Clinical results of intra-arterial adjuvant chemotherapy for prevention of liver metastasis following curative resection of biliary tract cancer.

BACKGROUND: This is a report on the clinical results of intra-arterial adjuvant chemotherapy in the prevention of liver metastasis following curative resection of biliary tract cancer. METHODS: Nineteen patients of advanced biliary tract underwent a pathologically radical operation between 2001 and 2006 (8 M and 11 F; mean age 66.2 years). Intra-arterial adjuvant chemotherapy with CDDP and 5-FU was performed selectively for 9 patients. The control group comprised 10 patients. Age, gender, staging of the disease, resection of the portal vein, postoperative radiotherapy, histological liver invasion as demographics and clinical characteristics were compared between the two groups. RESULTS: Demographics and clinical characteristics were similar in the two groups. Liver metastasis occurred in 4 of 9 patients (44.4%) in the chemotherapy group and in 5 of 10 patients (50%) in the control group. There was no difference in the rate of liver metastasis between the two groups. The median survival term was 23.3 months for 9 patients who underwent the intra-arterial adjuvant chemotherapy, whereas the median survival term for 10 patients who were curatively resected without intra-arterial adjuvant chemotherapy was 21.7 months. The median survival term was statistically similar in both groups. Furthermore, in the recurrence-free survival, there was no major difference between the chemotherapy and control groups statistically. CONCLUSIONS: In the patients with advanced biliary tract cancer who underwent the curative operation, the intra-arterial adjuvant chemotherapy could not suppress the rate of liver metastasis nor improve cumulative survival.

Duct-to-mucosa pancreaticojejunostomies with a hard pancreas and dilated pancreatic duct and duct-to-mucosa pancreaticojejunostomies with a soft pancreas and non-dilated duct.

BACKGROUND: We performed duct-to-mucosa pancreaticojejunostomy with resection of jejunal serosa in 55 patients, and here compare the clinical results between duct-to-mucosa pancreaticojejunostomies with a non-dilated pancreatic duct and those with a dilated duct. PATIENTS AND METHODS: In the period 1999 to 2005, 55 patients (27 F, 28 M; mean age 63.4 years) underwent duct-to-mucosa pancreaticojejunostomy with resection of jejunal serosa. A non-dilated pancreatic duct was observe in 29 patients in group A and a dilated pancreatic duct in 26 patients in group B. Clinical characteristics (age, gender, benign or malignant condition, presence of diabetes mellitus, anastomotic time) were analyzed in both groups and postoperative complications were compared between groups. RESULTS: In a comparison of clinical characteristics, all factors were similar between groups. In group A, the postoperative complication occurred in 4 (wound infection in 2, pulmonary embolism in 1, gastric ulcer in 1) of 29 patients (13.8%), and in group B in 1 (pneumothorax) of 26 patients (3.8%). No pancreatic leakage was observed in either group. The difference between group A and group B in the rate of postoperative complication was not statistically significant. CONCLUSIONS: There was no statistical difference in the rate of postoperative complications, including pancreatic leakage, between duct-to-mucosa pancreaticojejunostomies with a dilated pancreatic duct and those with a non-dilated duct. We consider that the diameter of the pancreatic duct is irrelevant to results of duct-to-mucosa pancreaticojejunostomy.

[Prevention of renal toxicity of cisplatin by administration of bismuth subnitrate].

The effect of pretreatment with bismuth subnitrate (BSN) for prevention of the renal toxicity of cisplatin (CDDP) was examined in 44 patients with lung cancer (43 non-small cell and one small cell lung cancer). In non-small cell lung cancer cases, the effect of the antitumor activity of chemotherapeutic drugs was observed in 62% of patients pretreated with BSN, and 42% in the group without pretreatment with BSN. No antitumoral activity of chemotherapeutic drugs was suppressed by treatment with BSN. In the group without pretreatment of BSN, serum creatinine and BUN were in proportion to the number of administrations of chemotherapeutic drugs. On the other hand, no renal toxicity was shown in the group with pretreatment by BSN. No protective effect against myelosuppression with pretreatment by BSN was demonstrated, perhaps because of the influence of anti-cancer drugs apart from CDDP.

[Effect of morphine in cancer pain].

The usefulness of oral morphine to alleviate pain has been tested in 70 patients with cancer. The efficacy was found to be 87% (61/70). The starting dose was 10 mg/d-12 mg/d (mean 36 mg/d), and the maximum dose was 10 mg/d-3,600 mg/d. Twenty four of these patients were able to stay at home or go to the hospital for dose treatment. In 27 patients, oral morphine dose were able to administrated until death. Although vomiting and constipation were frequent side effects, the administration of adjuvant drugs relieved these symptoms. It was found that these oral morphine doses did not shorten a patient's life span. Thus we have concluded that oral morphine proved a useful, safe, and convenient drug for the control of cancer pain.

