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1.
Anticancer Res ; 40(1): 393-399, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892592

RESUMO

AIM: This study was performed to confirm the superior overall survival (OS) after pulmonary oligo-recurrence compared to pulmonary sync-oligometastases in a large nationwide study. PATIENTS AND METHODS: Patients that met the following criteria were included: 1 to 5 lung-only metastases at the beginning of stereotactic body radiation therapy (SBRT) was performed between January 2004 and June 2015, and the biological effective dose (BED) of SBRT was 75 Gy or more. The parameters included in the analyses were age, gender, ECOG PS, primary lesion, pathology, oligoetastatic state, SBRT date, chemotherapy before SBRT, chemotherapy concurrent SBRT, chemotherapy after SBRT, maximum tumor diameter, number of metastases, field coplanarity, dose prescription, BED10, OTT of SBRT. RESULTS: In total, 1,378 patients with 1,547 tumors were enrolled. Oligo-recurrence occurred in 1,016 patients, sync-oligometastases in 118, and unclassified oligometastases in 121. The three-year OS was 64.0% for oligo-recurrence and 47.5% for sync-oligometastasis (p<0.001). In the multivariate analysis, the hazard ratio (HR) for sync-oligometastases versus oligo-recurrence was 1.601 (p=0.014). Adverse events of Grade 5 were occurred in 3 patients. CONCLUSION: This is the first nationwide to indicate that the OS of patients with pulmonary oligo-recurrence is better than that of patients with sync-oligometastases.


Assuntos
Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Radiocirurgia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
2.
Sci Rep ; 9(1): 17971, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31784549

RESUMO

We developed anticancer drug-conjugated biodegradable polymer-nanoparticle-loaded adipose-derived stem cells (AdSCs) as a tool for biodrug delivery systems for cancer therapy. Pirarubicin was conjugated in polylactic/glycolic acid (PLGA) followed by formation of nanoparticles (NPs), which were loaded with human AdSCs and cocultured. The pirarubicin-conjugated PLGA NP-loaded AdSCs (PirNP-AdSCs) were overall viable within 48 h and exhibited significantly enhanced migration activity. We confirmed that pirarubicin was gradually released into the culture medium from PirNP-AdSCs, and the conditioned medium significantly inhibited the proliferation activity and induced the apoptosis of human pancreatic cancer cells (KP1N). PirNP-AdSCs also significantly induced tumor cell apoptosis in an ex vivo culture system with KP1N-derived tumors, and there was increased invasion/migration of PirNP-AdSCs inside the tumor. Finally, we compared the therapeutic efficacy of the PirNP-AdSCs on KP1N-derived tumor growth with that of treatments of AdSCs alone, PirNPs alone or normal saline (control) in immunodeficient mice. Subcutaneous local administration of PirNP-AdSCs significantly inhibited tumor growth, inducing the apoptosis of tumor cells and vasculature compared with the other groups. The present therapeutic strategy might give rise to a novel cancer therapy minimizing the adverse side effects of anticancer drugs in patients who suffer from cancer.

