Transcatheter Arterial Chemoembolization with Spherical Embolic Agent in Patients with Pulmonary or Mediastinal Metastases from Breast Cancer.

PURPOSE: To evaluate safety and feasibility of transcatheter arterial chemoembolization with superabsorbent polymer microspheres (SAP-MS) for patients with pulmonary or mediastinal metastasis from breast cancer. METHODS: Between November 2002 and January 2015, 14 patients with 29 unresectable pulmonary or mediastinal breast cancer metastases underwent transcatheter arterial chemoembolization using SAP-MS (50-100 µm) after injection of a combination of 2-4 types of anticancer drugs (eg, cisplatin [30 mg] + fluorouracil [500 mg], or epirubicin [40 mg] + mitomycin C [4 mg] + fluorouracil [500 mg]). As a primary endpoint, local tumor response and adverse events were evaluated 1 month after the first transcatheter arterial chemoembolization, according to Response Evaluation Criteria In Solid Tumors Version 1.1 and Common Terminology Criteria for Adverse Events Version 4 criteria. Transcatheter arterial chemoembolization was repeated as needed. Overall survival was analyzed as a secondary endpoint. RESULTS: Response rate was 28.6% (partial response, 4 patients; stable disease, 10 patients). Median progression rate was -12.7%. No cases of hematologic toxicity of grade 3 or higher were observed. A grade 3 maculopapular rash was observed in 1 patient. After the first transcatheter arterial chemoembolization sessions, 63 additional transcatheter arterial chemoembolization sessions were performed (average, 5.5 sessions per patient; range, 2-10 sessions). The median overall survival time after the first session was 29 months, and the 5-year survival rate was 49.5%. CONCLUSIONS: Transcatheter arterial chemoembolization with SAP-MS is a well-tolerated and feasible palliative treatment option for patients with pulmonary or mediastinal metastasis from breast cancer.

[Introduction of Hyperthermia Therapy with Low Dose Systemic Chemotherapy and Hepatic Transarterial Chemo-Embolization for a Case of Advanced Prostatic Cancer].

The case of a 78-year-old man with hormone-independent locally advanced prostatic cancer with liver metastases is reported. Standard systemic chemotherapy was not administered due to his poor general condition. At the initial consultation, rapidly growing liver metastases, multiple lymph node metastases, and extensive locally advanced prostatic lesions were found. Transcatheter arterial chemoembolization, low dose systemic chemotherapy, and thermotherapy were administered. After introduction of this combination therapy, marked regression of all of the lesions, including the liver metastases, lymph node metastases, and pelvic extension was observed. The patient's condition and prognosis were markedly improved without serious complications.

[Transarterial Chemoembolization for Liver Metastasis of Ovarian Malignant Melanoma Resulting in Long-Term Survival].

Melanoma is a potentially aggressive disease, and patients with metastatic melanoma have a poor prognosis, with a median survival of only 6-9 months. There is no effective standard treatment for liver metastasis of malignant melanoma. Primary ovarian malignant melanoma is extremely rare and is usually associated with teratoma. We report a case of malignant melanoma arising in a mature ovarian cystic teratoma that had metastasized to the liver. Six courses of systemic chemotherapy were administered. However, as the liver metastases became enlarged, we performed transarterial chemoembolization(TACE). Following repeated TACE using drug-eluting microspheres for the liver metastasis, the patient survived 80 months from the initial diagnosis.

[A Case of Successful Drug-Eluting Microsphere Transcatheter Arterial Embolization for Hepatocellular Carcinoma with Associated Tumor Thrombus in the Inferior Vena Cava and Right Atrium].

Hepatocellular carcinoma(HCC)with severe vascular invasion has a dismal prognosis, and there is no well-established effective therapy. We report an 84-year-old man who benefited from multiple transcatheter arterial chemoembolization (TACE)treatments for advanced HCC with severe vascular invasion. Initial CT revealed a recurrent, poorly differentiated HCC with tumor thrombus in the inferior vena cava(IVC)and right atrium(Vv3). Two cycles of TACE with 5-FU, DOC, MMC, and superabsorbent polymer microspheres(SAP-MS)with BV resulted in considerable reduction of the tumor thrombus. Tumor markers(PIVKA- / / II)showed remarkable improvement(from 3,803 mAU/mL to 673 mAU/mL). The patient has been alive for 25 months following the appearance of tumor thrombus in the IVC. This case suggests that, in patients with tumor thrombi due to hepatocellular carcinoma, thrombus control and long-term survival are achievable with TACE.

[Trans-Arterial Chemoembolization Therapy for Giant Cholangiocellular Carcinoma - A Single Case Report].