[Clinical evaluation of serum carbohydrate antigen 19-9 in carcinoma of the lung--a comparison with carcinoembryonic antigen].

Serum levels of carbohydrate antigen 19-9 (CA 19-9) were measured in 235 untreated patients with lung cancer, 20 patients with benign pulmonary disease and 39 healthy controls. In almost all these patients, carcinoembryonic antigen (CEA) was determined at the same time. The positivity of CA 19-9 in lung cancer patients was significantly higher than in those with benign pulmonary disease (30.2% vs. 5%: P less than 0.05). With regard to histological types of lung cancer cases, the positivity of CA 19-9 in adenocarcinoma cases was higher than that in cases of squamous cell carcinoma (39.6% vs. 16.4% : P less than 0.01). With regard to clinical stages of lung cancer positivity of CA 19-9 in stage IV (37.9% vs. 10.3% : P less than 0.01) or stage III (30.3% vs. 10.3% : P less than 0.05) was significantly higher than in stage I. Sensitivity, specificity and accuracy in the detection of lung cancer were 31%, 95%, and 36% for CA 19-9, and 46%, 80% and 49% for CEA, respectively. Combined evaluation with CA 19-9 and CEA gave the highest specificity (98%) when both were measured, and the highest sensitivity (55%) when at least one was measured. Combined assessment of CA 19-9 and CEA improved the measurement of each one in the detection of lung cancer.

[Determination of various tumor markers, with special reference to neuron-specific enolase in lung cancer].

Serum neuron-specific enolase (NSE) was measured in 23 patients with small cell lung cancer (SCLC) and 184 patients with non-small cell lung cancer (non-SCLC), both of which were untreated. Increased levels of serum NSE were observed in 82.6% (19/23) of SCLC, whereas 9.8% (18/184) of non-SCLC had positive results showing an overall positive rate of 17.9% (37/207) in lung cancer cases. In addition, the elevation of serum NSE levels in non-SCLC patients seemed to suggest poor prognosis. Elevated serum NSE levels returned to normal with either surgical resection of the tumor or response to chemotherapy, after which serum NSE levels were again raised to levels higher than the previous ones in cases of relapse or progression. The evaluation of serum NSE may be a useful marker for both diagnosis and monitoring of responsiveness to therapy as well as for recognition of relapse and progression in SCLC. Identification of NSE as assessed by immunohistochemical procedure employing the ABC method on formalin-fixed paraffin-embedded tissue sections in lung cancer cases of each histological type, showed that some materials from non-SCLC cases were positively stained despite the presence of normal serum NSE levels, and did not always parallel the serum levels. Among other various tumor markers determined, serum CA 19-9 had a relatively high positive rate of 38.2% (42/110) in adenocarcinoma of the lung.

[A combination chemotherapy of cisplatin and etoposide in small cell lung cancer].

Fourteen patients with small cell lung cancer were treated with cisplatin (80 mg/m2 i.v.) and etoposide (300, 400, 500 mg/m2 i.v.). This combination chemotherapy was administered over a three- or four-week period. Eleven of 13 evaluable patients showed a greater than 50% tumor reduction, but there were 3 complete responses and 5 partial responses, giving a response rate of 61%. Four patients who were initially treated achieved major responses. In 9 patients who had received prior chemotherapy, 4 achieved a major response. Of 3 complete responders, 2 patients had previously received etoposide treatment alone. The renal toxicity of this regimen was minimal and no patients developed any clinical symptoms. Nausea and vomiting were well controlled by high-dose metoclopramide and methylprednisolone. All patients, however, experienced appetite loss after treatment. The dose-limiting toxic effect of this regimen was hematologic toxicity. We therefore concluded that the combination of etoposide (300 mg/m2 i.v.) and cisplatin (80 mg/m2 i.v.) is repeatable at 3 or 4 week intervals and effective in patients with small cell lung cancer.

[Experience with induced hypertension chemotherapy for lung cancer].

Induced hypertension chemotherapy (IHC) using angiotensin II was applied for patients with lung cancer who had not been treated previously, and the results compared with those of preceding conventional chemotherapy as a sequential control. Twenty-nine patients with non-small cell lung cancer (non-SCLC) were treated with MTX and MMC. Response rate among evaluable cases was 23.1% (3/13) for conventional chemotherapy and 18.2% (2/11) for IHC. Twenty-eight patients with small cell lung cancer (SCLC) were treated with VCR, CPA and ACNU. Among evaluable cases, both chemotherapy groups with and without IHC showed the same response rate, 66.7% (8/12). With respect to response rate, there were no differences between conventional chemotherapy and IHC for non-SCLC or SCLC.