3.
BMC Cancer ; 19(1): 974, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638948

RESUMO

BACKGROUND: Recent studies have shown that immune-related adverse events (irAEs) caused by immune checkpoint inhibitors were associated with clinical benefit in patients with melanoma or lung cancer. In advanced gastric cancer (AGC) patients, there have been few reports about the correlation between irAEs and efficacy of immune checkpoint inhibitors. In this study, we retrospectively investigated the correlation between irAEs and efficacy in AGC patients treated with nivolumab. METHODS: The subjects of this study were AGC patients received nivolumab monotherapy between January 2015 and August 2018. IrAEs were defined as those AEs having a potential immunological basis that required close follow-up, or immunosuppressive therapy and/or endocrine therapy. We divided the patients who received nivolumab into two groups based on occurrence of irAEs; those with irAEs (irAE group) or those without (non-irAE group). We assessed the efficacy in both groups. RESULTS: Of the 65 AGC patients that received nivolumab monotherapy, 14 developed irAEs. The median time to onset of irAEs was 30.5 days (range 3-407 days). Median follow-up period for survivors was 32 months (95% CI, 10.8 to 34.5). The median progression-free survival was 7.5 months (95% CI, 3.6 to 11.5) in the irAE group and 1.4 months (95% CI, 1.2 to 1.6) in the non-irAE group (HR = 0.11, p < 0.001). The median overall survival was 16.8 months (95% CI, 4.4 to not reached) in the irAE group and 3.2 months (95% CI, 2.2 to 4.1) in the non-irAE group (HR = 0.17, p < 0.001). Multivariate analysis demonstrated that number of metastatic sites ≥2 (HR = 2.15; 95% CI, 1.02 to 4.54), high ALP level (HR = 2.50; 95% CI, 1.27 to 4.54), and absence of irAEs (HR = 9.54, 95% CI, 3.34 to 27.30 for yes vs. no) were associated with a poor prognosis. The most frequent irAEs was diarrhea/colitis (n = 5). Grade 3 adverse events were observed in 6 patients; hyperglycemia (n = 2), diarrhea/colitis (n = 1), adrenal insufficiency (n = 1), aspartate aminotransferase increased (n = 1), peripheral motor neuropathy (n = 1). There were no grade 4 or 5 adverse events related to nivolumab. CONCLUSIONS: Development of irAEs was associated with clinical benefit for AGC patients receiving nivolumab monotherapy.

4.
Invest New Drugs ; 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31264067

RESUMO

Background Ramucirumab (RAM) plus solvent-based (sb)-paclitaxel (PTX) is the standard second-line chemotherapy for advanced gastric cancer (AGC). The subset analysis of the ABSOLUTE trial, which confirmed non-inferiority of weekly nanoparticle albumin-bound (nab)-PTX to weekly sb-PTX, suggested that nab-PTX might have better efficacy than sb-PTX in patients with peritoneal metastasis. We retrospectively evaluated the efficacy and safety of RAM plus sb-PTX and nab-PTX in patients with peritoneal metastasis of AGC. Methods AGC patients who received RAM plus sb-PTX or nab-PTX as second-line chemotherapy from June 2015 to February 2019 were included in the study. Overall survival (OS), progression-free survival (PFS), response rate, and safety were assessed. Results A total of 128 patients were included in this study (93 in the RAM plus sb-PTX group and 35 in the RAM plus nab-PTX group). PFS was 4.1 months in the RAM plus sb-PTX group and 4.6 months in the RAM plus nab-PTX group (HR 0.90; 95%CI 0.58-1.41, p = 0.643). OS was 8.9 months in the RAM plus sb-PTX group and 11.4 months in the RAM plus nab-PTX group (HR 0.95; 95%CI 0.56-1.62, p = 0.847). A total of 62 and 31 patients had peritoneal metastasis in the RAM plus sb-PTX and the RAM plus nab-PTX groups, respectively. RAM plus nab-PTX showed a slightly longer survival compared to RAM plus sb-PTX in patients with peritoneal metastasis (PFS 5.8 vs 3.5 months, HR 0.66; 95% CI 0.40-1.10, p = 0.109). Conclusion This study suggests that RAM plus nab-PTX might be a more effective treatment for peritoneal metastasis of AGC.

