The efficiency of 18F-FDG-PET/CT in the assessment of tumor response to preoperative chemoradiation therapy for locally recurrent rectal cancer.

BACKGROUND: Locally recurrent rectal cancer (LRRC) remains a major problem after curative resection of primary rectal cancer. A noninvasive, prognostic biomarker with which to accurately evaluate disease status and assess the treatment response is critically needed to optimize treatment plans. This study assesses the effectiveness of PET/CT evaluation of preoperative chemoradiation therapy (CRT) in patients with LRRC. METHODS: Since 2004, we have been performing preoperative CRT to improve local tumor control and survival. Between 2004 and 2013, 40 patients with LRRC underwent preoperative CRT (radiation: 50 Gy/25 fractions; chemotherapy: irinotecan plus UFT [tegafur and uracil]/leucovorin) and radical surgery, and underwent 18F-FDG-PET/CT before and 3 weeks after the completion of CRT. The maximum standardized uptake values (SUVmax) of the pre-CRT scan (Pre-SUV) and the post-CRT scan (Post-SUV) were measured. The predictive value of the 18F-FDG-PET and CT/MRI response assessments was evaluated. RESULTS: The mean Pre-SUV was significantly higher than the Post-SUV (8.2 ± 6.1, vs. 3.8 ± 4.0; P < 0.0001). Following CRT, 17/40 patients (42.5%) were classified as responders according to the Mandard tumor regression grade (TRG1-2). The mean Post-SUV was significantly lower in responders than in nonresponders (2.0 ± 1.7 vs. 5.1 ± 3.9; P = 0.0038). Pathological response was not correlated with the response as evaluated by CT (P > 0.9999) or MRI (P > 0.9999). Multivariate regression analysis identified Post-SUV as an independent predictor of local re-recurrence-free survival (P = 0.0383) and for overall survival (P = 0.0195). CONCLUSIONS: PET/CT is useful in assessing tumor response to preoperative CRT for LRRC and predicting prognosis after surgery.

microRNA-181a is associated with poor prognosis of colorectal cancer.

miRNAs regulate gene expression at the post-transcriptional level by degradation of mRNA and translational repression. Recent studies have shown that miR-181a is dysregulated in several types of cancer; however, the clinical significance of miR­181a in colorectal cancer (CRC) remains unclear. We addressed this question by using quantitative real-time PCR (qRT-PCR) to analyze miR-181a expression in 162 CRC patients. There was no significant difference in miR-181a expression in normal colon vs. colorectal cancer tissue. The cancer tissue samples were categorized into a low and high expression group based on miR-181a expression. Comparison of the clinicopathological factors and prognosis in these two groups showed that the high expression group had a significantly poorer prognosis than the low expression group (P=0.011). Multivariate analysis indicated that high miR-181a expression was an independent significant prognostic factor for CRC. However, there no correlation was observed between miR-181a expression and clinicopathological parameters. In vitro analysis revealed that the overexpression of miR-181a repressed the expression of the tumor suppressor, phosphatase and tensin homolog (PTEN) located on chromosome 10, at the mRNA level. These data suggest that miR-181a may be a new independent prognostic factor for CRC patients.

[A 14-month surviving patient on advanced esophageal cancer with big lymph node metastasis to cardia responding to S-1 plus cisplatin (CDDP) therapy at home].

This case was a 70s male patient. He was hospitalized with some dysphasia and a severe body weight loss since August 2004. The diagnosis was the esophageal cancer (type 2, 11 cm) with big lymph node metastasis on cardia (8 cm), and also pathologically poorly differentiated squamous cell carcinoma from two legions. He wanted a home chemotherapy for it. We administered a combination chemotherapy of S-1 plus cisplatin (CDDP) therapy. An eight-day admission within an each course to CDDP treatment and nutritional support were required for adverse events of anorexia (grade 3), but for other days home chemotherapy was done with good compliance of S-1 up to 6 courses. After 2 courses, endoscopic findings showed a pathological complete response of esophageal mass, and CT findings also showed a partial response of the lymph node. After 6 courses of S-1 + plus cisplatin in May 2005, a home S-1 single therapy which was not needed the admission started at will. But the lymph node mass of cardia progressed again in September 2005, and his therapy moved to the terminal care at home.

[A clinical significance of peritoneal carcinomatosis to recurrent colorectal cancer with ileus].

