A sixty-eight year old female patient was transferred to our department for the resection of a solitary pulmonary nodule on the right lower lobe. An intraoperative frozen-section revealed a bronchioloalveolar carcinoma. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. The permanent pathologic diagnosis of this patient was a sclerosing hemangioma. Herein, our experience of the treatment of a sclerosing hemagioma presenting with a solitary pulmonary nodule by a lobectomy is reported with a review of the literature
Adenocarcinoma, Bronchiolo-Alveolar ; Diagnosis ; Female ; Histiocytoma, Benign Fibrous* ; Humans ; Lymph Node Excision ; Solitary Pulmonary Nodule

Endobronchial lipomas are rare lesions that usually obstruct a major bronchus and cause irreversible pulmonary damage distally. Herein, a case of an endobronchial lipoma combined with broncholithiasis, found 3 months after first noticing symptoms including dry cough, and voice change, successfully removed by surgical resection is reported
Bronchi ; Cough ; Lipoma* ; Voice

PURPOSE: In general, it is possible to generate better leaf sequencing from the ideal fluence map or dose distribution close to the optimized results of the radiation treatment planning (RTP) system, from the filed smaller segment size in Intensity modulated radiation therapy (IMRT). Conversely, an intra-treatment organ motion issue, which prevents the smallest segment size from being chosen, always exists. Furthermore, the question has been raised regarding the proper target margin for IMRT cases with a moving target, as the field itself moves while the target moves, unlike traditional static fields. In this study, the effects of intra-treatment target motion on the segment size have been examined. MATERIALS AND METHODS: Various sizes of rectangular patterns were designed for an IMRT fluence map. A leaf sequence was generated using the step and shoot beam delivery method. The intensity ratios between adjacent segments were 0.2, 0.4 and 0.8. The range of target motion was assumed to be +/-0.3~2.0 cm, in a sinusoidal shape. The dynamic leaf motion that reflected the target motion was calculated to simulate the motion. Film dosimetry was performed to analyze the motion effects. RESULTS: The intensity ratios of the adjacent segments were degraded in all cases. The dose distribution with segment sizes less than half the breathing amplitude showed a significantly degraded intensity map. With a beam irradiation time for a segment greater than two breathing cycles, the dose distribution around the target margin showed a similar tendency as the static fields. CONCLUSION: The minimum size of IMRT segments in the fluence map should be chosen taking the intra-treatment organ motion into consideration. The dose distribution with segment sizes less than half the breathing amplitude was degraded significantly in the intensity map. With a beam irradiation time for a segment greater than two breathing cycles, the target margin can be defined as the same as for a conventional static field
Film Dosimetry ; Lung Neoplasms ; Lung* ; Respiration

PURPOSE: The goal of this study was to find lung cancer-related single nucleotide polymorphisms (SNP) and define their association with clinical results. Material and Methods: One hundred and thirty-six non-small cell lung cancer patients, who received radiotherapy at the Asan Medical Center, were recruited between August 2002 and September 2003. Demographic and clinical informations were obtained from a self-administered questionnaire and from the subject's medical records, respectively. Blood samples were collected from all study subjects at the time of enrollment. Genomic DNA was extracted from peripheral blood lymphocytes using a QIAamp DNA Blood Mini Kit. TaqMan assay, denaturing HPLC and single base pair primer extension assay using SNaPshot kits were employed as the SNP screening techniques. The candidate SNP for screening was XRCC1-R399Q. RESULTS: Patients carrying the 399Gln variant allele had a significantly longer progression-free survival than those with the 399Arg homozygote in tumor stages I-IIIa (p=0.005). In the Cox-proportional hazards model, the XRCC1 codon 399 polymorphism was a statistically significant predictor for progression-free survival in tumor stages I-IIIa (p=0.03). CONCLUSION: The use of molecular predictors of the progression-free survival in non-small cell lung cancer patients, particularly at stages I-IIIa, may provide important criteria for prognosis of the patients undergoing radiotherapy. However, there is still a need for further study to establish the role of these polymorphisms as useful predictors
Alleles ; Base Pairing ; Carcinoma, Non-Small-Cell Lung ; Chromatography, High Pressure Liquid ; Chungcheongnam-do ; Codon ; Disease-Free Survival ; DNA Repair* ; DNA* ; Homozygote ; Humans ; Lung ; Lung Neoplasms ; Lymphocytes ; Mass Screening ; Medical Records ; Polymorphism, Single Nucleotide ; Prognosis ; Proportional Hazards Models ; Surveys and Questionnaires ; Radiation Tolerance* ; Radiotherapy