5.
ESMO Open ; 4(3): e000488, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231567

RESUMO

Background: Nivolumab showed a survival benefit for advanced gastric cancer (AGC). However, an acceleration of tumour growth during immunotherapy, (hyperprogressive disease, HPD) has been reported in various cancers. This study reviewed the HPD in patients with AGC treated with nivolumab or irinotecan. Methods: The subjects of this retrospective study were patients with AGC with measurable lesions, and their tumour growth rates (TGR) during nivolumab or irinotecan were compared with those during prior therapy. HPD was defined as an increase in TGR more than twofold. Results: 34 and 66 patients received nivolumab and irinotecan in third or later line between June 2009 and September 2018 at our hospital; 22 patients receiving nivolumab had prior treatment with irinotecan, and one patient received irinotecan after nivolumab. Nivolumab and irinotecan showed no differences in disease control rates (38.2% and 34.8%) and in progression-free survival (PFS) (HR 1.1, 95% CI 0.7 to 1.6, p=0.802). The incidence of HPD was slightly higher after nivolumab (29.4%) than after irinotecan (13.5%) (p=0.0656), showing no differences in background between the patients with and without HPD. Compared between HPD and PD other than HPD after nivolumab, the HRs for PFS and overall survival (OS) were 1.1 (95% CI 0.5 to 2.7; p=0.756), and 2.1 (95% CI 0.7 to 5.8; p=0.168), but such clear difference in OS was not observed after irinotecan. Conclusions: HPD was observed more frequently after nivolumab compared with irinotecan, which was associated with a poor prognosis after nivolumab but not so clearly after irinotecan.

6.
Mol Clin Oncol ; 10(6): 625-630, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31031979

RESUMO

The aim of the present retrospective study was to investigate the predictability of dual-energy computed tomography (DECT) for pararectal lymph node (PRLN) metastasis and lateral pelvic lymph node (LPLN) metastasis in rectal cancer (RC). The present study involved 44 patients with RC who were examined by DECT and then underwent surgery between May 2015 and September 2017. LPLN dissection was performed in 24 patients. The normalized iodine concentration (nIC), the ratio of iodine concentration in the lymph node (LN) to that in the common iliac artery on DECT, of the largest PRLN and LPLN was calculated, and the association between LN metastasis and nIC was analyzed. The median nIC value for PRLNs was significantly lower in PRLN metastasis-positive cases compared with PRLN metastasis-negative cases in the arterial phase [0.18 vs. 0.25; P=0.01; cut-off, 0.24; area under the curve (AUC), 0.733] and portal phase (0.47 vs. 0.61; P=0.03; cut-off, 0.59; AUC, 0.701). A significant difference was not identified between the median maximum short axis diameter of PRLNs in PRLN metastasis-positive and metastasis-negative cases (7.6 vs. 6.4 mm; P=0.33). The nIC for LPLNs was not significantly different between LPLN metastasis-positive and metastasis-negative cases in the arterial phase (0.15 vs. 0.21; P=0.19); but was significantly lower in LPLN metastasis-positive cases compared with LPLN metastasis-negative cases in the portal phase (0.29 vs. 0.56; P=0.04; cut-off, 0.29; AUC, 0.877). The maximum short axis diameter of LPLNs was significantly larger in metastasis-positive cases compared with LPLN metastasis-negative cases (9.1 vs. 4.8 mm; P=0.03; cut-off, 7.0 mm; AUC, 0.912). In conclusion, the nIC was identified to be significantly lower in metastasis-positive cases, which may be useful for the prediction of PRLN and LPLN metastases. A combination of size-based diagnosis and DECT may increase the accuracy of preoperative diagnosis.

