratory gated phases respectively. CONCLUSION : The tumor movement measured in 4D CT images and MIP images was well agreed, so we propose to use of MIP image for contouring of tumor in full respiration phases and respiratory gated phases. In full respiration radiation treatment and respiratory gated radiation therapy, the tumor movement included in radiation exposure was well agreed with measured tumor movement in 4D CT images or MIP images, so we ascertain though this phantom study we can exactly treat the tumor including tumor movement. In respiratory gated radiation therapy, the tumor movement included in radiation exposure was about 30% smaller than measured tumor movement in 4D CT images or MIP images, so we ascertain that we can safely treat the tumor including tumor movement in current provided technique
Four-Dimensional Computed Tomography ; Humans ; Lung Neoplasms* ; Lung* ; Radiosurgery* ; Respiration

PURPOSE : To assess the respiratory tumor movement using 4D-CT (4-dimensional computed tomography) for minimizing setup and target volume uncertainty of body-frame based stereotactic radiosurgery (SRS) in lung tumor. MATERIALS AND METHODS : Fifty-seven stereotactic radiation therapies with respiratory gating system in 44 patients (two targets in seven patients and three in three patients) were executed in Asan Medical Center from May 2005 to June 2006. We used respiratory gating system consisted of RPM (Real-time Positioning Management system, Varian, USA) and 4D-CT (GE healthcare, USA), if tumor movement was exceeding 5 mm by respiration on fluoroscopy. Accurate tumor movement on reconstructed 4D-CT image was determined for respiratory gated therapy. Respiratory gated therapy was done if tumor movement was exceeding 5 mm, and non-gated therapy was done if it was below 5 mm. RESULTS : Forty-five tumors were treated with supine position, and the other twelve were with prone position. Median tumor movement (3-dimensional) by respiration was 8.78+/-5.30 mm, and it was mostly affected by superior-inferior movement (8.53+/-5.23 mm). Tumor movements were different by tumor location, whether upper (5.38+/-2.85 mm) or lower (10.12+/-5.08 mm) lobe (p=0.015). Tumor movement was exceeding 5 mm in 27 (47.3%) tumors, and below 5 mm in 30 tumors in 4D-CT evaluation. Tumor movements on adopted respiratory gated phase were wholly below 5 mm, and its median value was 3.70+/-1.13 mm. CONCLUSION : Assessment of respiratory tumor movement using 4D-CT and gating system was helpful for minimizing target volume uncertainty. As a result, image-guided radiation therapy could improve the treatment accuracy of high precision stereotactic radiosurgery
Chungcheongnam-do ; Delivery of Health Care ; Fluoroscopy ; Four-Dimensional Computed Tomography* ; Humans ; Lung* ; Prone Position ; Radiosurgery* ; Radiotherapy, Image-Guided ; Respiration ; Supine Position ; Uncertainty

