Construction and validation of a simple scoring system for stage III colorectal cancer recurrence (SiS-SCORE). A case control study.

BACKGROUND: Stage III colorectal cancer is an indication for adjuvant chemotherapy; however, there is no definite view on the selection of regimen. If the recurrence can be predicted, it can serve as the indicator of regimen selection. The present study aimed to predict the recurrence of stage III colorectal cancer by constructing a simple scoring system. METHODS: The information of stage III cases that underwent curative surgery was obtained from two facilities and analyzed. A scoring system was constructed from the analysis results and evaluated based on the cases from a different facility. RESULTS: Five factors were extracted by multivariate analysis: age > 65, male, rectum, ≥pN2 and CA19-9 > 37. When these parameters were scored as 1 point each, the score was correlated with the cumulative recurrence rate. Additionally, when cases were divided into three groups (≤1 point, 2 points, ≥3 points), the 5-year recurrence rate was as follows:, ≤1 point: 33.3%, 2 points: 42.1%, ≥3 points: 78.6%. The cumulative recurrence rate of ≥3 points was significantly higher than that of ≤1 point (P < 0.001). Similar results were obtained by evaluating that cases at a different facility (P = 0.032). Both cases with 2 points were located between ≤1 point and ≥3 points, reflecting the average recurrence rate of each institution. CONCLUSION: As the SiS-SCORE presented the same result in the facility that was different from the base facility, it can be used widely. However, a prospective study is required to prove the usefulness of the SiS-SCORE.

Quadruple Valve Replacement for Repaired Transposition of the Great Arteries.

A 37-year-old man with repaired transposition of the great arteries had extensive infective endocarditis, and a multidisciplinary therapeutic strategy was planned based on surgical indications, invasiveness, and future prospects. After adequate antibiotic treatment, simultaneous replacement of quadruple valve and aortic root using mechanical valves was performed to intervene in the healed valvular disease and the concurrent anatomic and functional abnormalities. We believe that this extensive one-stage surgery contributed to maximizing the quality of life and minimizing the number of future reoperations. Our approach can provide suggestions for the management of adult patients with repaired congenital heart disease.

Endovascular Aortic Repair for Thoracic Aortic Compression Resulting From Chance Fracture of the Thoracic Spine.

Blunt aortic injury is a serious condition with a high mortality rate. Although rare, blunt aortic injury associated with spinal fracture has also been reported, and appropriate management of aortic disease is key to a good outcome. This report is a case of a 78-year-old man who was found to have a transverse fracture (Chance fracture) in the ninth thoracic vertebra, with a sharp bone fragment compressing the thoracic aorta. Early spinal surgery was needed; however, there was concern about the possibility of bleeding from the aorta and surrounding small arteries associated with the bone fragment during spinal surgery. Therefore, thoracic endovascular aortic repair was performed before spinal surgery. The next day after thoracic endovascular aortic repair, posterior spinal instrumentation was performed, and the postoperative course was uneventful. Because aortic injury associated with vertebral fracture can lead to massive bleeding and spinal cord injury, endovascular repair before spinal surgery is reasonable.

[Reduction of angialgia during peripheral administration of oxaliplatin mixed with dexamethasone].

Seven patients who had been receiving capecitabine+oxaliplatin±bevacizumab(CapeOX±BV)therapy at our hospital between February 2010 and March 2011, had complained of angialgia during oxaliplatin(L-OHP)administration. Therefore, 3. 3 mg of dexamethasone(DEX)was added to their infusion solution. The patients were then asked to rate their angialgia severity using a numerical rating scale(NRS), when L-OHP in a 5% dextrose solution was administered with or without DEX. By changing the L-OHP in 5% dextrose solution without DEX to the solution containing 3. 3 mg of DEX, the mean NRS was improved to 2. 4 from 7. 1. These findings indicate that L-OHP in 5% dextrose solution mixed with 3. 3 mg of DEX seems to be useful in reducing angialgia during peripheral administration of L-OHP.

Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma.