7.
Oncol Lett ; 17(2): 2431-2440, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30719114

RESUMO

Hepatoblastoma is the most commonly occurring liver tumor in children. Preoperative chemotherapy and surgery have improved treatment outcomes; however, further improvements are required in the treatment of advanced cases. Recently, the efficacy of transarterial chemoembolization (TACE) has garnered attention. TACE increases the local concentration of drugs by transcatheterically administering antitumor agents, and induces necrosis in the tumor by embolizing the feeding artery. However, studies have revealed that tumors exhibit resistance to anticancer drugs in hypoxic environments. Metformin is a drug used to treat type 2 diabetes; however, recent reports have indicated that it may also exhibit antitumor effects in various cancer cell lines. These effects are hypothesized to be mediated by the activation of adenosine monophosphate-activated protein kinase and reduction of mammalian target of rapamycin signaling, but these effects occur at high concentrations that are not suitable for use in a clinical setting. The potential efficacy of metformin at increased physiological concentrations has not been evaluated. The present study investigated the therapeutic effect of low concentrations of metformin in combination with cisplatin on liver cancer HepG2 cells in hypoxic conditions. HepG2 cells were treated with cisplatin alone, metformin alone, or a combination of these two drugs and cultured in normoxia or hypoxia. Treatment with either 5 µM cisplatin or 1 mM metformin alone did not significantly affect cell proliferation or apoptosis in hypoxic conditions. However, when 5 µM cisplatin was combined with 1 mM metformin, a significant inhibition of cell proliferation and induction of apoptosis was observed in hypoxic HepG2 cells. In conclusion, a low concentration of metformin attenuates hypoxia-induced resistance to cisplatin in HepG2 cells. Selective delivery of an effective dose of metformin to a hepatoblastoma tumor may be achievable and clinically useful with TACE.

8.
Asia Pac J Clin Oncol ; 15(5): e91-e96, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30549220

RESUMO

AIM: Gastric cancer patients are normally treated with oral fluoropyrimidine and cisplatin or oxaliplatin; however, treating patients who also have a gastrointestinal obstruction is often difficult because of their poor oral intake. Instead, a modified (m)FOLFOX-6 regimen is administered, even to patients with gastrointestinal obstructions. The aim of this study was to assess the efficacy of mFOLFOX-6 for gastric cancer patients with a gastrointestinal obstruction. METHODS: Patients with a poor oral intake because of a gastrointestinal obstruction who received mFOLFOX-6 as systemic chemotherapy were retrospectively analyzed. Poor oral intake was defined as receiving a daily intravenous drip infusion due to a gastrointestinal obstruction. RESULTS: Eighteen patients received mFOLFOX-6; the median progression-free survival was 6.8 months (95% confidence interval [CI], 1.9-9.7), the median overall survival was 8.0 months (95% CI, 2.8-20.8) and the median time to treatment failure was 2.2 months (95% CI, 1.2-5.7). An improved oral intake was observed in 13 of the 18 treated patients, with 12 of these continuing treatment as outpatients. CONCLUSIONS: A mFOLFOX-6 treatment regimen seems promising for gastric cancer patients who have a gastrointestinal obstruction.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gastrointestinais/tratamento farmacológico , Obstrução Intestinal/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso , Feminino , Fluoruracila/administração & dosagem , Neoplasias Gastrointestinais/patologia , Humanos , Obstrução Intestinal/patologia , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Oxaliplatina/administração & dosagem , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do Tratamento
9.
J Radiat Res ; 60(1): 142-149, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30476198

RESUMO

The Breast Cancer Group of the Japanese Radiation Oncology Study Group conducted a nationwide questionnaire survey on the clinical practice of postoperative radiotherapy for breast-conserving treatment for breast cancer. This questionnaire consisted of 18 questions pertaining to the annual number of treated patients, planning method, contouring structure, field design, dose-fractionated regimen, application of hypofractionated radiotherapy, boost irradiation, radiotherapy for synchronously bilateral breast cancer, and accelerated partial breast irradiation. The web-based questionnaire had responses from 293 Japanese hospitals. The results indicated the following: treatment planning is performed using relatively similar field designs and delivery methods; the field-in-field technique is used at more than one-third of institutes; the commonest criteria for boost irradiation is based on the surgical margin width (≤5 mm) and the second commonest criteria was age (≤40 or ≤50 years), although some facilities applied a different age criterion (>70 years) for omitting a tumor bed boost; for conventional fractionation, almost all institutes delivered 50 Gy in 25 fractions to the conserved whole breast and 10 Gy in 5 fractions to the tumor bed. This survey revealed that 43% of hospitals offered hypofractionated radiotherapy, and the most common regimens were 42.56 Gy in 16 fractions for whole-breast irradiation and 10.64 Gy in 4 fractions for boost irradiation. Almost all of the facilities irradiated both breasts simultaneously for synchronously bilateral breast cancer, and accelerated partial breast irradiation was rarely offered in Japan. This survey provided an overview of the current clinical practice of radiotherapy for breast-conserving treatment of breast cancer in Japan.


