[More effective positioning of capecitabine for advanced and metastatic breast cancer].

We investigated 30 patients with advanced and metastatic breast cancer who underwent capecitabine therapy in our department from July, 2004 to April, 2009. Patients' backgrounds: 35-82 years of age (median, 62 years of age). Performance status (PS): 0 approximately 1 in 21 cases, PS:2 in 7 cases and PS:3 in 2 cases. 63% of patients were positive ER and/or PgR, and 33. 3% were positive HER2. Of these patients, 17 had bone, 15 lymph node, 13 lung, 7 liver, and 4 skin metastasis. The capecitabine response in these patients was evaluated as follows: partial response (PR) in 9, stable disease (SD)in 6, long SD in 4, and progressive disease(PD)in 11, indicating a response rate(RR)of 30% and a clinical benefit rate (CBR) of 43. 3%. In comparison with after third-line treatment, capecitabine proved more effective as first or second-line treatment. Interestingly, the capecitabine response in HER2 negative-expressing patients, especially in HR(+)/HER2(-)subgroup, was significantly better than that in HER2-over-expressing patients. The soft tissue lesions(primary tumor and metastasis of skin and lymph nodes)showed a significantly better response to capecitabine treatment than other metastases such as lung, liver and bone. There was a significant difference in the response rate between soft tissue metastasis (lymph nodes, skin and primary tumor)and other types of metastasis (lung, liver, and bone). Finally, it was suggested that use of capecitabine in upfront line for HER2-negative expressing cases or soft tissue metastatic cases contributed to the prolongation of time to treatment failure(TTF)and overall survival.

[Clinical significance of pyrimidine nucleoside phosphorylase (PyNPase) in breast cancer].

To clarify the clinical significance of pyrimidine nucleoside phosphorylase (PyNPase) activity in breast cancer, we examined the possible correlation of PyNPase activity to clinicopathological features and prognosis in twenty-one patients with primary breast cancer from April 2000 to December 2001. Flow signals of tumors were analyzed by Power Doppler sonography (PDUS), and maximal velocity (V(max)) was calculated. PyNPase activity of resected specimens was assayed by ELISA method. PyNPase activities in resected cancerous tissue were 156.9+/-63.5 unit/mg (mean+/-SD), which were significantly higher than that in normal tissue (19.0+/-18.1 unit/mg, p<0.0001). PyNPase activity was positively correlated with tumor size (r=0.496, p=0.026) and V(max) (r=0.498, p=0.021). The disease free survival rate was significantly lower in the high PyNPase activity group than in the low PyNPase activity group. In overall survival rate, there was no significant difference between the high and low PyNPase activity groups. In the multivariate analysis, PyNPase activity was an independent predictor of postoperative recurrence (p=0.032). We suggest that PyNPase activity is associated with progression and proliferation of breast cancer, and that it may be useful for prediction of the prognosis.

[A case of gastric cancer with abdominal para-aortic lymph node metastases responding to TS-1 + CDDP neoadjuvant chemotherapy].

The patient was a 54-year-old woman with extremely advanced gastric cancer of type 3. A CT scan of the abdomen showed enlargement of many huge abdominal para-aortic lymph nodes. Combined chemotherapy of TS-1 and CDDP was planned in order to reduce the tumor. TS-1 (100 mg/body/day) was administered for 21 days followed by 14 days rest as one course. CDDP (96 mg/body) was administered 8 days after the start of TS-1. After 2 courses of treatment, a CT scan showed complete disappearance of lymph node metastasis, and no high grade toxicities. Therefore, one month after the completion of the chemotherapy, total gastrectomy and D2 lymph node dissection were performed. The histological effect was judged to be grade 1a-1b. There were no viable cancer cells in any lymph nodes. One year after surgery, the patient is still alive without recurrence. Neoadjuvant chemotherapy with TS-1 and CDDP is so effective that can it be adapted for advanced gastric cancer with para-aortic lymph node enlargement for downstaging.

