Trans-sacral resection of a solitary fibrous tumor in the pelvis: report of a case.

Solitary fibrous tumors (SFTs) develop most commonly in the pleura, although they have occasionally been reported to arise in the pelvic cavity. We report a case of an SFT presenting as a painless nodule in the pelvis of a 56-year-old woman. Histologically, the tumor was composed of spindle-shaped cells arranged without pattern, with short and narrow fascicles and interspersed bundles of thick collagen, and numerous blood vessels with a focally hemangiopericytoma-like appearance. Immunohistochemically, the tumor cells strongly expressed vimentin, CD34, and bcl-2. The tumor was excised via a trans-sacral approach, without preoperative transcatheter embolization, and the patient remains well more than 2 years after her operation. To our knowledge, this is the first case of an SFT in the pelvis, which was excised completely via a trans-sacral approach.

[Results of preoperative chemoradiotherapy for T4 rectal cancer].

We reviewed clinical records of 11 cases with preoperative chemoradiotherapy to evaluate the clinical effectiveness of chemoradiotherapy for T4 rectal cancer. The preoperative radiotherapy consisted of 40-50 Gy delivered in fractions of 1 .8- 2.0 Gy per day, five days per week. A treatment of 5-fluorouracil, 500 mg/body per day intravenously, or oral UFT-E (300 mg/m²) with l-leucovorin (75 mg) per day, or oral S-1 (80 mg/m²) per day five days per week, was given during radiotherapy. One patient died due to pelvic abscess in 63 days after chemoradiotherapy. Invasive findings to the adjacent organs identified by CT and MRI disappeared in 6 cases with complete or partial response 1 month after chemoradiotherapy. Curative surgery was performed in 7 patients. Although the adjacent organs were also removed during surgery in 7 patients, there was no histological invasion to the adjacent organs in 4 patients, and one patient had histological complete disappearance of tumor. Although complications after surgery were found in all of the patients, they were improved by conservative treatment. Two of 7 patients with curative surgery had recurrence, but the rest of them survived without recurrence. Preoperative chemoradiotherapy was expected to be an effective treatment to improve the resection rate and prognosis for T4 rectal cancer. However, it was thought that it was necessary to be careful about severe toxicity, such as pelvic abscess.

[Four cases of anal squamous cell carcinoma treated by chemoradiotherapy].

We reviewed clinical records of 4 cases with squamous cell carcinoma in anus to evaluate the clinical effectiveness of the chemoradiotherapy. The radiation therapy consisted of 40 Gy was delivered to pelvis and bilateral inguinal lesion, and perianal booster dose of 20 Gy, in fractions of 2.0 Gy per day, was given five days a week. On the first day of radiation therapy, 750 mg/m2 of 5-FU in the form of a continuous 24-hour infusion for 5 days was given. On the first day of chemotherapy, 10 mg/m2 of MMC was also given as a single bolus infusion. 5-FU and MMC were administered 4 times every 4 weeks. Three patients had T2 tumor, and one patient had T1 tumor. One patient had metastases in para-aortic and Virchow lymph node. No patients had hematogenous metastases. Grade 1 or 2 adverse effects occurred in 3 patients during chemoradiotherapy, but the completion of chemoradiotherapy was achieved in all of the 4 patients. All patients had complete response in the anal lesion after chemoradiotherapy. No patients had any sign of recurrence in anal lesion. Chemoradiotherapy was expected to be a safe and effective treatment to improve prognosis for anal squamous carcinoma.

[HAI chemotherapy for liver metastases of colorectal cancer].

We evaluated the effect of hepatic arterial infusion(HAI)chemotherapy for liver metastases from colorectal cancer. A total of 65 patients received HAI chemotherapy. The chemotherapy regimen consisted of weekly 5-FU (1, 500 mg/body) or 5-FU (400 mg/mm2) and l-LV (200mg/mm2). The survival and response rates were assessed according to RECIST. Median survival time with HAI chemotherapy was 13. 5 months, 5-year survival rate 8% and response rates 55%. There was no evidence of myelosuppression, and HAI could be continued for a long time even for poor PS patients. There were no differences in survival time between synchronous, metachronous and postoperative metachronous liver metastases. In the patients who underwent curative hepatectomy after HAI chemotherapy, the 5-year survival rate was 21%, which was better than in patients with HAI chemotherapy alone. HAI chemotherapy could thus be an option for unresectable liver metastases, which could be well tolerated.