PURPOSE: To investigate the effectiveness and safety of definitive radiation therapy for Stage I non-small cell lung cancer patients who were medically inoperable or refused surgery. Material and M ethods: A retrospective study was conducted of 36 patients who received definitive radiation therapy for pathologically proven Stage I non-small cell lung cancer in the Department of Radiation Oncology, Asan Medical Center, between July 1989 and July 2003. Twenty three patients received conventional radiation therapy with a fraction size of 1.2~3.0 Gy, with a total dose of 50.0~70.2 Gy (CRT group). Thirteen patients received stereotactic radiosurgery with a fraction size of 10~12 Gy, with a total dose of 30~48 Gy using a Stereotactic Body Frame (Precision TherapyTM, SRS group). RESULTS: The two- and 5-year overall survival rates (OS) of all the patients were 79 and 44%, respectively. The two- and 5-year OS of the CRT and SRS groups were 43 and 53%, and 7 and 27%, respectively, but showed no statistically significant difference (p=0.5173). The two- and 5-year cause-specific survival rates (CSS) of the SRS group were superior to those of the CRT group (2YCSS: 100 vs. 70%, 5YCSS: 50 vs. 39%), but were not statistically significant (p=0.2086). The two- and 5-year local progressionfree survival rates (LPFS) of all the patients were 67 and 57%, respectively. The 5-year LPFS of the SRS group was superior to that of the CRT group (66 vs. 54%), but was not statistically significant (p=0.3937). The T-stage, tumor size, treatment method (CRT vs. SRS) and tumor dose did not affect the 2-year LPFS. Grade 2~3 radiation pneumonitis developed in 5 patients (14%), all in the CRT group. The omission of elective nodal irradiation (ENI) did not affect the incidence of Grade 2~3 radiation pneumonitis in the CRT group (ENI group 17%, no ENI group 25%, p=0.538). CONCLUSION: Definitive radiation therapy for Stage I non-small cell lung cancer patients that were medically inoperable or who refused surgery was considered effective and safe. Stereotactic radiosurgery was proven to be superior to that of conventional radiation therapy, although no statistically significant difference was shown. To investigate the optimal radiation dose and fractionation scheme of SRS, a prospective study, including more patients, is mandatory
Carcinoma, Non-Small-Cell Lung* ; Chungcheongnam-do ; Humans ; Incidence ; Radiation Oncology ; Radiation Pneumonitis ; Radiosurgery ; Retrospective Studies ; Survival Rate