PURPOSE : Cyclooxygenase-2 (COX-2) and its metabolite, PGE2 affect multiple tumorigenesis, including angiogenesis, invasion, and tumor-induced immune suppression. Their overexpression is association with impaired immune cell function in many tumors. Indoleamine 2,3-dioxygenase (IDO) is an emerging immuno-regulatory enzyme that can catalyze the initial rate-limiting step in tryptophan catabolism, by causing tryptophan depletion can block T lymphocyte activation, and thus, enable tumor cells to escape from immune system. Although the potential of immunosuppression associated with tumorproduced COX-2 has been suggested, the mechanism of immunosuppression in tumor immunology is not yet well defined. Thus, we hypothesized that the tumor immunity of COX-2 could be partly due to IDO-dependent immune tolerance. To test this hypothesis, we evaluated IDO expression in cancer cells treated with selective COX-2 inhibitor. MATERIALS AND METHODS : The A549 human adenocarcinoma cell line, murine Lewis lung carcinoma (LLC) cell line and C57Bl/6 mice were used for in vitro and in vivo studies. In vitro studies, A549 cells were treated with various concentrations of COX-2 inhibitor (PTPBS) or PGE2. IDO enzyme activity and protein expression were checked by IDO enzyme activity assay and Western blotting. In vivo study, the 20 mice were randomized into normal control, LLC inoculated control, and low and high selective COX-2 inhibitor (celecoxib 25 or 250 mg/kg/day) treated LLL inoculated mice groups (n=5 per group). At one month, mice were sacrificed and tumor mass was isolated for quantification of IDO expression by immunohistochemical stain and western blotting. RESULTS : In vitro studies, PTPBS treated A549 cells showed a significant decreased in IDO enzyme activity and expression but PGE2 treated A549 cells showed increased in IDO expression. In vivo studies, the tumor mass and lung metastasis were attenuated by celecoxib (respectively, p<0.05, p<0.01). Compared with the LLC inoculated control group, mice treated with celecoxib had significant reductions in IDO expression of tumor mass (IDO immunohistochemical stain and western blotting ). CONCLUSION : The present study reveals that COX-2 inhibitor serves to restore the tumor-induced IDO expression and promotes antitumor reactivity in an immunocompetent murine lung cancer model. These findings further support the suggestion that COX-2 inhibitor is a potential pharmacological immunotherapy in cancer
Adenocarcinoma ; Allergy and Immunology ; Animals ; Blotting, Western ; Carcinogenesis ; Carcinoma, Lewis Lung ; Cell Line ; Cyclooxygenase 2* ; Dinoprostone ; Humans ; Immune System ; Immune Tolerance* ; Immunosuppression ; Immunotherapy ; Indoleamine-Pyrrole 2,3,-Dioxygenase* ; Lung ; Lung Neoplasms ; Lymphocyte Activation ; Metabolism ; Mice ; Neoplasm Metastasis ; Tryptophan ; United Nations ; Celecoxib

PURPOSE : We performed a pilot study on defining duration of docetaxel and cisplatin combination chemotherapy in patients with advanced non-small cell lung cancer to evaluate its efficacy. PATIENTS AND METHODS : Sixteen chemonaive patients with biopsy proven, unresectable (stage IIIB or IV) non-small cell lung cancer (NSCLC) were enrolled between January 2003 and December 2004. Treatment consisted of docetaxel (75 mg/m2/day) and cisplatin (70 mg/m2/day) every 3 week up to 4 cycles. The outcome was compared with that of a historical control group of 42 patients treated from January 1998 until December 2001, who were treated with mitomycin-C, vinorelbine, cisplatin for unresectable stage IIIB or IV NSCLC. RESULTS : Median age was 68 (age range 43~72). Among 16 patients, 5 patients were stage IIIB and 11 were stage IV. Fourteen patients had performance status of 0-1 and, 2 had performace status 2 respectively. Two patients were lost due to refusal of receiving chemotherapy. By intention-to- treat-analysis, overall response rate was 44% (C.I. : 0.19~0.68). No complete response was noted. Median time to progression (TTP) was 144 days. Overall survival (OS) was 285 days. There is no difference in TTP & OS between docetaxel, cispatin (DP) group and mitomycin, vinorelbine, cisplatin (MVP) group statistically. Neutropenia was the most common grade III or IV toxicity; (two patients had Grade III toxicity and five Grade IV toxicity). Five patients developed febrile neutropenia, and three of neutropenia patients died due to pneumonia or septic shock. The most common non-hematologic toxicity was infection. Two of 3 patients with infection required admission. CONCLUSION : These findings suggested that four cycles of docetaxel and cisplatin might be as effective as MVP continous therapy for advanced NSCLC
Biopsy ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Disulfiram ; Drug Therapy ; Drug Therapy, Combination* ; Febrile Neutropenia ; Humans ; Mitomycin ; Neutropenia ; Pilot Projects ; Pneumonia ; Shock, Septic

