Interstitial lung disease associated with gemcitabine treatment in patients with non-small-cell lung cancer and pancreatic cancer.

PURPOSE: Although there are several reports concerning gemcitabine-induced interstitial lung disease (ILD), the risk factors for ILD are not well known. In addition, data comparing the incidence and pattern of ILD associated with gemcitabine treatment in patients with non-small-cell lung cancer (NSCLC) versus those with pancreatic cancer are scarce. METHODS: We reviewed clinical records of 118 patients treated with gemcitabine between November 2004 and November 2010. The radiographic findings and other relevant clinical data were reviewed to identify patients who had developed ILD associated with gemcitabine treatment. RESULTS: Out of these 118 patients, we identified 62 patients with NSCLC (group A) and 56 patients with pancreatic cancer (group B), which were then analysed. After gemcitabine administration, ILD was detected in 9 out of the total 118 patients (7.6%). Three patients had grade 2 ILD and 6 patients had grade 3 ILD. Multivariate analysis revealed that prior thoracic radiotherapy (odds ratio: 26.3) and pre-existing pulmonary fibrosis (PF) (odds ratio: 6.5) were correlated with ILD occurrence, but the incidence of ILD was not different between groups A and B. The median dose of gemcitabine administered till the manifestation of ILD tended to be lower in group A than in group B. CONCLUSIONS: Prior thoracic radiotherapy and pre-existing PF were correlated with higher ILD rate in gemcitabine-treated patients. ILD incidence did not differ between NSCLC and pancreatic cancer patients, which may be due to the differences in treatment strategy and tumour properties.

Obstructions of portal veins and tumor numbers are associated with humped hepatocellular carcinoma.

Tumor protrusion in hepatocellular carcinoma (HCC) is one of the risk signs of tumor rupture. Despite curative tumor treatments, HCC recurrences sometimes occur with rapidly growing humped or ruptured HCC in small sized tumors. The aim of this study was to clarify the characteristics of humped HCC clinically and radiologically associated with tumor progression, liver damage, and treatment. The subjects were 179 consecutive HCC patients who underwent angiographic examination. Dynamic studies, using helical computed tomography and magnetic resonance imaging were assessed, and the HCC area were measured. The tumor-node-metastasis (TNM) stage differed significantly between the humped and non-humped HCC groups. Humped HCC was more frequently observed in the right lobe (29.3% of right-lobe HCCs) than in the left (10.1%; p=0.003). Analysis of recurrent HCC revealed that patients with multiple treatments of >4 sessions had more humped HCC (33.8%) than those with 1-3 sessions (16.7%; p=0.042). Multivariate regression analysis revealed that tumor invasion in the portal vein, rather than large tumor size, was significantly associated with tumor protrusion. HCC recurrence with humped HCC occurs often in patients with multiple treatments. Tumor factors of the TNM classification, especially tumor invasion in the portal vein, might be associated with the mechanisms of tumor protrusion.

Safety of and tolerance to adenosine infusion for myocardial perfusion single-photon emission computed tomography in a Japanese population.

BACKGROUND: Adenosine has been available for use in myocardial perfusion single-photon emission computed tomography (SPECT) in Japan since 2005. The purpose of this study was to evaluate the safety of and tolerance to thallium-201 myocardial perfusion SPECT with intravenous adenosine infusion in Japanese patients with suspected coronary artery disease. METHODS AND RESULTS: Two hundred and six consecutive patients who underwent an adenosine infusion (120 mug . kg(-1) . min(-1)) SPECT at Sumitomo Besshi Hospital (Niihama, Japan) were investigated. The effects of adenosine infusion were monitored for each patient. A coronary angiography was performed in 81 patients. Adenosine infusion significantly decreased blood pressure and increased heart rate. Adverse reactions were observed in 161 patients (78.2%). Most reactions were transient, disappearing soon after the termination of adenosine infusion. No serious adverse reactions, such as acute myocardial infarction or death, occurred. Adenosine infusion was terminated in 3 patients (1.5%) because of near syncope or sustained 2:1 atrioventricular block. Electrocardiographic changes occurred in 15 patients (7.3%). Self-assessed scoring after SPECT showed that the patients were very tolerant (74.6% of 177 patients) of adenosine infusion myocardial SPECT. The sensitivity and specificity were 75.0% and 69.7%, respectively. CONCLUSIONS: Adenosine infusion myocardial SPECT is safe and well tolerated in the Japanese population, despite the frequent occurrence of minor adverse reactions.