We studied a clinical significance of peritoneal carcinomatosis to metastatic recurrent colorectal cancer with ileus. The subjects were 16 patients with ileus confirmed in 1995-2005. Of the 16 patients, 7 had surgical treatment and the other 9 had conservative treatment. The median survival time of the 16 patients was 98 days; the 7 patients of surgical treatment were 235 days; the 9 patients of conservative treatment were only 67 days. Only 4 patients survived more than 200 days. These 4 patients had surgical treatment, and were the cases where no peritoneal fluid was confirmed and the metastatic tumor was excised. However, only 2 patients improved in QOL. The 3 patients in the surgical treatment were aggravated. An optimum resection may prolong a survival time and patient's QOL could be improved. On the other hand, an extended resection may contribute to shorting a survival time.

[A case of ascending colon carcinoma metastasized to an inguinal hernia sac].

While inguinal hernia is one of the most common diseases, metastatic cancer of an inguinal hernia sac is rare. We report a case of ascending colon cancer metastasized to an inguinal hernia sac. A 60-year-old man, who was undergone a right hemicolectomy for an ascending colon cancer, was pointed out a palpable inguinal mass at one year and eight months after the operation. He was diagnosed as inguinal hernia, and herniorrhaphy was performed. In the operation, a tumor of the inguinal hernia sac, which invaded to spermatic cord, could be found and was removed with right testis. Bassini's method was performed after the resection of the inguinal tumor. Histological examination revealed that the tumor was metastasis of colon carcinoma. Examination of the entire body showed no other metastasis. As for the advanced colon cancer, we need to mention the possibility of metastatic saccular tumor.

[Three successful cases with CPT-11 + CDDP chemotherapy where S-1 failed to respond to recurrent gastric cancer].

We report three successful cases with irinotecan (CPT-11 60 mg/m2) + cisplatin (CDDP 30mg/m2) chemotherapy (once in 2 weeks) where S-1 failed to respond to recurrent gastric cancer. Case 1: A total gastrectomy and splenectomy were performed for a cardiac gastric cancer (T3, N2, H0, P0, CY0, por 1, Stage IIIB). An abdominal CT revealed paraortic lymph node metastases 4 months after the surgery. No reductions were noted after S-1 monotherapy. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CRin after 11 courses. Case 2: A total gastrectomy, splenectomy and cholecystectomy were performed for a cardiac gastric cancer (T3, N3, H0, P0, CY1, tub1, Stage IV). After the surgery, we treated this patient with S-1 mono-therapy. However, we finished this treatment for abdominal recurrence. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CR after 24 courses. Case 3: A distal gastrectomy and cholecystectomy were performed for a pyloric gastric cancer (T2, N1, H0, P0, CY0, tub 2, Stage II). An abdominal CT revealed paraortic lymph node metastases 10 months after the surgery. We treated this patient with S-1 + paclitaxel (PTX) chemotherapy. No reductions were noted after 2 courses. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CR after 8 courses.

Intracystic papilloma in the breast of a male given long-term phenothiazine therapy: a case report.

We experienced a very rare case of intracystic papilloma in a 57-year-old man who came to our hospital complaining of a left subareolar mass and nipple discharge. The patient had a history of chronic schizophrenia, necessitating long-term treatment with phenothiazines. His serum prolactin levels were elevated. Mammography demonstrated a well defined mass with microcalcifications. Ultrasonography revealed a cyst with an intracystic component. The inner lesion of the mass enhanced on contrast-enhanced computed tomography. The carcinoembryonic antigen concentration of the cyst fluid was 400 ng/mL and no malignant cells were found by aspiration biopsy cytology. Excisional biopsy was performed under local anesthesia. Pathological examination revealed the intracystic component to be intracystic papilloma. There are ten reports of male intracystic papilloma including ours. We report the second case of a patient given long-term phenothiazine therapy, which is known to increase serum prolactin levels.

[A case of malignant fibrous histiocytoma of the buttocks].

A 67-year-old woman was admitted because of a tumor of the buttocks wall. The tumor was 13 x 10 x 8 cm in size, elastic hard, fixed to the gluteus maximum muscle. She was suspected of having a malignant tumor in the soft tissue, and the tumor was resected as completely as possible. After the first operation, she was diagnosed with recurrence of tumor in the local area a year later. After the second resection, she was found with recurrence of the tumor in the same area five years later. After the third operation, she has been doing well without any recurrences for five years. The prognoses of MFH are usually not so good, but this case could turn out to be a case of long metastasis free survival after local recurrences.

[A long term survival case of advanced colon cancer with adjacent organ involvement and multiple liver metastases].