Assuntos
Neoplasias da Mama/radioterapia , Mama/efeitos da radiação , Tratamentos com Preservação do Órgão , Padrões de Prática Médica , Inquéritos e Questionários , Relação Dose-Resposta à Radiação , Feminino , Hospitais , Humanos , Japão/epidemiologia , Hipofracionamento da Dose de Radiação , Planejamento da Radioterapia Assistida por Computador
10.
Cancers (Basel) ; 10(8)2018 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-30072613

RESUMO

Pretreatment pulmonary interstitial change (PIC) has been indicated as a risk factor of severe radiation pneumonitis (RP) following stereotactic body radiation therapy (SBRT) for early-stage lung cancer, but details of its true effect remain unclear. This study aims to evaluate treatment outcomes of SBRT for stage I non-small cell lung cancer in patients with PIC. A total of 242 patients are included in this study (88% male). The median age is 77 years (range, 55⁻92 years). A total dose of 40⁻70 Gy is administered in 4 to 10 fractions during a 4-to-25 day period. One, two, and three-year overall survival (OS) rates are 82.1%, 57.1%, and 42.6%, respectively. Fatal RP is identified in 6.9% of all patients. The percent vital capacity <70%, mean percentage normal lung volume receiving more than 20 Gy (>10%), performance status of 2⁻4, presence of squamous cell carcinoma, clinical T2 stage, regular use of steroid before SBRT, and percentage predicting forced expiratory volume in one second (<70%) are associated with worse prognoses for OS. Our results indicate that fatal RP frequently occurs after SBRT for stage I lung cancer in patients with PIC.

11.
Technol Cancer Res Treat ; 17: 1533033818783904, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29983096

RESUMO

Stereotactic body radiotherapy (SBRT) is widely used as a curative treatment option for stage I non-small-cell lung cancer, but for patients with stage I small-cell lung cancer, the role of stereotactic body radiotherapy is unclear. In this study, we retrospectively analyzed the outcomes of a subset of patients with stage I small-cell lung cancer treated with stereotactic body radiotherapy in the database of the Japanese Radiological Society-Multi-Institutional stereotactic body radiotherapy Study Group. The 43 patients treated with stereotactic body radiotherapy for stage I small-cell lung cancer between 2004 and 2012 at 11 Japanese institutions were studied: median age = 77 years; 32 (74%) males and 11 females; and 80% were medically inoperable. The clinical stage was IA in 31 and IB in 12. In all patients, the lung tumors were pathologically proven as small-cell lung cancer. A total dose of 48 to 60 Gy was administered in 4 to 8 fractions. The median biologically effective dose (α/ß = 10 Gy) was 105.6 Gy. Chemotherapy and prophylactic cranial irradiation were administered in only 8 patients, respectively. The median follow-up time was 23.2 months. The 2-year overall survival, progression-free survival, and distant metastasis-free survival rates were 72.3%, 44.6%, and 47.2%, respectively. The 2-year local control was 80.2%. Regarding the patterns of failure, distant metastasis, lymph node metastasis, and local recurrence were observed in 47%, 28%, and 16% of patients, respectively. No ≥grade 3 stereotactic body radiotherapy-related toxicities were observed. Although stereotactic body radiotherapy was thus revealed to be effective for the local control of stage I small-cell lung cancer, the incidence of distant metastases was high. Further investigations of larger cohorts are needed, including analyses of the effects of combined chemotherapy.


Assuntos
Neoplasias Pulmonares/radioterapia , Radiocirurgia/métodos , Carcinoma de Pequenas Células do Pulmão/radioterapia , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Bases de Dados Factuais , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Intervalo Livre de Progressão , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/mortalidade , Resultado do Tratamento
12.
Radiat Oncol ; 13(1): 106, 2018 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-29880006

RESUMO

BACKGROUND: The purpose of this study was to evaluate the impact of markerless on-board kilovoltage (kV) cone-beam computed tomography (CBCT)-based positioning uncertainty on determination of the planning target volume (PTV) margin by comparison with kV on-board imaging (OBI) with gold fiducial markers (FMs), and to validate a methodology for the evaluation of PTV margins for markerless kV-CBCT in prostate image-guided radiotherapy (IGRT). METHODS: A total of 1177 pre- and 1177 post-treatment kV-OBI and 1177 pre- and 206 post-treatment kV-CBCT images were analyzed in 25 patients who received prostate IGRT with daily localization by implanted FMs. Intrafractional motion of the prostate was evaluated between each pre- and post-treatment image with these two different techniques. The differences in prostate deviations and intrafractional motions between matching by FM in kV-OBI (OBI-FM) and matching by soft tissues in kV-CBCT (CBCT-ST) were compared by Bland-Altman limits of agreement. Compensated PTV margins were determined and compensated by references. RESULTS: Mean differences between OBI-FM and CBCT-ST in the anterior to posterior (AP), superior to inferior (SI), and left to right (LR) directions were - 0.43 ± 1.45, - 0.09 ± 1.65, and - 0.12 ± 0.80 mm, respectively, with R2 = 0.85, 0.88, and 0.83, respectively. Intrafractional motions obtained from CBCT-ST were 0.00 ± 1.46, 0.02 ± 1.49, and 0.15 ± 0.64 mm, respectively, which were smaller than the results from OBI-FM, with 0.43 ± 1.90, 0.12 ± 1.98, and 0.26 ± 0.80 mm, respectively, with R2 = 0.42, 0.33, and 0.16, respectively. Bland-Altman analysis showed a significant proportional bias. PTV margins of 1.5 mm, 1.4 mm, and 0.9 mm for CBCT-ST were calculated from the values of CBCT-ST, which were also smaller than the values of 3.15 mm, 3.66 mm, and 1.60 mm from OBI-FM. The practical PTV margin for CBCT-ST was compensated with the values from OBI-FM as 4.1 mm, 4.8 mm, and 2.2 mm. CONCLUSIONS: PTV margins calculated from CBCT-ST might be underestimated compared to the true PTV margins. To determine a reliable CBCT-ST-based PTV margin, at least the systemic error Σ and the random error σ for on-line matching errors need to be investigated by supportive preliminary FM evaluation at least once.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Marcadores Fiduciais , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/métodos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Próstata/diagnóstico por imagem , Dosagem Radioterapêutica , Risco , Incerteza
13.
Anat Sci Int ; 93(4): 487-494, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29725864

RESUMO

To evaluate the anatomical classification and location of breast sentinel lymph nodes, preoperative computed tomography-lymphography examinations were retrospectively reviewed for sentinel lymph nodes in 464 cases clinically diagnosed with node-negative breast cancer between July 2007 and June 2016. Anatomical classification was performed based on the numbers of lymphatic routes and sentinel lymph nodes, the flow direction of lymphatic routes, and the location of sentinel lymph nodes. Of the 464 cases reviewed, anatomical classification could be performed in 434 (93.5 %). The largest number of cases showed single route/single sentinel lymph node (n = 296, 68.2 %), followed by multiple routes/multiple sentinel lymph nodes (n = 59, 13.6 %), single route/multiple sentinel lymph nodes (n = 53, 12.2 %), and multiple routes/single sentinel lymph node (n = 26, 6.0 %). Classification based on the flow direction of lymphatic routes showed that 429 cases (98.8 %) had outward flow on the superficial fascia toward axillary lymph nodes, whereas classification based on the height of sentinel lymph nodes showed that 323 cases (74.4 %) belonged to the upper pectoral group of axillary lymph nodes. There was wide variation in the number of lymphatic routes and their branching patterns and in the number, location, and direction of flow of sentinel lymph nodes. It is clinically very important to preoperatively understand the anatomical morphology of lymphatic routes and sentinel lymph nodes for optimal treatment of breast cancer, and computed tomography-lymphography is suitable for this purpose.


