PURPOSE : Lung cancer is the leading cause of cancer death in the world, including Korea. The aim of this study was to investigate the clinical features of the lung cancer patients who were seen in a University hospital between 1994 to 1998. MATERIALS AND METHODS : We performed a retrospective review of lung cancer clinical information at Kosin University Gospel Hospital from 1994 to 1998. We analyzed the age, gender, pathologic types, treatment methods and survival. RESULTS : Among 1,547 patients, 1,232 patients (79.6%) were male. The age distribution ranged from 20 to 84 years, and the mean age was 60.2 years old. Squamous cell carcinoma was the most common type of lung cancer (39.7%), followed by adenocarcinoma (23.1%), and small cell carcinoma (16.4%). However, there was an increasing incidence of adenocarcinoma every year. The stages at the diagnosis were I : 6.6%, II : 6%, III : 45.6% and IV : 41.8%. For the small cell carcinoma, 44.6% of the patients were in a limited stage and 55.4% were in an extensive stage. The initial treatments included chemotherapy (46.5%), surgery (15.1%) and radiotherapy (5.1%), but 32.2% of the patients received supportive care only. For the cases receiving surgery, the 5 year survival rate for the stage I patients was 66%, that for the stage II patients was 43.2% and that for the stage III patients was 11.8%. The median survival time (MST) for patients who underwent surgery plus adjuvant chemotherapy was 3.22 year, but the MST of the surgery-treated only patients was 1.51 years. So, adjuvant chemotherapy prolonged survival (p=0.000). On the subgroup analysis, young age and female lung cancer patients who did not receive adjuvant chemotherapy showed poor survival. CONCLUSION : Squamous cell carcinoma was the most common type of lung cancer. The active treatments were important for the patients' prognosis. For the patients receiving surgery, adjuvant chemotherapy had a role in improving survival and especially for young age and female lung cancer patients
Adenocarcinoma ; Age Distribution ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chemotherapy, Adjuvant ; Female ; Humans ; Incidence ; Korea ; Lung ; Lung Neoplasms ; Male ; Prognosis ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: Mutations of the epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene (KRAS) are important in the pathogenesis of lung cancer, and recent reports have revealed racial and geographical differences in mutation expression. METHODS: This study was conducted to investigate the prevalence of EGFR and KRAS mutations and their correlation with clinical variables in Korean patients with adenocarcinoma of the lung. Formalin-fixed adenocarcinoma specimens from 104 randomly selected patients diagnosed at Kosin University Gospel Hospital from October 1996 to January 2005 were used for the study. RESULTS: We found a high prevalence of EGFR mutations and a low prevalence of KRAS mutations. EGFR mutations were present in 24% (25 of 104) of the samples: one mutation in exon 18, 13 in exon 19, one in exon 20, and 10 in exon 21. The presence of an EGFR mutation was not associated with gender, smoking history, histological grade, age, bronchioalveolar components, or cancer stage in patients with adenocarcinoma of the lung. CONCLUSIONS: Mutations of KRAS were present in 9.6% (9 of 94) of the samples: eight in codon 12 and one in codon 13. EGFR mutations were never found in tumors with KRAS mutations, suggesting a mutually exclusive relationship.
Adenocarcinoma/*genetics/metabolism/mortality ; Adult ; Aged ; DNA, Neoplasm/*genetics ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Korea/epidemiology ; Lung Neoplasms/*genetics/metabolism/mortality ; Male ; Middle Aged ; *Mutation ; Polymerase Chain Reaction ; Prognosis ; Proto-Oncogene Proteins/biosynthesis/*genetics ; Receptor, Epidermal Growth Factor/biosynthesis/*genetics ; Retrospective Studies ; Survival Rate ; ras Proteins/biosynthesis/*genetics

BACKGROUND: Pemetrexed has been prescribed newly as a second line chemotherapy in advanced non-small cell lung carcinoma (NSCLC). The aim of study was to determine the efficacy and toxicity of pemetrexed in advanced NSCLC. METHODS: Patients with histologically or cytologically confirmed NSCLC were evaluated from June 2006 to December 2008. The patients had relapsed or progressed after prior chemotherapy treatment. They were treated with intravenous pemetrexed 500 mg/m2 for 10 min on Day 1 of each 21-day cycle. RESULTS: A total of 89 patients were eligible for analysis. The response rate and disease control rate were 11% and 66%. Non-squamous cell carcinoma histology was significantly associated with a superior response rate (p=0.035) and disease control rate (p=0.009) than squamous cell carcinoma histology. The median survival time was 13 months and the median progression free survival time was 2.3 months. The median survival time of patients with ECOG PS 0~1 was 13.2 months, whereas median survival time was 11.6 months for patients with PS 2 (p=0.002). The median progression free survival time of patients with PS 0~1 were 3.8 months, but 2.1 months for patients with PS 2 (p=0.016). The median progression free survival time of smokers with non-squamous cell carcinoma was 3.4 months, which was significant (p=0.014). Grade 3~4 neutropenia were seen in 7.9% patients. CONCLUSION: Pemetrexed has efficacy in patients who had prior chemotherapy with advanced NSCLC and less hematologic toxicity.
Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Glutamates ; Guanine ; Humans ; Lung ; Neutropenia ; Pemetrexed

Photodynamic therapy (PDT) that is based on the science of photochemistry has been recognized as a lung sparing local therapeutic modality that can achieve remarkable responses. It is an alternative treatment for early stage lung cancer patients who have poor lung function or multiple sites of cancer. Recently we treated a 70-year-old man who presented with squamous carcinoma in situ at a previous pneumonectomy site, and a 64-year-old man with a newly developed secondary superficial lung cancer, with PDT. There were no complications related to the procedure. Both patients had poor lung function due to prior lung cancer surgery. Clinical and histological complete remissions were achieved without any evidence of recurrence during 30 months of follow-up in both patients.
*Treatment Outcome ; Time Factors ; *Photochemotherapy ; Middle Aged ; Male ; Lung Neoplasms/*therapy ; Humans ; Carcinoma, Squamous Cell/*therapy ; Aged

Autofluorescence bronchoscopy (AFB) is one of the newly developed diagnostic tools to detect the pre-cancerous lesions in the bronchial tissue. The utility of DLight/AFB in the detection of pre-cancerous lesions was compared to the standard white light bronchoscopy (WLB). In 113 patients (male 106, female 7), who visited hospital for evaluation of lung cancer, WLB and AFB were done and 364 biopsy specimens were obtained from November 2001 to August 2002. The bronchoscopic findings on WLB and AFB were compared to the pathological findings. The pathologic diagnoses of the specimens were as follows: normal in 96; hyperplasia in 69; metaplasia in 32; mild dysplasia in 13, moderate dysplasia in 6, severe dysplasia in 4; carcinoma in situ in 6; invasive carcinoma in 57. The relative sensitivity of adjunctive AFB to WLB vs. WLB alone was 1.5 in moderate dysplasia or worse lesions, and 3.2 in intraepithelial neoplasia. The specificity of adjunctive AFB and WLB alone were 0.91 and 0.5, respectively. The adjunctive AFB to the standard WLB increased the detection rate of the localized pre-invasive lesions. However, there was high rate of false positive in AFB.
Precancerous Conditions/diagnosis/pathology ; Middle Aged ; Metaplasia ; Male ; Lung Neoplasms/diagnosis/pathology ; Hyperplasia ; Humans ; Fluorescence ; Female ; Carcinoma, Squamous Cell/diagnosis/pathology ; Carcinoma in Situ/diagnosis/pathology ; Bronchoscopy/*methods ; Bronchial Neoplasms/*diagnosis/pathology ; Bronchi/pathology ; Aged, 80 and over ; Aged ; Adult

