Phase II trial in Japan of sequential administration of weekly paclitaxel followed by FEC as neoadjuvant chemotherapy for locally advanced breast cancer [KBCSG0206 trial: Kinki Breast Cancer Study Group (KBCSG)].

OBJECTIVE: We conducted a phase II trial in Japan to evaluate the efficacy and tolerability of weekly paclitaxel followed by fluorouracil, epirubicin, and cyclophosphamide (FEC) as neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC). METHODS: Patients with clinical stage IIIA-IIIB breast cancer received NAC consisting of 12 once-a-week cycles of paclitaxel followed by 4 once-every-third-week cycles of FEC. RESULTS: Fifty patients with LABC were enrolled, 47 of whom were administered paclitaxel followed by FEC as NAC. The clinical response rate for all chemotherapies was 85.1%, and the pathological complete response rate was 27.7%. Regarding toxicity, grade 3-4 neutropenia was observed in 10% of patients. No serious toxicities requiring the discontinuation of treatment were encountered. The rate of breast conservation surgery was 31.9%, median survival had not been reached at the time of conclusion of this study, and the 3-year survival rate was 85.1%. Median disease-free survival was 40.2 months, and the 3-year disease-free survival rate was 62.1%. CONCLUSIONS: Weekly paclitaxel followed by FEC demonstrated efficacy and tolerable toxicity in a neoadjuvant setting for LABC.

[Radio-frequency ablation therapy for metastatic liver tumors from colorectal carcinoma].

UNLABELLED: Radio-frequency ablation therapy (RFA) as a treatment for metastatic liver tumors from colorectal carcinoma was examined. METHODS: Ten patients with a total of 30 liver metastases from colorectal carcinoma were treated using a Cool-tip RF system from March 2003 to December 2004. RESULTS: Patients had a mean age of 69.8 years and the mean diameter of the metastatic lesions was 29.5 mm (range, 5-82). Two patients had received RFA therapy 2 times, and another 2 patients had received 3 times. Critical complications were not seen, though 5 therapies were performed using CT-guided trans-pulmonary puncture. The rate of partial recurrence was 23.1% and the average observation period was 14.8 months. The partial recurrence had occurred within the mean period of 6.2 months. Although after multimodal therapy was given, it is suggested that repeated RFA for the liver metastasis would improve survival rates. CONCLUSION: RFA is a safe and effective treatment for metastatic liver tumors from colorectal carcinoma as multimodal therapy.

[A case of T4 esophageal squamous cell carcinoma in esophagogastric junction effectively treated by neoadjuvant FAP therapy].

A 59-year-old man was admitted to our hospital because of vomiting and body weight loss. Upper GI series and upper digestive tract endoscopy revealed type 3 cancer lesion in the area from the lower thoracic esophagus to the middle gastric body. In the biopsy specimen squamous cell cancer was shown. We perfomed neoadjuvant chemotherapy because the computed tomography revealed invasion to the diaphragm and aorta. After chemotherapy a 65% reduction was obtained, and we performed total gastrectomy with lower esophagectomy and lower mediastinal and abdominal lymph node dissection and Roux-en Y reconstruction in the left thoracoabdominal serial incision. In the histological examination, Grade 1 response was obtained in the primary specimen and Grade 3 response in the lymph node specimens. In the 44 months since surgery, the patient has remained well and disease free. It was suggested that a combination of neoadjuvant chemotherapy and surgery was successful treatment for this case.

Influence of adjuvant tamoxifen treatment on bone mineral density and bone turnover markers in postmenopausal breast cancer patients in Japan.

The effect of adjuvant tamoxifen treatment on bone mineral density (BMD) and bone turnover markers was studied in postmenopausal breast cancer patients. The relationship of tamoxifen's effect with the genetic polymorphisms of estrogen receptor (ER)-alpha and ER-beta gene was also studied. Twenty-one postmenopausal breast cancer patients were given tamoxifen (20 mg/day) as the adjuvant treatment after the surgery. BMD of the lumbar supine (dual emission X-rays absorptiometry) and bone resorption (deoxypyridinoline, aminoterminal telopeptide of type I collagen, and carboxyterminal telopeptide of type I collagen) and formation (propeptide of type I procollagen, osteocalcin, and bone-specific alkaline phosphatase) markers were examined at baseline (before the surgery), 6 and 12 months after the start of tamoxifen treatment. Genetic polymorphisms analyzed were TA dinucleotide repeats polymorphism in the promoter region and PvuII and XbaI restriction fragment length polymorphism for the ER-alpha gene and the CA dinucleotide repeats polymorphism in the intron 5 for the ER-beta gene. Tamoxifen significantly increased BMD of the lumbar spine at both 6 (P<0.01) and 12 months (P<0.01) after the start of tamoxifen as compared with that at baseline. The mean percent increase in BMD was 3.3% at 6 months and 2.7% at 12 months. All bone resorption and formation markers significantly decreased at both 6 and 12 months. Among the four genetic polymorphisms studied, only ER-beta CA repeat polymorphism was found to be significantly associated with BMD at 12 months, i.e. BMD of the 21 CA repeats allele carriers was significantly higher than that of the non-carriers (P=0.025). These results suggest that tamoxifen increases BMD of the lumbar supine by reducing the bone turnover in postmenopausal breast cancer patients, and this bone restoring effect of tamoxifen is more marked in ER-beta 21 CA repeats allele carriers than non-carriers.