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Objective: The optimal management of stage I lung cancer is surgical resection. However, some of these patients are not candidates for surgery because of several medical problems. We analyzed prognosis of non-surgically treated, clinical stage I lung cancer patients., Methods and Results: There were 21211 lung cancer patients registered from 1982 to 1991 in the data-base of the Japanese National Chest Hospital Study Group for Lung Cancer, and the number of non-surgically treated, clinical stage I lung cancer patients during the 10 years was 802. The 5- and 10-year survival rates of the 799 patients, exclusive of two carcinoid tumors and one adenid cystic carcinoma which have good prognosis, were 16.6 and 7.4%. We analyzed the 799 patients according to several prognostic factors. Sex, T factor of the tumor, histology, performance status and the method in which lung cancer was detected were prognostic factors, but age and treatment method were not associated with prognosis. Forty-nine patients survived for 5 years or more without surgical resection, but the survival rate continued to decrease even after 5 years, and the 7- and 10- year survival rates were 34.4 and 18.1% in the 49 patients., Conclusions: It is a fact that there are long-term survivors in non-surgically treated, stage I lung cancer patients. However, the rate is low, and the survival curve continues to decrease even after 5 years. Long-term survivors might suggest the presence of a lung cancer in which the tumor growth is slow.

We conducted a trial to clarify what Japanese clinical doctors think about the present status of therapy for non-small cell lung cancer, as well as to clarify which problems are still unresolved. One-hundred five Japanese doctors who treat lung cancer patients were asked how they would choose to be treated, if they suffered from non-small cell lung cancer. Six scenarios were presented and the doctors had to choose one treatment method for each of the six scenarios. Adjuvant chemotherapy or radiotherapy after complete resection, increase with progression of the pathological stage. Ninety-three per cent of Japanese doctors wanted surgery, even if mediastinal lymph node metastases were present. In the scenario of only one distant metastasis to the brain, 44% of doctors wanted surgery while 39% wanted chemotherapy and/or radiotherapy. In the scenario of multiple bone metastases, 33% wanted chemotherapy, 77% did not. It was concluded therefore that Japanese doctors choose surgery as the number one treatment modality when all lesions are considered resectable.

944 cases of thoracic empyema were treated surgically in a 6-year period (from 1981 through 1986) in 37 institutions under supervision of Ryoken. Preoperative backgrounds, operative modes and surgical results are evaluated. Preoperative backgrounds are as follows; Acute cases comprised only 5.5% of the total. Primary cases outnumbered postoperative ones, the former occupying 65.8% of the total. Fistulous empyema comprised 68.6% of the total. Extension of the empyema; total empyema 56.0%, partial empyema 44.0%. Concerning respiratory reserve, those with FEV1/VCpr (to be denominated RI) less than 40 comprised 44.3% of the total. As to bacteriological findings; positive 49.9%, negative 40.0%, unknown 10.1%. Surgical modes; Pleuroresection 20.8%, decortication 22.4%, space-reducing 28.6%, air-plombage 9.7%, open drainage 6.8%, closed drainage 4.3%, others 7.4%. Overall results; success 83.8%, unsuccess 11.5%, death 4.7%. Those with positive microorganisms and RI less than 40 fared most poorly; success 73.2%, unsuccess 19.7% death 7.1%. Those with negative microorganisms and RI more than 41 fared most well; success 97.9%, unsuccess 1.5%, death 0.5%. Success rate with regard to surgical modes; air-plombage 95.7%, decortication 95.3% pleuroresection 92.6%, space-reducing 80.0%, closed drainage 68.3%, open drainage 29.7%.