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We retrospectively evaluated the survival benefit of dispensing erlotinib after gefitinib administration in patients with nonsmall cell lung cancer. Ninety patients treated with erlotinib in our hospital were divided into two groups: G+ group patients who were treated with erlotinib with prior gefitinib administration, and G- group patients who were treated with erlotinib without prior gefitinib administration. Median survival time (MST) in all 90 patients was 275 days. MST of 22 patients in the G+ group was shorter than that of 68 patients in G- group, but this difference was not statistically significant (283 days vs 177 days, p=0. 329). MST in 19 patients of the G+group who were administered erlotinib for over 1 month was shorter than that of 49G-group patients who were administered erlotinib over 1 month. However, this difference was also not statistically significant(395 days vs 238 days, p=0. 575). Univariate analysis demonstrated that EGFR mutation unknown, time to progression (TTP) with gefitinib longer than 1 year, gefitnib administration longer than 1 year, and responder to gefitinib, suggest a better prognosis. Mutivariate analysis revealed that only TTP with gefitinib longer than 1 year was an independent prognostic factor for patients in the G+ group.

We present a case of malignant pleural mesothelioma which responded to a cisplatin plus pemetrexed rechallenge. A 78- year-old man was diagnosed as stage IV malignant pleural mesothelioma in International Mesothelioma Interest Group (IMIG) stage by biopsy using ultrasonography and chest to abdominal CT. 6 courses of cisplatin at 60 mg/m2 plus pemetrexed at 500 mg/m2 were administered every 3 to 4 weeks. After this treatment, all of the lesions shrank, and the best overall response was partial response (PR) in Response Evaluation Criteria in Solid Tumors (RECIST). Although vinorelbine, gemcitabine and S-1 were administered subsequently because of the re-growth of the lesions, they were enlarged. Cisplatin plus pemetrexed was administered as fifth-line chemotherapy again, the lesions shrank, and the best overall response was PR in RECIST.

Gefitinib is a molecular targeting agent and more effective in patients with characteristics of oriental ethnicity, female gender, adenocarcinoma and non-smokers. It is sometimes effective in smokers, but few papers have focused on the association between efficacy and smoking history. The aim of this study is to evaluate the association between efficacy of gefitinib and patients' characteristics, especially smoking history. Between July 2002 and September 2006, 89 patients were diagnosed as non-small cell lung cancer and administered gefitinib. Eighty of them were assessable for efficacy and toxicity of gefitinib. Response rate was 16.2% and 39.6%(p=0.031)in smokers and non-smokers. Survival was statistically greater in non-smokers. In smokers, there are more cases which showed response to gefitinib with a lower smoking index and longer duration after smoking cessation. Smoking index and duration after smoking cessation should be considered when gefitinib is administered or EGFR mutation analysis is conducted in patients with non-small cell lung cancer.

We report a case of pulmonary arteriovenous fistula with multiple hepatic arterioportal shunts. A 23-year-old man was admitted for evaluation of a nodular shadow in the right lower lung field. Chest CT showed a homogeneous and well-defined nodular shadow in the right S7. 3-dimensional CT revealed an arteriovenous fistula composed of a feeding artery and a draining vein in the right S7. Abdominal enhanced CT revealed a diffusely heterogeneous pattern in the liver parenchyma and the portal vein staining diffusely at the late arterial phase. We diagnosed pulmonary arteriovenous fistula associated with multiple hepatic arterioportal shunts. Pulmonary arteriovenous fistula is often associated with hereditary hemorrhagic telangiectasia (HHT). This case did not meet the criteria for HHT at this time. However, we could not exclude the possibility of HHT because clinical manifestations of HHT become apparent after 40 years old among 10% of patients. The natural history and treatment of HHT are not clear. We concluded that we should be careful to detect possible manifestations as HHT when we diagnose and follow up patients with pulmonary arteriovenous fistula.

A 61-year-old man visited another hospital with chief complaints of dry cough, appetite loss and body weight loss. On chest X ray film and CT, right supraclavicular and mediastinal lymph nodes were swollen. For further examination, he was referred to our hospital and diagnosed as primary mediastinal choriocarcinoma. We conducted surgery after four cycles of chemotherapy using cisplatin, etoposide and bleomycin. After chemotherapy, residual tumors were found on chest CT. In FDG-PET some parts of the residual tumors seen on CT showed much less uptake and the others showed similar uptake. Histologically the areas showing similar uptake contained more viable cells, and the other areas showing less uptake almost completely consisted of necrotic tissue. We believe FDG-PET can be useful to evaluate the viability of tumors after chemotherapy in extra gonadal choriocarcinoma in the mediastinum.