[A Case of Alcoholic Liver Disease Presenting as Prominent Accumulation of Ascites Associated with Liver Damage Due to CapeOX].

A 75-year-old man with rectal cancer had consumed an average of6 6 g of alcohol per day for 47 years. However, his liver function was within normal limits and his Child-Pugh classification was A before initiation of therapy. He underwent neoadjuvant chemoradiation and a low anterior resection. The patient then received CapeOX as an adjuvant therapy. During the fourth cycle of CapeOX, computed tomography(CT)showed massive ascites. The chemotherapy was discontinued and treatment including a diuretic agent was initiated. The ascites gradually decreased and 8 months after the discontinuation of CapeOX, CT showed neither the presence ofascites nor recurrence ofthe cancer or metastasis. When a patient has a history ofexcessive alcohol intake, even iftest results for liver function are within normal limits, we should be aware ofthe hepatic toxicity ofCapeOX.

Prevalence and risk factors of bone metastasis and skeletal related events in patients with primary breast cancer in Japan.

BACKGROUND: Bone metastasis (BM) is important for studying systemic spread of breast cancer. It often causes skeletal-related events (SREs) that worsen quality of life. We investigated the prevalence and risk factors for BM and SRE using a dataset from the Breast Oncology Research Network (BORN) in Japan. PATIENTS AND METHODS: We collected data on primary breast cancer patients with node-positive or node-negative disease at intermediate to high risk of recurrence. The risk factors affecting the BM-free rate, SRE-free rate and overall survival were analyzed by using the Cox proportional hazard model. RESULTS: Data of 1,779 patients who were diagnosed with breast cancer during 2003-2005 were collected from the BORN and 1,708 cases were used for analysis. The median follow-up duration was 5.71 years. BM developed in 193 cases (11.3 %) and the BM-free rate at 5 years was 89.2 %. The annual hazard ratio of BM development differs remarkably according to the tumor subtype. SREs occurred in 133 (68.9 %) out of 193 patients and the SRE-free rate at 5 years was 92.6 %. In the multivariate analysis, clinical stage (P < 0.0001), number of lymph node (LN) metastases (P = 0.0029), tumor subtype (P = 0.034) and progesterone receptor status (P = 0.038) were independently significant risk factors for BM-free rate, but only clinical stage (P < 0.0001) and number of LN metastases (P = 0.0004) significantly correlated with SRE-free rate. CONCLUSIONS: This retrospective study clarifies the prevalence and risk factors for BM and SRE in Japanese breast cancer patients. Our results show the importance of considering subtype in the care of BM and SRE.

Quality of gastric cancer care in designated cancer care hospitals in Japan.

OBJECTIVE: To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. DESIGN: A retrospective medical record review. SETTING: Eighteen designated cancer care hospitals throughout Japan. PARTICIPANTS: A total of 1685 patients diagnosed with gastric cancer in 2007. MAIN OUTCOME MEASURES: Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. RESULTS: Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). CONCLUSIONS: Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

Gallbladder cancer detected by elevated serum KL-6 levels during the follow-up of interstitial pneumonia: a case report.

Serum Krebs von den Lungen-6 (KL-6) is clinically used for the diagnosis of interstitial pneumonia (IP) as well as the evaluation of its disease activity. A female patient was diagnosed with idiopathic IP when she was 62 years old. Four years later, serum levels of KL-6 had been elevated gradually from 2400-3821 U/ml, and she was found to have gallbladder cancer detected by contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. She thus underwent a radical extended cholecystectomy. After the operation, serum levels of KL-6 showed a steep decline to 590 U/ml. Immunohistological examination revealed that KL-6 presented in gallbladder cancer cells. Taken together, serum KL-6 was shown to be produced by gallbladder cancer cells. Here, we present the first patient in whom increased serum KL-6 levels led to the diagnosis of gallbladder cancer during follow-up of IP. When serum levels of KL-6 are elevated during the follow-up care of IP despite no worsening of IP, an examination of the whole body should be performed to find possibly existing malignant tumors.

Pancreatic-type Acinar Cell Carcinoma of the Stomach Included in Multiple Primary Carcinomas.

BACKGROUND/AIM: Pancreatic-type acinar cell carcinoma (ACC) in the stomach is extraordinarily rare. We pathologically examined two cases with multiple primary carcinomas, including gastric tumors. PATIENTS AND METHODS: Gastric cancer specimens were examined by immunostaining and electron microscopy. RESULTS: Both cases had cancer cells with acinar patterns, resembling pancreatic ACC. The cancer cells in the first case were positive for exocrine markers, including chymotrypsin, lipase and alpha-1 antichymotrypsin (ACT), as well as neuroendocrine markers, including chromogranin A and synaptophysin. The cancer cells in the second case were positive for chymotrypsin and alpha-1 ACT, while being slightly positive for chromogranin A and synaptophysin. Ultrastructurally, cancer cells contained zymogen granules in both cases. The final diagnosis was pancreatic mixed acinar-neuroendocrine carcinoma and pure pancreatic ACC, respectively. CONCLUSION: We confirmed two cases with gastric pancreatic-type ACC included in multiple primary carcinomas. This type of double cancer has not been reported previously.

