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1 Akita J Med 43 : 79-86, received 19 July 2016, accepted 29 July 2016 Two cases of histological CR for squamous cell lung cancer with invasion to the pulmonary artery after induction therapy Kasumi Tozawa 1, Kimito Orino 1, Koumei Kameyama 1, Masaji Hashimoto 1, Hajime Miura 2, Kenji Yazaki 2, Yutaka Saitou 3, Misa Yamauchi 4 and Akihiro Sugita 4 1 Department of Surgery, Yuri - Kumiai General Hospital, Akita, Japan 2 Department of Pulmonary Medicine, Yuri - Kumiai General Hospital, Akita, Japan 3 Department of Radiology, Yuri - Kumiai General Hospital, Akita, Japan 4 Department of Pathology, Yuri - Kumiai General Hospital, Akita, Japan Abstract Locally advanced lung cancer treated by surgery alone does not show a good prognosis. Recently we can see many reports which induction therapy for Stage IIIA/IIIB non - small cell lung cancer possibly improves the outcome of surgery. In this article, we report about two cases of induction therapy for Stage IIB lung cancer with locally invaded to pulmonary artery. After induction chemo radiotherapy, locally invasion was reduced then we could perform lobectomy without any additional resection. Each case had no remnant lung cancer Ef3 of pathological diagnosis. adjuvant chemotherapy has done to one patient with keratinization of lymph node. No recurrence of lung cancer was found both two patients. Even if it s not a Stage III case, operation is simpler and safer after induction therapy ; also we believe induction therapy followed by surgery reads to better prognosis. Key words : Non - small - cell lung cancer, Induction, chemoradiotherapy, Pathological CR Correspondence to : Kasumi Tozawa Department of Surgery, Yuri - Kumiai General Hospital, 38 Yago, Kawaguchi, Yurihonjo , Japan Tel : Fax : E - mail : 20kasumimail07@yuri - hospital.honjo.akita.jp IIIA 79

16 2 III IIA IIB Ef3 2 1 : 72 : : :1 CT 2014 5 : : : Fig. 1 CT : 3.3 cm Fig. 2 : Fig.

2 16 2 III IIA IIB Ef3 2 1 : 72 : : :1 CT : : : Fig. 1 CT : 3.3 cm Fig. 2 : Fig. 3 ct2a N1 M0 StageIIA CBDCA 500 mg+ts mg + 40 Gy CBDCA 400 mg+ts mg 40 Gy 2 CT : 3.3 cm Fig. 1. Fig. 2. CT 3.3 cm 1.1 cm Fig : 5 A 1 3 A 4 5 A

3 17 Fig. 3. Squamous cell carcinoma 10 : Fig. 5 1 Fig. 4. CT 3.3 cm 1.1 cm A : 65 : : : : : : cm Fig. 6 CT : cm 81

18 術前化学放射線療法が奏功した肺癌の 2 例 Fig. 5. 切除標本の病理組織検査癌遺残なし肺動脈周囲の肺胞内に器質化したコレステリン結晶様の異物を貪食した巨細胞を認めた気管支鏡検査 : 扁平上皮癌の診断となった Fig. 7 2015 年 1 月に手術目的に当科紹介となったが CT 再検にて腫瘍は 5.5 4.1 4.

0 4.5 cm 大の腫瘤影を認める第 43 巻 2 号 500 mg+ts-1 120 mg 術前化学療法後の CT Fig.

4 18 術前化学放射線療法が奏功した肺癌の 2 例 Fig. 5. 切除標本の病理組織検査癌遺残なし肺動脈周囲の肺胞内に器質化したコレステリン結晶様の異物を貪食した巨細胞を認めた気管支鏡検査 : 扁平上皮癌の診断となった Fig 年 1 月に手術目的に当科紹介となったが CT 再検にて腫瘍は cm と増大左肺動脈上肺静脈が不整に狭窄しており血管浸潤疑われた Fig. 8 以上より通常の上葉切除術は不可能と判断し術前治療として化学放射線療法施行した治療レジメン ① CBDCA 500 mg+ts mg +放射線照射 40 Gy ② CBDCA Fig. 6. 初診時胸部レントゲン左中肺野に cm 大の腫瘤影を認める第 43 巻 2 号 500 mg+ts mg 術前化学療法後の CT Fig. 9 で腫瘍と左肺門リンパ節は縮小肺動脈肺静脈の浸潤性変化も改善あり切除可能と判断したが骨髄抑制が遷延していたため 2 回目の化学療法から 2 か月後に左上葉切除施行した手術所見 : 第 5 肋間開胸施行したところ肺と壁側胸膜に膜状の癒着を認めた照射部位は臓側胸膜の発赤毛細血管拡張を認めた腫瘍の露出は認めなかったが肺門部に硬い腫瘤を触れ肺動脈に広く接していた最初に上肺静脈を切離し左肺動脈本幹にテーピングした A4 5 を切離後末梢側肺動脈をテーピング肺動脈は腫大したリンパ節と強固に癒着してお 82

5 19 Fig. 7. CT cm Fig. 8. N/C Squamous cell carcinoma 6 12 Fig

6 20 2 Fig. 9. CT Fig. 10. CBDCA 500 mg+ts mg IIIA 30.9% IIIB 16.7% IIB 42.3% 1 IIIA IIIB C1 I - IIIA 11 IIA IIB Gy 40 Gy 40 Gy CT 40 Gy

7 21 2 Ef3 Ef3 13 RECIST PET 14 PET CT 1 Ef2 Ef CR , Carboplatin Paclitaxel Ef3 III 3 47, Mebio 29, N2 WJOG5008L 55, , Carboplatin Paclitaxel Bevacizumab , , Neoadjuvant Therapy I 34 10, Daniz, Y Neoadjuvant Radiotherapy/ Chemoradiotherapy in Locally Advanced Non - Small Cell Lung Cancer. Balkan Med. J., 32 1, , EBM Induction chemotherapy 36 4, ,

8 Ozeki, N., Kawaguchi, K., Fukui, T., Fukumoto, K., Nakamura, S., Okasaka, T. and Yokoi, K Which variables should be considered in patients with stage II and III non - small cell lung cancer after neoadjuvant therapy? Nagoya J. Med. Sci., 77,

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TP T-13i AST ALT ALP Y CTP LOH CHE CRP 8.7 id 0.4 mg/d 21 AWL 131U/L 257 LU/L 12 111/L 234 11J/L 344 IU/L 0.30 mid No K a BUN ORE UA 142 meq/1 4.3 meqa 108 meqa 15.8 met! 0.71 mg/di 5.0 mg/d CEA 5_5 n8/m1