OBJECTIVE: This prospective randomized multicenter study aims to evaluate the efficacy of extensive intraoperative peritoneal lavage followed by intraperitoneal chemotherapy (EIPL-IPC) on the overall 5-year survival of advanced gastric cancer patients with intraperitoneal free cancer cells without overt peritoneal metastasis (CY+/P-). The study also aims to determine the merit and reliability of EIPL-IPC therapy as a prophylactic strategy for peritoneal metastasis. SUMMARY BACKGROUND DATA: Although the prognosis of advanced gastric cancer patients with CY+/P- is extremely poor, a suitable standard regimen for treating such patients has not yet been established. METHODS: A total of 88 patients with CY+/P- from 1522 patients with advanced gastric cancer at multicenters were enrolled in this study and were randomly allocated to 3 groups: surgery alone group, surgery plus intraperitoneal chemotherapy (IPC) group, and surgery plus EIPL and IPC (EIPL-IPC) group. Prognostic significance of EIPL-IPC therapy was evaluated by Kaplan-Meier curves, and its value as an independent prognostic factor was assessed by univariate and multivariate analyses. RESULTS: The overall 5-year survival rate of the patients with EIPL-IPC was 43.8%, and this data were significantly better than that of the IPC group (4.6%, P < 0.0001) and the surgery alone group (0%, P < 0.0001). Among various recurrent patterns, the EIPL-IPC group had a significantly lower incidence of peritoneal recurrence than both of the other groups (P < 0.0001). Univariate and multivariate analyses revealed that EIPL was the most significant impact factor. CONCLUSIONS: The present study clearly revealed that EIPL-IPC therapy significantly improved the 5-year survival span of advanced gastric cancer patients with CY+/P-. Thus, EIPL-IPC therapy is strongly recommended as a standard prophylactic strategy for peritoneal dissemination.

[A case of advanced rectal cancer responding to radiation therapy and chemotherapy with S-1].

We report a case of a 72-year-old man with advanced rectal cancer who refused an operation for cancer therapy. We underwent radiation therapy (40 Gy) for the purpose of suppressing tumor bleeding. Consequently, we administered S-1 (100 mg/day) orally. As a result, the tumor has disappeared by radiation therapy and chemotherapy with S-1 for 2 years. We have recognized no side effects. This therapy seemed to be an effective treatment for poor-risk elderly patients.

[Long survival of a colon cancer case with multiple liver metastases cured by multidisciplinary therapy].

The patient was a 79-year-old a man who had a sigmoid colon resection for sigmoid colon carcinoma in another hospital 11 years ago. Four years later,he was noted to have multiple unresectable hepatic metastases on CT. Therefore,intrahepatic arterial and portal infusion with CDDP 10 mg + 5-FU 250 mg, respectively,were started. His CEA level decreased to the normal range,and a partial response (PR) was achieved. But two years later, the CEA level increased again,so radiofrequency ablation (RFA) therapy was given during abdominal surgery. Then, IFL, CPT-11+S-1, and FOLFOX were administered. Currently, the patient is being treated as an outpatient with CPT-11+S-1. The patient's multiple hepatic metastases were treated with multidisciplinary therapy, and the man has lived for 6 years 11 months since his first hepatic metastases were noted. The multidisciplinary therapy that was used lengthened this patient's life.

[Second-or third-line chemotherapy with CPT-11+TS-1 for 5 cases of metastatic and recurrent colorectal cancer].

The 3-drug regimen of CPT-11+5-FU+l-LV is generally used for metastatic and/or recurrent colorectal cancer. We have applied this treatment as the first-line intervention in our hospital. However,when the efficacy is reduced we try chemotherapy using CPT-11+TS-1 for 5 outpatients as second- or third-line chemotherapy. Decreased CEA levels were subsequently observed in 4 of 5 cases. In addition, 2 cases exhibited grade 1 or 2 adverse effects, but no case developed neutropenia. We could expect such effects even for patients after only 5-FU, and this treatment may be performed safely on ambulatory patients.

[A case of intrahepatic cholangiocarcinoma successfully treated by hepatic arterial infusion chemotherapy].

The patient was a 67-year-old man who had been operated for eshophageal cancer 4 years ago. He was diagnosed as intrahepatic cholangiocarcinoma by CT after 2 years of the operation. After admission to our hospital, he was treated by hepatic arterial infusion chemotherapy with CDDP, levofolinate calcium (L-LV) and 5-FU with chronomodulation. After a few more months of the treatment, abdominal CT revealed that the size of hepatic tumor decreased remarkably. There were no side effects without bone marrow suppression (grade 1). It seemed that hepatic arterial infusion chemotherapy with chronomodulation may be an effective strategy against intrahepatic cholangiocarcinoma in high risk case.

[Assessment of efficacy of arterial infusion chemotherapy with gemcitabine for four cases of advanced pancreatic cancer].

We treated 4 cases of advanced pancreatic cancer: 2 cases were nonresectable and the other 2 cases did not choose an operation but arterial infusion chemotherapy with gemcitabine after the transcatheter peripancreatic arterial embolizaiton. One case resulted in a tumor decrease but the other 3 cases observed a tumor progress. Although we confirmed cancer pain suppression in all cases and a disappearance of tumor fever in one case, the survival period was 7 months in spite of the treatment. As for the complication of arterial infusion chemotherapy with gemcitabine, we recognized bone marrow suppression (grade 1) in 3 cases. This therapy seemed to be effective for suppression of pain and tumor fever caused from the advanced pancreatic cancer. However, we need to improve in survival period from this therapy.

[Utility of arterial infusion chemotherapy and radiation therapy for the pelvic local recurrence of rectal cancer].

We treated 3 cases of local pelvic recurrence due to a rectal cancer post operation by arterial infusion chemotherapy with 5-FU and levofolinate calcium and also by radiation therapy. The result of imaging analysis showed that a recurrent tumor was decreased effectively in 2 cases by chemo-radiation therapy. We confirmed the cancer pain and tumor bleeding were gone for all of the 3 cases. As for side effects of arterial infusion chemotherapy and radiation therapy, we confirmed a paralysis of the pelvic nerve in 1 case and dermatopathy in 1 case. This therapy seemed to be an effective treatment for elderly patients with inoperable cases.

Preoperative evidence of circulating tumor cells by means of reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen messenger RNA is an independent predictor of survival in non-small cell lung cancer: a prospective study.

OBJECTIVE: We conducted a prospective study of 103 consecutive patients with non-small cell lung cancer who underwent a curative lobectomy to test whether circulating tumor cells detected in the peripheral blood by means of reverse transcriptase-polymerase chain reaction of carcinoembryonic antigen messenger RNA is a prognostic indicator independent of tumor stage in patients with non-small cell lung cancer. METHODS: We assayed for carcinoembryonic antigen messenger RNA by means of reverse transcriptase-polymerase chain reaction in peripheral blood taken at the time of diagnosis before an operation and again 2 to 3 weeks after an operation from patients with non-small cell lung cancer who underwent a curative lobectomy between March 1996 and April 1998. We analyzed the prognostic value of carcinoembryonic antigen messenger RNA expression in the patients with non-small cell lung cancer in a univariate and multivariate manner. RESULTS: Patients with carcinoembryonic antigen messenger RNA in the preoperative blood samples had a poor survival when compared with those without carcinoembryonic antigen messenger RNA. Of these patients, the worst survival was seen in those with carcinoembryonic antigen messenger RNA in the postoperative blood samples. The multivariate stepwise analysis selected the preoperative carcinoembryonic antigen messenger RNA expression (P =.0004; relative risk, 0.21) and the pathologic stage of disease (P =.0002; relative risk, 1.43) as the independent prognostic factors for survival. CONCLUSIONS: The molecular detection of carcinoembryonic antigen messenger RNA in the preoperative peripheral blood is an independent prognostic factor in patients with non-small cell lung cancer who undergo a curative operation.

[Endoscopic local ablation therapy (ELAT) for hepatocellular carcinoma--inventive approaches to achieve radical treatment and to expand the indication of ELAT].

We introduce some inventive approaches in endoscopic local ablation therapy (ELAT) for patients with hepatocellular carcinoma (HCC). ELAT is applied in cases of HCC when the tumor is smaller than 3 cm on the surface of the liver (smaller than 4 cm with extrahepatic growth), and tumor numbers < or = 3. Appropriate use of the laparoscopic, thoracoscopic and hand-assisted approaches, suitable preceding embolizations with the angiographic technique, a combination of ablation therapy, and the use of CO2-angio US, DIMON puncture system and cluster needle are important. If necessary, additional surgeries such as endoscopic hepatectomy, laparoscopic cholecystectomy or laparoscopic devascularization must be performed together. As a result, it will be possible to expand the indication of ELAT safely and radically.

A proposal of a practical and optimal prophylactic strategy for peritoneal recurrence.

Peritoneal metastasis, which often arises in patients with advanced gastric cancer, is well known as a miserable and ill-fated disease. Once peritoneal metastasis is formed, it is extremely difficult to defeat. We advocated EIPL (extensive intraoperative peritoneal lavage) as a useful and practical adjuvant surgical technique for those gastric cancer patients who are likely to suffer from peritoneal recurrence. In this paper, we review the effect of EIPL therapy on prevention of peritoneal recurrence on patients with peritoneal free cancer cells without overt peritoneal metastasis (CY+/P-) through the prospective randomized study, and we verified its potential as an optimal and standard prophylactic therapeutic strategy for peritoneal recurrence.