Assuntos
Neoplasias da Mama/patologia , Linfonodo Sentinela/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Variação Anatômica , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Imagem Tridimensional/métodos , Vasos Linfáticos/anatomia & histologia , Vasos Linfáticos/diagnóstico por imagem , Linfografia/métodos , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
14.
Intern Med ; 57(19): 2847-2851, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-29709944

RESUMO

A 73-year-old woman with massive ascites associated with a giant hepatic mass accompanied by arterio-portal (AP) shunt was admitted to our hospital. Based on contrast-enhanced computed tomography (CT) and angiography findings, hepatic hemangioma with AP shunt and ascites due to portal hypertension was diagnosed. Transcatheter arterial embolization (TAE) by N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's ascites disappeared, and her liver function test results improved after the treatment. The patient has maintained a steady state for two years. This case indicates that TAE with NBCA is a safe and effective treatment for hepatic hemangioma accompanied by AP shunt.


Assuntos
Ascite/terapia , Embolização Terapêutica , Hemangioma/terapia , Hipertensão Portal/terapia , Neoplasias Hepáticas/terapia , Idoso , Angiografia , Ascite/diagnóstico , Ascite/etiologia , Meios de Contraste , Embucrilato/uso terapêutico , Feminino , Hemangioma/complicações , Hemangioma/diagnóstico , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Tomografia Computadorizada por Raios X
15.
World J Surg Oncol ; 16(1): 53, 2018 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-29530096

RESUMO

BACKGROUND: Laparoscopic and endoscopic cooperative surgery (LECS) was performed for the local resection of gastrointestinal stromal tumors (GIST). LECS enables less resection of the lesion area and preserves function. Furthermore, LECS can be safely performed and independent of tumor location. However, LECS is not usually used for cases involving gastric carcinoma because it may seed tumor cells into the peritoneal cavity when the gastric wall is perforated. Here, we report seven cases of LECS for intra-mucosal gastric carcinoma, which were difficult to carry out by endoscopic submucosal dissection (ESD) because of ulcer scars. METHODS: We performed LECS (classical LECS and inverted LECS) in seven cases of intra-mucosal gastric carcinoma. All cases had ulcer scars beside the tumor. LECS was chosen because ESD was thought to be difficult because of the ulcer scars. We only selected cases in which the patients did not prefer gastrectomy and endoscopic examination was indicative of intra-mucosal gastric carcinoma. RESULTS: In all cases, LECS was performed without severe complications including postoperative stenosis. Histopathology findings proved that the tumors were intra-mucosal carcinoma and had been resected completely. Furthermore, there were ulcer scars (Ul IIIs-IVs) beside the tumor. Currently, dissemination and recurrence have not been apparent. CONCLUSIONS: LECS for intra-mucosal gastric carcinoma is an efficient procedure, but strict observation is necessary because of the possibility of peritoneal dissemination. Results suggest that LECS is likely to be effective for cases involving intra-mucosal gastric carcinoma that are difficult to treat by ESD due to ulcer scars.