Pneumatosis intestinalis is an uncommon condition that is characterized by the presence of gas within the bowel wall. We experienced a case of pneumatosis intestinalis after cession of chemotherapy and we herein report on this case. A 58-year old man was admitted to our hospital for the evaluation of incidentally recognized pneumatosis intestinalis. He was diagnosed as having non small cell lung cancer in August 2006 and he received radiation therapy for concomitant brain metastasis and SVC syndrome in September 2006. He achieved a partial response after completing 6 cycles of chemotherapy with gemcitabine and cisplatin. Newly enlarged lymph nodes were observed on the follow-up CT, and chemotherapy with paclitaxel and carboplatin was started in July 2007. Due to the lack of a response, the therapeutic regimen was switched to oral erlotinib. After 1 month of treatment, the follow-up CT for response evaluation revealed pneumatosis intestinalis in the ascending colon without any subjective symptoms such as fever or abdominal pain. The laboratory results were within the normal range except for a slight increase of leukocytes. He underwent right hemicolectomy, but he didn't survive his postoperative acute renal failure and pneumonia
Abdominal Pain ; Acute Kidney Injury ; Brain ; Carboplatin ; Cisplatin ; Colon, Ascending ; Deoxycytidine ; Fever ; Follow-Up Studies ; Humans ; Leukocytes ; Lung ; Lung Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Paclitaxel ; Pneumonia ; Quinazolines ; Reference Values ; Small Cell Lung Carcinoma ; Erlotinib Hydrochloride

A sixty-seven year old male was treated with palliative radiation therapy due to his right hip joint pain, and the pain was caused by osteolytic right acetabular metastasis. He underwent 30 Gy irradiation and then his painful symptoms disappeared at the 1 month follow-up after radiation therapy. He next received received systemic chemotherapy with 3 cycles of gemcitabine plus cisplatin and then 6 cycles of docetaxel. He visited the emergency room at the time of 4 months after the completion of radiation therapy with complaints of relapsed right hip joint pain. On MRI, localized muscular swelling with infiltration and without contrast-enhancement was seen within the previous radiation field, and the clinical impression was radiation-recall myositis. We provided symptomatic treatment and his right hip joint pain with disability disappeared 2 weeks after the treatment. No relapse of the right hip joint pain developed during the patient's survival period. We experienced a case of radiation-recall myositis that was related to gemcitabine use after radiation therapy
Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Deoxycytidine ; Emergencies ; Follow-Up Studies ; Hip Joint ; Humans ; Lung Neoplasms ; Male ; Myositis ; Neoplasm Metastasis ; Recurrence ; Taxoids

With the progress of computed tomography (CT), the detection of small pulmonary nodules has been increased. The conventional diagnostic modalities for tissue confirmation, such as bronchoscopic biopsy or transthoracic needle biopsy, may not be successful in some cases. Too small a nodule or the nodules located far from the pleural surface can be marked and localized with device preoperatively and then this tissue can be obtained surgically. CT-guided hook wire fixation is useful in marking pulmonary nodules and there are few complications with this procedure. We report here on a case of double primary lung cancer that was diagnosed by percutaneous localization with using a hook wire
Biopsy ; Biopsy, Needle ; Lung ; Lung Neoplasms

Metastases Pilomatrix carcinoma is a rare locally aggressive hair-follicle tumor. We report a 54-year-old man who presented with a tumor in the left flank that was found by skin biopsy to be pilomatrix carcinoma. A contrast-enhanced computed tomographic scan of the chest, abdomen, and pelvis showed multiple small nodules in both lungs and lymphadenopathy in the abdomen. Video-assisted thoracoscopic biopsy of the lung lesions was consistent with metastatic pilomatrix carcinoma. After intravenous cisplatin and 5-fluorouracil, the skin, lung, and lymph node lesions shrank
Abdomen ; Biopsy ; Cisplatin ; Fluorouracil ; Humans ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neoplasm Metastasis ; Pelvis ; Skin ; Thorax