PURPOSE: Definitive high dose thoracic radiation therapy (TRT) alone in stage III non-small cell lung cancer (NSCLC) has resulted in only modest survival gains that are far from satisfaction. When using conventional fractionation schedules, which usually last for about 7 weeks, issues relating to the cost versus the benefit ratio are raised, including the treatment costs, protracted side effects and inconvenience to patients and family, especially if they reside in a remote district from the hospital. A retrospective analyses on the stage III NSCLC patients who received definitive high dose TRT alone, in 3 Gy per fractions lasting less than 4 weeks, were performed. MATERIALS AND METHODS: Between October 1994 and June 2001, 82 NSCLC patients were given definitive high dose TRT alone, in 3 Gy fractions, at Samsung Medical Center. Of these patients 37 (45.1%) had a stage IIIA and 45 (54.9%) had a IIIB disease. Squamous cell carcinomas were the most common (65.9%) pathology followed by adenocarcinomas (23.2%). External beam radiation therapy (ERT) alone was employed in 61 patients (74.4%), with additional high dose rate endobronchial brachytherapy (EBB) in 21 patients (25.6%). The TRT was typically started with the AP/PA technique using 10 MV X-rays for 30 Gy, and then a computerized CT plan was performed to keep the total spinal cord dose below 40 Gy. The median total TRT dose was 54 Gy/18 fractions (range: 39-60 Gy). RESULTS: The median age was 68 years (43-84), with a male to female ratio of 4.9/1. After a median follow-up of 10 months (1~72), 31 (37.8%) and 24 (29.3%) developed local in-field failures and distant metastases, respectively, with the lung being the most common site (12, 38.7%). The median and overall survivals at 1-, 2-, 3- and 4-year were 10 months and 45.9, 19.4, 12.9 and 9.7%, respectively. The median relapse-free survival was 13.0 months, and relapse-free survival rates at 1-, 2-, 3-, and 4-year were 51.9, 23.3, 11.6 and 7.3%, respectively. From a univariate analysis, the performance status (p= 0.0366) and radiotherapy response (p=0.0323) were significant on the overall survival, gender (p=0.0329) and response (p=0.0107) on the relapse free survival, and histology (p=0.0466) on the local relapse. From a multivariate analysis, the nodal status, radiotherapy response and mediastinal radiation dose were significant prognostic factors on both the relapse free survival and local control. Treatment related morbidities were observed in 75 patients (91.5%), 10 of whom had grade 3 or 4 complications (12.2%), with esophagitis being the most common (73 patients). Symptomatic radiation pneumonitis occurred in 20 patients (24.4%), with 17 requiring steroid medication and a further 1 each required mechanical dilatation for an esophageal stricture and tracheal stenosis. CONCLUSION: Based on the above results, definitive high dose TRT in 3.0 Gy per fractions was adjudged to be comparable to TRT using the conventional fractionation schedules reported in the literature, with the advantages of shorter treatment duration and less overall cost
Adenocarcinoma ; Appointments and Schedules ; Brachytherapy ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Dilatation ; Esophageal Stenosis ; Esophagitis ; Female ; Follow-Up Studies ; Health Care Costs ; Humans ; Lung ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Pathology ; Radiation Pneumonitis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Spinal Cord ; Survival Rate ; Tracheal Stenosis

PURPOSE: Many studies for unresectable stage III non-small cell lung carcinomas (NSCLC) have focused on patients with good prognostic factors. However, there have been few reports on patients with poor prognostic factors. Herein, those patients with poor prognostic factors were treated with conservative split course radiation therapy (RT) alone, and the feasibility and survivals evaluated. Methods and Materials: Between Jan 1997 and Dec 2001, 73 patients started conservative split course RT. They were confirmed to have unresectable stage III NSCLC with poor prognostic factors; performance scale> or = ECOG 2 or weight loss> or =5% during the last 6 months. They initially received 30 Gy of radiation in 2.5 or 3 Gy per fractions to the gross tumor volume (GTV). The tumor response was evaluated 2~3 weeks later. A second course of RT was also recommended for good responders: > or =50% tumor diameter reduction or improved distal atelectasis. The treatment related toxicity was also evaluated. RESULTS: Nine patients failed to finish the initial course of RT (3~27 Gy) due to disease progression or personal reasons. Thirty-four (53.1%) of the 64 patients who completed the first course of RT showed a good tumor response. Twenty-seven good responders received the second course of RT, with a total of 51 to 60 Gy. Seven of these did not receive the second course of RT due to distant metastasis or poor performance. The two-year survival rate and median survival in all patients and in the 27 good responders who completed the second course of RT were 19.7% and 12 months and 30.3 and 20 months, respectively. Five (12.8%) of the 39 evaluable patients had grade III radiation esophagitis (N=1) or pneumonitis (N=4). Conclusions: Conservative split course RT was a tolerable and effective modality for unresectable stage III NSCLC with poor prognostic factors. In addition, it was able to produce relatively good survival results in patients showing a good response after the first course and who completed the second course of RT
Disease Progression ; Esophagitis ; Humans ; Lung* ; Neoplasm Metastasis ; Pneumonia ; Pulmonary Atelectasis ; Survival Rate ; Tumor Burden