We report a long-term survival case of advanced colon cancer with adjacent organ involvement and multiple liver metastases. A 50-year-old man was admitted to our hospital because of occult bloody feces. An advanced colon cancer of the cecum was found with a colonoscopy. Histopathologically, it was a moderately differentiated adenocarcinoma with a biopsy examination. Abdominal CT showed advanced colon cancer with adjacent organ involvement and multiple liver metastases. He received right hemi-colon resection and right hepatic lobectomy. The patient was followed by 8 courses of adjuvant chemotherapy with 5-FU. He has been doing well without any recurrence for five years and six months after the operation. Usually the prognoses of Stage IV colorectal cancer patients are very unpleasant. Even thougn a few patients with Stage IV colorectal cancer can be a long-term survivor after multiple operations, we need to consider carefully the indication of the operation and QOL for a Stage IV colorectal cancer patient.

[A clinical significance of direct invasion to adjacent organs in stage IV colorectal cancer].

We studied a clinical significance of direct invasion to adjacent organs in Stage IV colorectal cancer. The subjects were 19 consecutive patients who underwent R0 surgery to the primary tumor for colorectal carcinoma, pT4, M1 1995-2003. We studied the relationship of pathologic invasion to adjacent organs of tumor among other clinicopathological factors to prognosis. Of the 19 patients, 11 (57.8%) had R0 surgery to the metastatic tumor. Only 4 (36.7%) patients survived more than 3 years. Of the 8 patients without the surgery, none of the patients survived more than 3 years. And the median survival time was only 8.5 months. Multivariate analysis indicated that RO surgery to the metastatic tumor was only an independent prognostic factor. The optimum resection for adjacent organs may prolong survival. But an extended resection is a possibility in shortening survival time.

[A case report of the 8 year survivor--unresectable liver metastases from advanced gastric cancer (Stage IV) were completely responsive, after 4 years from a total sequential gastrectomy, combining docetaxel treatment to regress the recurrence].

This case was a 69-year-old male who had advanced gastric cancer with unresectable multiple liver metastases (Stage IV). He received a combination therapy consisting of a continuous venous infusion (cisplatin: CDDP 10 mg/body, 5-FU 500 mg/body, day 1-28). As a result, metastatic tumors in the liver completely disappeared and a total gastrectomy was sequentially performed. Four years after the surgery, neck lymph node (LN) metastases and the right adrenal metastasis appeared, and chemotherapy (TS-1, and sequentially TS-1+CDDP) was performed. But, the chemotherapy to eradicate the metastases was hardly enough to be effective. Next, docetaxel (DOC 60 mg/m2 q3w) was started. After 9 courses, they were effective and marked regressions (70%). A total of 15 courses of docetaxel administration were possible until tumor progression recurred. This regimen was not severe in toxicity for the duration except for grade 3 poor appetite. Docetaxel will be a key drug for the gastric cancer. In case of responding well to the chemotherapy, we can hope for an extended long-term survival with a continuation of this regimen.

[A case of rectal cancer with solitary adrenal metastasis].

This is the case of a 67-year-old woman with a sudden on-set of lower abdominal pain and pre-shock. A physical examination showed signs of pan-peritonitis. Emergency was operation performed 5 hours after the onset. She had undergone Hartmann's operation for rectal cancer. Six month after the operation, abdominal CT scan revealed the mass of puriform acites, about 20 mm in diameter, in the right suprarenal region. Right adrenalectomy was performed with a diagnosis of solitary adrenal metastasis from rectal cancer. Histologically, the metastatic adenocarcinoma was moderately differentiated to the adrenal medulla. The capsule was kept intact, and no swelled lymph nodes were found around the adrenal gland. There have been no signs of recurrence for 4 years after the operation.

[A case of hepatic metastasis and local recurrence from rectal cancer responding to hepatic arterial infusion and systemic chemotherapy].

A 71-year-old man underwent low anterior resection for rectal cancer. Two years after the surgery, liver metastasis and local recurrence were found on the CT scan. The first-line treatment was systemic chemotherapy (CPT-11 and 5'-DFUR). Effect was satisfactory for local recurrence, but a new liver tumor was found on the CT scan. The second-line treatment was a hepatic arterial infusion (5-FU) and systemic chemotherapy (UFT). After 4 courses, the liver metastasis was reduced, but after 5 courses, the liver tumors had enlarged. The third-line treatment was a hepatic arterial infusion (5-FU + levofolinate) and systemic chemotherapy (UFT). After 5 courses, the liver tumor disappeared, and no other recurrence was found on the CT scan.

[Long-term survival after neck lymph node metastases from sigmoid colon cancer--a case report].

We report a 73-year-old female who had been operated on for sigmoid colon cancer and neck lymph node metastases. Tumor size was controlled by systemic chemotherapy for about 3 years. During the chemotherapy, toxicity over grade 2 was not observed and good QOL was maintained on an outpatient basis. It is suggested that low-dose systemic chemotherapy may be useful for patients with poor general status.