Here, we report a case of cholangiocellular carcinoma that was successfully treated with chemotherapy using a selective intra-arterial infusion technique. A 65-year-old man presented to our hospital to obtain a second opinion regarding his disease. The patient was diagnosed with cholangiocellular carcinoma. The giant tumor was located in the porta hepatis. Some small nodules that were considered to be metastatic lesions were also observed in the surroundingarea. The tumor was judged by the primary physician to be too large for surgical treatment. Consequently, it was decided to treat the patient with trans-arterial chemoembolization(TACE)by selectingintra -arterial infusion of 5-FU, epirubicin(EPI), and mitomycin C prior to EPI-loaded HepaSphere(super-absorbent polymer microsphere)embolization, combined with concurrent systemic gemcitabine chemotherapy. After 5 sessions of the above treatment, the primary lesion reduced dramatically in size. In addition, the levels of CEA and CA19-9 decreased from 34.2 to 2.6 ng/mL and 1,540 to 149 U/mL, respectively. Although the patient's initial life expectancy was only 3 to 6 months, his life expectancy was extended to as longas 26 months followingthe initiation of TACE. This case suggests that treatment with TACE together with systemic chemotherapy can be a powerful therapeutic option for patients with inoperable cholangiocellular carcinoma.

[Trans-Arterial Chemoembolization Therapy for Refractory Advanced Non-Small Cell Lung Cancer with Spherical Embolic Material--A Single Case Report].

Here, we report the use of trans-arterial chemoembolization for primary lung cancer. The patient was a 56-year-old woman with refractory Stage Ⅳ non-small cell lung cancer who had been treated with repeated systemic chemotherapy. The primary lesion in the right lower lobe was 75 mm in size, with multiple lung metastases. It invaded the right main bronchus and caused severe cough. Radiotherapy was not indicated because of the size and extent of the lesion. During a period of 6 months, chemoembolization of the bilateral bronchial arteries using cisplatin 20 mg, docetaxel 20 mg, and 5-FU 250 mg with HepaSphere (super-absorbent polymer microspheres) was performed 5 times. Twenty mg of docetaxel was loaded onto 25 mg of HepaSphere. The microspheres were between 50 and 100 microns in the dry state. The endpoint of embolization was not stasis but the reduction of arterial flow. There were no serious complications during or after the procedure. Immediately after the first session, the patient's cough was significantly improved. After 5 sessions of the same treatment, the primary lesion was reduced to 48 mm and the level of CEA was reduced from 9.8 to 4.3 ng/mL. The invasion to the right main bronchus was reduced. The patient has been well without any symptoms for 9 months after initiation of trans-arterial chemoembolization.

[Transcatheter Arterial Chemoembolization with Super absorbent Polymer Microspheres for a Large Lung Cystic Adenocarcinoma in the Left Pulmonary Cavity].

A 57-year-old woman presented with lung adenocarcinoma and carcinomatous pleurisy in January 2013. The primary lesion had been treated with 60-Gy radiation therapy. She, however, showed a recurrence of the tumor in her pulmonary cavity. She received systemic chemotherapy for 1 year but did not show any improvement. She visited our clinic in March 2014. Her performance level was 3. Her hemoglobin level was 8.5 g/dL. The CT scan showed that the size of the cystic tumor was 200 × 144 × 143 mm. The tumor severely compressed her heart. We performed TACE using a spherical embolic agent. The microcatheter was guided through the left bronchial artery; left intercostal artery 9, 10, and 11; and the left inferior phrenic artery. The anticancer drugs selected were CDDP and 5-FU. The embolic material used was SAP-MS. After 3 therapy sessions, the CT scan showed shrinkage of the target lesion to 100 × 93 × 54 mm. Her hemoglobin level increased to 13.8 g/dL; furthermore, the severity of dyspnea decreased, and she showed a performance status of 0. TACE with SAP-MS was successfully performed for the large cystic tumor in the pulmonary cavity that metastasized from the lung cancer and was refractory to standard treatments. After the treatment, the tumor size decreased and the patient's symptoms alleviated.

Inquest results on the aged: comparison between Mie Prefecture and three Medical Examiners' Offices in Japan.

In Japan, the medical examiner system was enforced only in three large cities, Tokyo metropolitan, Osaka and Kobe Cities. In other areas without this system, autopsy rates are much lower than in the areas with the system. Since the population of the aged (>/=65 years old) has been increasing recently, the subjects for medicolegal investigations seem to be also increasing. In the present study, between Mie Prefecture and those three Medical Examiner's Offices in Japan, the inquest results during the 5-year-period from 1996 to 2000, especially on the aged, were compared. The aged accounted for approximately 50% of all inquest cases in those areas. Autopsy rates for the aged were 16, 24 and 75% in Tokyo, Osaka and Kobe, respectively. Seventy-five to eighty percent was classified in deaths due to disease. Seventy to seventy-five percent of death due to disease was subclassified in circulatory diseases. The highest incidence of vascular diseases was observed in Kobe whose autopsy ratio was the highest. On the contrary, ambiguous causes of deaths, e.g. heart failure or unknown, were still frequent in Mie Prefecture.