[Our experiences of preoperative chemoradiotherapy for rectal cancer with invasion to adjacent organs].

We reviewed clinical records of 10 cases with preoperative chemoradiotherapy to evaluate the clinical effectiveness of the chemoradiotherapy for T4 rectal cancer. The preoperative radiation therapy consisted of 40-50 Gy delivered in fractions of 1.8-2.0 Gy per day for five days per week. A treatment of 5-fluorouracil (500 mg/body) per day intravenously, or oral UFT-E (300 mg/m2) with l-leucovorin (75 mg/body) per day, or oral S-1 (80 mg/m2) per day for five days per week, was given during radiotherapy. Grade 1 or 2 adverse effects occurred in 3 patients during chemoradiotherapy, but a completion of chemoradiotherpy was achieved in all of the 10 patients. Invasive findings to the adjacent organs identified by CT and MRI disappeared in 6 cases with complete or partial response 1 month after chemoradiotherapy. Although the adjacent organs were also removed during surgery in 7 patients, curative surgery was performed in 7 patients. There was no histological invasion to the adjacent organs in 4 patients, and one patient had a histological complete disappearance of tumor. Although complications after surgery were found in all of the patients, they were improved by conservative treatment. Two of 7 patients with curative surgery had recurrence, but the rest of them survived without recurrence. Preoperative chemoradiotherapy was expected to be a safe and effective treatment to improve the resection rate and prognosis for T4 rectal cancer.

[Our experiences of preoperative chemo-radiotherapy for T4 primary rectal cancer].

We reviewed 7 cases of clinical record with preoperative chemo-radiotherapy to evaluate the clinical effectiveness of the chemo-radiotherapy for T4 rectal cancer. The preoperative radiation therapy consisted of 40-45 Gy delivered in fractions of 1.8-2.0 Gy per day, five days a week. A treatment of 5-fluorouracil, 500 mg/body per day intravenously, or oral UFT-E (300 mg/m2) with l-leucovorin (75 mg) per day, or oral S-1 (80 mg/m2) per day five days a week, was given during radiotherapy. Grade 1 or 2 adverse effects occurred in 3 patients during chemo-radiotherapy, but the completion of chemo-radiotherapy was achieved in all of the 7 patients. Tumor invasion identified by CT and MRI to other organs in the pelvis disappeared in four cases with complete or partial response after a month of chemo-radiotherapy. Although the other organs were also removed during surgery in 4 patients, curative surgery was performed in 5 patients. There was no histological invasion seen to other organs in 4 patients, and one patient had histological complete disappearance of tumor. Although complications after surgery were found in all of the patients, they were improved by conservative treatment. One of 4 patients with curative surgery had liver and local recurrence, but others survived without recurrence. Preoperative chemo-radiotherapy was expected to be a safe and effective treatment to improve the resection rate and prognosis for T4 rectal cancer.

[Five cases of locally advanced rectal cancer or local recurrence performed intra-arterial infusion chemotherapy via the internal iliac artery].

Intra-arterial infusion chemotherapy via the internal iliac artery was performed in 5 patients with locally advanced rectal cancer or recurrent rectal cancer. Arterial infusion chemotherapy was conducted into the internal iliac artery via bilateral femoral artery following a blood flow change with a coil. 5 FU 500 mg and l-leucovorin 125 mg/m2 were injected weekly. An average time of injections or its duration was 40 (17-74) times or 12.8 (5-23) months, respectively. Disappearance or improvement of symptoms was observed in 4 cases. A decrease of tumor size observed by CT was in 2 cases and a decrease of blood CEA level was in 3 cases. As for the complication of arterial infusion chemotherapy, dermatopathy was found in all of the cases, and sensory disturbance of lower extremities was in 3 cases, infection was in 2 cases and catheter obstruction was in 2 cases. A decrease of dosage or abundance of continuation was done during the course due to complications. Two patients with primary cancer died 1-3 years after the treatment, and 2 patients with recurrence died 7 months to 1 year after the treatment. One patient with primary cancer is continuing the treatment for the last 2 years though multiple metastatic diseases have been confirmed.