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━━ Background. It is well known that patients undergoing treatment for small cell lung cancer are at a high risk for developing secondary primary tumors. We herein report three resected cases of non-small cell lung cancer that developed following successful treatment for limited-stage small cell lung cancer (LD-SCLC). Case 1. A 63-year-old male received concurrent chemoradiotherapy for LD-SCLC in the middle lobe. He achieved a clinical complete response (CR) and underwent prophylactic cranial irradiation (PCI); he showed no signs of recurrence for five years. On an annual follow-up examination, chest computed tomography (CT) revealed a solid nodule in the left lower lobe. We performed left basal segmentectomy. A histopathological examination of the resected specimen revealed stage IA squamous cell carcinoma. Case 2. An 81-year-old male underwent right lower lobectomy for poorly differentiated carcinoma. He received adjuvant chemotherapy based on a final pathological diagnosis of LD-SCLC. Fifteen years later, chest CT revealed mixed ground glass nodules in the left upper lobe during follow-up for another disease. He underwent left upper segmentectomy. The histopathological diagnosis revealed stage IB multiple adenocarcinoma. Case 3. A 60-year-old woman received chemotherapy and sequential radiotherapy for LD-SCLC in the bronchus intermedius. She achieved a clinical CR and underwent PCI. Eight years later, CT revealed a pulmonary nodule in the right lower lobe. Positron emission tomography demonstrated uptake of fluorodeoxyglucose in the subcarinal lymph node. She underwent right lower lobectomy and was diagnosed with stage IIIA adenocarcinoma. All subjects were in good health, with no episodes of recurrence. Conclusions. Providing careful follow-up is necessary in order to detect second malignancies in patients with small cell lung cancer who survive for longer periods. (JJLC. 2013;53:760-766) KEY WORDS━━ Small cell lung cancer, Secondary cancer, Radiation therapy, Chemotherapy Reprints: Toshiya Fujiwara, Department of Thoracic Surgery, Hiroshima City Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima 7308518, Japan (e-mail: toshiyaf@pg7.so-net.ne.jp). Received June 5, 2013; accepted August 14, 2013. 要旨━━背景.小細胞肺癌治療後,二次癌の発生相対危 険度は高い.症例 1.63 歳,男性.右中葉原発限局型小 細胞肺癌(LD-SCLC)に対し同時併用放射線化学療法を 行った.画像上CRとなり,予防的全脳照射を行った.5 年後,再発は認めなかったが,対側肺にCT上充実性結節 が出現した.左底区域切除を施行し,術後診断は扁平上 皮癌,p-stage IA であった.症例 2.81 歳,男性.低分化 肺癌の診断で右下葉切除施行.術後病理検査で LD-SCLC と診断.術後補助化学療法を施行した.15 年後,他疾患 通院中にCTで対側肺に多発する混合型スリガラス影を 認めた.左上区域切除を施行し,術後診断は腺癌,p-stage IB であった.症例 3.60 歳,女性.前医で中間気管支幹 広島市立広島市民病院 1呼吸器外科,2呼吸器内科. 別刷請求先:藤原俊哉,広島市立広島市民病院呼吸器外科, 〒730-8518 広島市中区基町 7-33(e-mail: toshiyaf@pg7.so-net.ne. jp). 受付日:2013 年 6 月 5 日,採択日:2013 年 8 月 14 日. (肺癌.2013;53:760-766) 2013 The Japan Lung Cancer Society Secondary Lung Cancer After Successful Treatment for SCLC―Fujiwara et al Japanese Journal of Lung Cancer―Vol 53, No 6, Oct 20, 2013―www.haigan.gr.jp 761 Figure 1. a, b) Chest CT 5 years before treatment for small cell cancer showed a well-defined solid nodule in the middle lobe and interlobular lymph node swelling. c) Microscopic findings showed small cell carcinoma. HE staining, ×40. 原発 LD-SCLCに対し,化学療法と逐次的胸部放射線照 射を行った.画像上CRとなり,予防的全脳照射を行っ た.8年後,CTにて肺結節が出現,PETで同結節と気管 分岐下リンパ節にFDG集積を認めた.右下葉切除を施 行し,術後診断は腺癌,p-stage IIIA であった.全例無再 発生存中である.結論.小細胞肺癌治療後,長期生存例 に対して注意深い観察が必要であると考えられた. 索引用語━━小細胞肺癌,二次癌,放射線治療,化学療 法

Three Resected Cases of Non-small Cell Lung Cancer Following Successful Treatment for Limited-stage Small Cell Lung Cancer