BACKGROUND: The incidence of lung adenocarcinoma, which is more prevalent in women and nonsmokers, is increasing. The aim of this study was to determine the prognostic factors of an adenocarcinoma of the lung. MATERIAL AND METHOD: The clinical information of patients diagnosed with an adenocarcinoma of the lung at the Kosin University Gospel Hospital from January 1994 to July 2004 was reviewed retrospectively. The survival time of these patients was analyzed by the patient's age, gender, performance status, weight loss, smoking history, location of the primary tumor, clinical stage, serologic tumor markers, and treatment modality. RESULTS: For all 422 patients with an adenocarcinoma of the lung, 247 (58.5%) were male, and their mean age was 59.8 years the. The majority of patients were smokers (58.3%), and the tumors were located in the periphery (59.7%). In the smokers, the tumor was located more in the central airway compared to the non-smokers (42.8% vs. 31.9%, p=0.12). The overall median survival time was 390 days (95% CI;304-436 days). Univariate survival analysis revealed that an older age (>or=65 years old), male, weight loss, smoker, central type, advanced clinical stage, elevated serum carcinoembryonic antigen (CEA, >5 ng/ml) and neuron specific enolase (NSE, >15 ng/ml), and the supportive care only were significantly poor prognostic factors. The median survival time was shorter in the smokers than nonsmokers (289 days vs. 533 days, p<0.001). In addition, it was also shorter in the elevated NSE group than in the normal range group (207 days vs. 469 days, p<0.001). Multivariate analysis showed that age, clinical stage, serum NSE, smoking status, and treatment modality were independent predictors of survival (hazard ratios: 1.68, 1.94, 1.92, 2.39 and 1.57, respectively). CONCLUSIONS: Smoking is an important prognostic factor in an adenocarcinoma of the lung, but not gender. This suggests that the better prognosis of women is more related with the lower rate of smoking. In addition, the elevated serum NSE is also an important prognostic in an adenocarcinoma of the lung.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Female ; Humans ; Incidence ; Lung* ; Male ; Multivariate Analysis ; Phosphopyruvate Hydratase ; Prognosis ; Reference Values ; Retrospective Studies ; Smoke* ; Smoking* ; Biomarkers, Tumor ; Weight Loss

We experienced a 59-year-old immunocompetent female patient who complained progressive cough. A bronchoscopic examination revealed an endobronchial mass protruding from the left lower lobe and occluding anterior-basal segment bronchus. Bronchial biopsy and endobronchial ultrasound guided transbronchial needle aspiration were consistent with cryptococcal infection. However, the response of medical therapy was an unsuccessful. Finally, the patient underwent left lower lobectomy with lymph node dissection. We report a case of pulmonary cryptococcosis mimicking bronchogenic lung cancer, and surgical therapy with antifungal treatment resulted in successful resolution of the pneumonia.
Biopsy ; Bronchi ; Bronchial Neoplasms ; Bronchoscopy ; Cough ; Cryptococcosis* ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Node Excision ; Middle Aged ; Mycoses ; Needles ; Pneumonia ; Ultrasonography

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.
Adenoma, Pleomorphic ; Asthma ; Bronchi ; Cough ; Diagnosis ; Dyspnea ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; Recurrence ; Salivary Glands ; Thorax ; Trachea ; Tracheal Neoplasms ; Tuberculoma ; Tuberculosis, Pulmonary

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Methyl bromide is a commonly used fumigant to disinfect soil, grains, and warehouses. The accumulation of danger-ous concentrations can produce various neurotoxic effects in humans. A 45-year-old man, who had worked in the fumi-gation business, presented with polyneuropathy, optic neuropathy, and cerebellar sign, and serially sampled blood, urine and cerebrospinal fluid showed significant elevation of methyl bromide concentration. Regular education to workers and strict adherence to the safety precautions are needed to avoid the risk of toxicity associated with methyl bromide fumigation.
Edible Grain ; Cerebellar Ataxia* ; Cerebrospinal Fluid ; Commerce ; Education ; Fumigation ; Humans ; Middle Aged ; Optic Nerve Diseases* ; Poisoning* ; Polyneuropathies* ; Soil