PURPOSE: To evaluate the incidence of postpneumonectomy pulmonary edema (PPE) and determine the risk factors for PPE with non-small cell lung caner. MATERIALS AND METHODS: A group of 93 patients who underwent a pneumonectomy between 1994 and 2004 were retrospectively studied. Postpneumonectomy patients with pulmonary edema, with no clinically evident cause, with the exception of having undergone a pneumonectomy, were considered to have PPE. The incidence and mortality of PPE were recorded. The preoperative, perioperative and postoperative clinical data were reviewed, and the patients matched for known or suspected risk factors for PPE. A logistic regression analysis and Chi-square test were used to evaluate the relationships of the risk factors to the PPE. RESULTS: The incidence of PPE was 7.5% (n=7). The mortality in the group of patients who developed PPE was 86% (n=6). Patients who had fresh frozen plasma administered had a significantly higher incidence of PPE (risk ratio=14.9, p=0.024). CONCLUSION: Fresh frozen plasma (FFP) transfusion after a pneumonectomy was shown to be an important risk factor in our data. The mechanism has not been identified, but may be an increased capillary permeability of the pulmonary vessels due to an immunologic reaction following a FFP transfusion
Capillary Permeability ; Carcinoma, Non-Small-Cell Lung* ; Humans ; Incidence* ; Logistic Models ; Lung ; Mortality ; Plasma ; Pneumonectomy ; Pulmonary Edema* ; Retrospective Studies* ; Risk Factors*

Lung cancer remains the primary cause of cancer-related death in the world, and the number of cases continues to increase. Like any other human cancer, the development of lung cancer is associated with the activation of oncogenes or inactivation of tumor suppressor genes. Phosphatase and tensin homolog, deleted on chromosome ten (PTEN), is a part of a complex signaling system that affects a variety of important cell functions. PTEN opposes the action of phosphatidylinositol 3-kinase (PI3-kinase) by dephosphorylating the signaling lipid phosphatidylinositol 3, 4, 5-triphosphate (PIP3). In addition, it displays weak tyrosine phosphatase activity, which may down modulate the signaling pathways involving focal adhesion kinase (FAK) or Shc. Functions for PTEN have been identified in the regulation of many normal cell processes, including growth, adhesion, migration, invasion and apoptosis. PTEN appears to play particularly important roles in regulating anoikis (apoptosis of cells after loss of contact with extracellular matrix) and cell migration. Many studies have suggested that the loss of PTEN expression occurs commonly in primary lung cancers and correlates with the histological type. Regulation of PTEN expression may provide a new preventive and therapeutic modality in primary lung cancer. However, there is, in our opinion, a need for further study of this gene
Anoikis ; Apoptosis ; Cell Movement ; Focal Adhesion Protein-Tyrosine Kinases ; Genes, Tumor Suppressor ; Humans ; Lung Neoplasms* ; Lung* ; Oncogenes ; Phosphatidylinositol 3-Kinase ; Phosphatidylinositols ; Signal Transduction ; Tyrosine

PURPOSE: Chemotherapy, followed by radiation therapy, improves the survival of patients with locally advanced non-small cell lung cancer (NSCLC). However, it is not clear whether chemotherapy, followed by concurrent chemo-radiation therapy, can improve survivals compared to only concurrent chemo-radiation therapy. We conducted this study to evaluate the role played by induction chemotherapy followed by concurrent chemo-radiation therapy. MATERIALS AND METHODS: Between 1995 and 2000, 55 patients with locally advanced NSCLC were treated with concurrent chemo-radiation therapy. Twenty-seven patients received the induction chemotherapy prior to the chemo-radiation therapy, and their characteristics and survival compared. RESULTS: There were no significant differences in patient characteristics, with the exception of weight loss. The group receiving the induction chemotherapy showed a lesser weight loss, but with no statistical difference in the survival results. CONCLUSION: No advantage was shown with the induction chemotherapy when followed by concurrent chemo-radiation therapy in the treatment of locally advanced NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Weight Loss