Proliferative funiculitis with a prominent infiltration of mast cells.

A surgical case of proliferative funiculitis (pseudosarcomatous myofibroblastic proliferation of the spermatic cord) with a prominent mast cell infiltration is reported. A 67-year-old man with a history of right inguinal herniorrhaphy 7 years earlier was operated on for diffuse swelling of the inguinal region and scrotum. A large lipoma was found in the inguinal region, and a nodular lesion, measuring 2.7 cm in maximal dimension, was firmly attached to the right spermatic cord. The nodular lesion showed diffuse proliferation of fibroblasts and myofibroblasts associated with the deposition of collagen. A diffuse infiltration of numerous mast cells was found throughout the lesion. Lesions that belong to the group of inflammatory pseudotumors are rarely accompanied by a prominent mast cell infiltration, and the differentiation from mast cell neoplasms is often problematic in such cases. The present case is the first example of proliferative funiculitis associated with this rare phenomenon.

Preoperative assessment of hepatic function: Utility of a new convenient two-compartment model analysis using galactosyl human serum albumin scintigraphy.

BACKGROUND AND AIM: Preoperative hepatic function was evaluated using technetium-99 m-diethylenetriaminepenta-acetic acid-galactosyl-human serum albumin (Tc-GSA) and a scintillation camera to detect hepatic Tc-GSA uptake by the asialoglycoprotein receptor. METHODS: Sixty-two preoperative patients with liver cancer, including hepatocellular and cholangiocellular carcinomas, were studied, using two-parameter two-compartment model analysis. This model is simpler than either the three- or five-compartment model, both of which are accurate but which require complicated analysis and enormous calculation. The parameters k1 and k2 represented the transfer rate constant from the blood to the liver and from the liver to the blood, respectively. We calculated k1, k2, and k1/k2 from time-radioactivity curves of the heart and liver as well as VLmg, which represented the maximal amount of Tc-GSA in the liver. RESULTS: The results were compared to those of conventional liver function analysis using Tc-GSA (the index of blood clearance (HH15) and the receptor index (LHL15)) or indocyanine green (ICGR15). Both HH15 and LHL15 were significantly correlated with k1, k1/k2, and VLmg. In addition, they closely correlated with the results of ICGR15 and some serum hepatic function tests (aspartate aminotransferase, choline esterase, albumin, platelet). The pathological grading for liver cirrhosis also correlated with k1, k1/k2, and VLmg. From a clinical point of view, VLmg had a significant correlation with the Child-Pugh score. CONCLUSIONS: These results suggest that this new compartment analysis will be useful in evaluating liver function, as it is accurate, simple and convenient.

[Clinical benefit of bronchial arterial infusion chemotherapy to pulmonary metastasis from colorectal cancer--report of two cases].

Case 1: A 60-year-old woman with sigmoid colon cancer and multiple lung metastases developed dyspnea 34 months after sigmoidectomy and following systemic chemotherapy. Chest X-ray revealed left atelectasis and obstruction of the left main bronchus by lung metastasis, and stenosis of the right main bronchus was also suspected. Bronchial arterial infusion of CDDP, 5-FU and MMC relieved the atelectasis and dyspnea. The left bronchus remained patent for 12 months. Case 2: A 70-year-old man who had a pulmonary recurrence of rectal cancer suffered from hemoptysis and dyspnea, which had improved with systemic chemotherapy but then become exacerbated again. Bronchoscopic examination revealed intraluminal bleeding from a metastatic tumor. The symptoms were relieved after bronchial arterial infusion of CDDP, 5-FU and MMC. The diameter of the treated tumor was reduced by 15%. Hemoptysis was negligible until he died 8 months later. Bronchial arterial infusion chemotherapy for pulmonary metastasis from colorectal cancer is clinically beneficial, especially for patients with life-threatening respiratory symptoms like airway obstruction or intraluminal bleeding.