[Bi-weekly chemotherapy with medium-dose docetaxel for advanced and recurrent breast cancers (The 15th study of Keiji Breast Cancer Study Group)].

The efficacy and safety of bi-weekly administration of medium-dose docetaxel (TXT) were evaluated in patients with advanced and recurrent breast cancers. The additional effect of 5'-DFUR for non-responders was also evaluated. Forty patients with advanced and recurrent breast cancers were treated and 38 cases of 40 were evaluated (34 with recurrent cases and 4 with advanced cases). All cases were female, and their mean age was 56.0 (38-74). TXT of 60 mg/body, which was equivalent to 30-50 mg/m2 for standard-sized Japanese women, was administered every two weeks. 5'-DFUR of 800 mg/body was added for non-responders after 5 weeks. The response rate was calculated from the data of 32 cases with measurable lesions, and side effects were evaluated in about 34 cases with exact records. Two hundred seventy-one courses were performed for 38 patients (4-24 courses per person, average 7.13 courses). The mean dosage per course of TXT was 58.4 mg/body (38.3 mg/ m2). Three complete and 7 partial responses were observed (overall response rate: 31.3%). Ten non-responders were evaluated for the additional effect of 5' DFUR, and one case reached PR. Grade 3/4 bone marrow suppression occurred in 9 patients, and Grade 3/4 general malaise was observed in two patient. According to the results, bi-weekly administration of medium dose TXT is an active and safe regimen in patients with advanced and recurrent breast cancers. The additional effect of 5'-DFUR was observed in one of 10 non-responders of bi-weekly chemotherapy with medium-dose TXT.

Bi-weekly docetaxel in the adjuvant treatment of node-positive or high-risk breast cancer patients: phase I study of the Shiga Breast Cancer Study Group.

BACKGROUND: A phase I study of bi-weekly docetaxel was performed to determine the maximum tolerated dose (MTD) as well as the incidence and severity of toxicities in patients with high-risk node-negative and node-positive breast cancer. METHODS: Docetaxel was administered every 14 days to postoperative breast cancer patients who were axillary lymph node-positive or considered at high-risk. After the completion of six cycles of docetaxel, all patients received epirubicin + cyclophosphamide every 21 days for four cycles. The docetaxel dose was escalated in a stepwise fashion as follows: 45, 50, 55, 60, 65, and 70 mg/m(2) in levels 1, 2, 3, 4, 5, and 6, respectively. Patients were treated in cohorts of three to six per group using a standard phase I study design. The MTD was considered the dose level at which three of three patients or more than three of six patients experienced dose-limiting toxicity (DLT) in the first cycle. RESULTS: Twenty patients were enrolled and received a total of 110 cycles of chemotherapy. The MTD was not reached until level 5. Since three DLTs (grade 3 diarrhea, n = 2; grade 3 constipation, n = 1), were observed in five patients at level 6, level 6 was judged as the MTD. The recommended dose of bi-weekly docetaxel for a phase II trial is 65 mg/m(2). CONCLUSIONS: The MTD of bi-weekly docetaxel was 70 mg/m(2). Further evaluation is warranted to confirm the safety and efficacy in the treatment of early-stage breast cancer.

Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: final results of a randomized multi-institutional trial.

PURPOSE: Although the outcome of surgery for locally advanced pancreatic cancer remains poor, it is improving, with 5-year survival up to about 10% in Japan. The preliminary results of our multi-institutional randomized controlled trial revealed better survival after surgery than after radiochemotherapy. We report the final results of this study after 5 years of follow-up. METHODS: Patients with preoperative findings of pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric or common hepatic arteries, or distant metastasis, were included in this randomized controlled trial, with their consent. If the laparotomy findings were consistent with these criteria, the patient was randomized to a surgery group or a radiochemotherapy group (5-fluorouracil 200 mg/m2/day and 5040 Gy radiotherapy). We compared the mean survival time, 3-and 5-year survival rates, and hazard ratio. RESULTS: The surgery and radiochemotherapy groups comprised 20 and 22 patients, respectively. Patients were followed up for 5 years or longer, or until an event occurred to preclude this. The surgery group had significantly better survival than the radiochemotherapy group (P<0.03). Surgery increased the survival time and 3-year survival rate by an average of 11.8 months and 20%, respectively, and it halved the instantaneous mortality (hazard) rate. CONCLUSION: Locally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection.