[A case report of successful transcatheter arterial embolization therapy for osseous metastasis of hepatocellular carcinoma].

A 74-year-old man was admitted to our hospital with a chief complaint of severe local pain of the hip joint. Radiological findings showed a metastasized lesion on the left side of the pelvic wall originated from hepatocellular carcinoma (HCC) in the anterior segment of the liver. Transcatheter arterial embolization (TAE) therapy using epirubicin, Lipiodol and Spongel was successfully performed twice for primary HCC, and four times for osseous metastasis of HCC. After TAE therapy, the size of the metastasized lesion decreased with relief of pain, and an improvement in performance status of 4 to 2 was achieved. In conclusion, TAE therapy is thought to be very useful in the treatment of osseous metastasis of HCC with severe local pain.

[A case of liver metastasis of gastric leiomyosarcoma successfully treated by transarterial hepatic chemo-embolization and intra hepato-arterial chemotherapy repeated with infusion-a-port].

The patient was a 68-year-old male, who underwent total gastrectomy for giant leiomyosarcoma of the stomach and then had multiple hepatic metastases one year and six months later. Thus, transarterial hepatic chemo-embolization therapy with Lipiodol, adriamycin and gelfoam was given. Moreover, using a reservoir catheter and infusion arterial port, intermittent arterial infusion therapy with adriamycin, cyclophosphamide, and vincristine was attempted. In the metastasis lesion where there were rich blood vessels, Lipiodol was accumulated and the tumor was reduced on abdominal CT. The result indicated the efficacy of this treatment.

[A long-survival case of unresectable liver metastasis of colon cancer by hepatic arterial intermittent multidrug infusion chemotherapy].

We experienced a long-survival case with unresectable liver metastasis of sigmoid cancer by hepatic arterial intermittent multidrug infusion chemotherapy. The patient was a 65-year-old man. A movable tumor was palpable at the left lower abdomen. The serum CEA value was 15.6 ng/ml. Abdominal CT scan showed a 3 cm-sized low-density area near the root of the right and middle hepatic vein in segment 4. He had undergone sigmoidectomy, cholecystectomy and cannulation into the proper hepatic artery. Chemotherapy was performed by using 5-FU (250 mg), Adriacin (5 mg) and mitomycin C (4 mg) every second week from 4 months after surgery as an outpatient. In the CT scan image, the low-density area completely disappeared at 10 months after treatment, and the CR interval was 14 months. The patient has been alive for 5 years after surgery.

Apoptosis of acinar cells in the pancreas of rats fed on a copper-depleted diet.

Male Fischer 344 rats weighing 80-90 g were fed on a copper-depleted diet supplemented with 0.6% triethylenetetramine tetrahydrochloride (a copper chelator), and the death of pancreatic acinar cells of these rats was investigated morphologically and biochemically. The weight of the pancreas of these rats decreased from 3 weeks after feeding, and concomitantly the percentage of dead acinar cells increased to the maximum in about the 5th week and decreased subsequently. These dead acinar cells showed light microscopic and electron microscopic characteristics of apoptosis. Furthermore, the electrophoretic pattern of DNAs extracted from the pancreas having many dead acinar cells showed a ladder-like distribution, characteristic of apoptosis. The present results indicate that feeding of rats on a copper-depleted diet supplemented with a copper chelator results in apoptosis of acinar cells of the pancreas.

[Pharmacokinetics following intraperitoneal sequential administration of cisplatin and fluorouracil for gastric cancer].

Gastric cancer patients with peritoneal dissemination underwent a palliative resection of the stomach and received an intraperitoneal administration of CDDP (70 mg/m2) and 5-FU (700 mg/m2), immediately after the surgery. The levels of CDDP and 5-FU in serum and peritoneal cavity were serially monitored in order to study the pharmacokinetics of these drugs. group A (n = 9): CDDP dissolved in 500 ml saline was infused intraperitoneally at 200 ml/min, and one hour later, 5-FU dissolved in 500 ml saline was infused at the same speed. The infusion catheter was clamped for two hours after completion of 5-FU infusion. Group B (n = 3): CDDP in 500 ml saline were infused at 10 ml/min and then 5-FU in 500 ml were infused at 5 ml/min. Group C (n = 2): CDDP in 1,000 ml saline was infused at 200 ml/min. Group D (n = 2): 5-FU in 1,000 ml saline was infused at 200 ml/min. The free CDDP levels in the peritoneal cavity were 22 micrograms/ml in group A, 57 micrograms/ml in group B, and 13 micrograms/ml in group C at one hour after completion of the infusion. The 5-FU levels in the peritoneal cavity measured two hours after completion of the infusion were significantly higher in the group B (349 micrograms/ml) than in group A (132 micrograms/ml) and C (71 micrograms/ml). The Cmax of 5-FU in serum was lowest in group B. The AUCs in the peritoneal cavity of free CDDP and 5-FU were 63.6 micrograms.hr/ml and 925 micrograms.hr/ml, respectively. These values were above the 10th percentile of IC90 for gastric cancer. No serious complications were encountered in group A and B where both CDDP and 5-FU were administered as compared with group C and D, where either CDDP or 5-FU was administered.

[Evaluation of intra-arterial infusion chemotherapy and radical pancreatectomy in patients with locally advanced pancreatic cancer].

This is a retrospective study to evaluate arterial infusion chemotherapy and resection for locally advanced pancreatic cancer involving retro-peritoneal organs or large vessels such as superior mesenteric artery or celiac trunks. Intra-arterial chemotherapy was performed for 19 patients, and 15 underwent pancreatectomy. Patients in the intra-arterial chemotherapy group could live 11 months out of the hospital, against 4 months in the resected cases (p < 0.05). The period of over 2nd degree in performance status was 11 months in the arterial chemotherapy group and 3 months in resected groups (p < 0.05). The survival rates were 53, 18 and 9% at 1, 2 and 3 years in the patients with arterial chemotherapy, respectively, against 22, 15 and 15% in the resected patients (p < 0.05). These results suggested that intra-arterial chemotherapy was significantly effective in prolonging the survival period with a better quality of life.

["Wrapping therapy" for advanced hepatic cancer with arterial and intraportal infusion chemotherapy].

A new treatment method to intercept collaterals using silicone rubber sheeting was used for 5 patients with advanced hepatic cancer. The therapy was carried out to prevent new collaterals. This procedure was followed by arterial chemoembolization, arterial infusion chemotherapy and intraportal infusion chemotherapy. The results were complete response in 2 patients, partial response in 2 patients, and no change in 1 patient. The overall survival time was 7-54 months after wrapping. Although a randomized control study is necessary to assess the true value of this method, the new therapy is considered worth using as an adjuvant treatment for advanced hepatic malignancies uncontrolled by arterial chemotherapy or chemoembolization.

[Chemoembolization for liver metastasis from colorectal cancer].

Chemoembolization using Lipiodol, cisplatin, angiotensin II and Gelfoam (modified sandwich therapy) was carried out for the patients with liver metastasis from colorectal cancer. 1. Ten of 30 patients who underwent hepatic resection received TAE before operation, and the remaining 20 underwent surgery without preoperative TAE. Three-year survival of the former was 66%, and that of the latter was 44% (not significant). 2. Twenty-two patients who were assessed as non-resectable were surgically catheterized into the hepatic artery. Thirteen patients received TAE (totally 38 times) and intra-arterial infusion chemotherapy, and the remaining 9 underwent intra-arterial chemotherapy alone. The 50% survival of the former and the latter was 545 and 285 days, respectively. One year survival of the former was significantly better than that of the latter. 3. Fourteen patients had intrahepatic recurrences after hepatic resections. Eight patients received TAE and the remaining 6 did not. The 50% survival of the former was 615 days and that of the latter was 190 days. For one-year survival, the former was significantly better than the latter. These results suggested that TAE is an effective modality for liver metastasis from colorectal cancer.

[Intraarterial and intraportal chemotherapy combined with decollateralization for cholangiocellular carcinoma and metastatic liver cancer].

Two patients with cholangiocarcinoma and one patient with liver metastasis from inflammatory breast cancer underwent catheterization into both hepatic artery and portal vein following decollateralization using silicone rubber sheeting. They received arterial chemoembolization and chemotherapy and portal chemotherapy through the catheters repeatedly. Two patients with cholangiocarcinoma are still alive more than one year after the beginning of the treatments without regrowth of the tumors. The patient with metastatic liver cancer died of lung metastasis, although the liver foci were controlled by procedure. Thus, both intraarterial and intraportal chemotherapy combined with decollateralization by silicone rubber sheeting seems to be effective for advanced cholangiocarcinoma and metastatic carcinoma.