Assuntos
Cicatriz/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Gastrectomia/métodos , Mucosa Gástrica/cirurgia , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Úlcera/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cicatriz/patologia , Seguimentos , Mucosa Gástrica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Úlcera/patologia
16.
Radiat Oncol ; 12(1): 192, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29191234

RESUMO

BACKGROUND: The purpose of this study was to investigate the differences in the dosimetric advantage of using intraoperatively built custom-linked (IBCL) seeds between permanent iodine-125 (I-125) seed implantation (PI) alone and PI followed by external-beam radiation therapy (EBRT) for prostate cancer. METHODS: We reviewed the records of 62 patients with localized prostate cancer who received transperineal interstitial brachytherapy with I-125 using free seeds or IBCL seeds. Twenty-four low- and intermediate-risk patients underwent PI alone with the prescribed dose of 160 Gy, and 39 high-risk patients underwent PI with 110 Gy, followed by EBRT with 45 Gy (PI + EBRT). Intraoperative and post-implant dosimetric parameters 1 month after implantation were collected and analyzed. RESULTS: The numbers of patients implanted with free seeds and IBCL seeds were 14 (58.3%) and 10 (41.7%), respectively, in the PI group and 25 (65.8%) and 13 (34.2%), respectively, in the PI + EBRT group. In the PI group, although there were significant differences in prostate V100 (p = 0.003) and D90 (p = 0.009) and rectum V100 (p = 0.026) on intraoperative dosimetry, these differences were not found on post-implant dosimetry. In the PI + EBRT group, the dosimetric parameters of IBCL seeds, such as prostate V200 (p = 0.013) and V250 (p = 0.010) and urethra D30 (p = 0.038), were better than those of free seeds on intraoperative dosimetry. Furthermore, even on post-implant dosimetry, prostate D90 (p = 0.004), V150 (p = 0.001), and homogeneity index (HI, p = 0.001), as well as V200 (p = 0.001) and V250 (p = 0.020), and urethra D5 (p = 0.008) as well as D30 (p = 0.003) had a better dosimetric quality in IBCL seeds than in free seeds. There was no significant difference in the operation time between free seeds and IBCL seeds in each PI and PI + EBRT group. CONCLUSIONS: Our results reveal that greater dosimetric benefits could be obtained using IBCL seeds in the case of permanent implantation with a lower prescribed dose, such as PI + EBRT, rather than PI alone.


Assuntos
Braquiterapia , Radioisótopos do Iodo/uso terapêutico , Inoculação de Neoplasia , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Idoso , Humanos , Masculino , Prognóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Reto/efeitos da radiação , Uretra/efeitos da radiação
17.
Anticancer Res ; 37(5): 2709-2713, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28476849

RESUMO

AIM: To evaluate the efficacy of stereotactic body radiotherapy (SBRT) for pulmonary metastasis from colorectal cancer. PATIENTS AND METHODS: Data for 104 lesions from 93 patients who underwent SBRT for pulmonary oligometastases from colorectal cancer at ten Institutions were retrospectively analyzed. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. RESULTS: The median calculated biological effective dose using the linear-quadratic model with α/ß of 10 Gy (BED10) was 105.6 Gy. Adjuvant chemotherapy after SBRT was performed in 47 patients. The median observation period was 28 months. The 3- and 5-year local control rates were 65.2% and 56.2%, respectively. The 3- and 5-year overall survival rates were 55.9% and 42.7%, respectively. Only two patients had grade 3 radiation pneumonitis. In multivariate analysis for local control, primary site, age, adjuvant chemotherapy after SBRT and BED10 were selected as prognostic factors. CONCLUSION: Dose escalation and adjuvant chemotherapy might improve local control in SBRT for pulmonary oligometastases from colorectal cancer.


Assuntos
Neoplasias Colorretais/radioterapia , Neoplasias Pulmonares/radioterapia , Radiocirurgia , Adulto , Idoso , Quimioterapia Adjuvante , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversos , Dosagem Radioterapêutica , Resultado do Tratamento
18.
J Med Case Rep ; 11(1): 26, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28143501

RESUMO

BACKGROUND: Mucosa-associated lymphoid tissue lymphomas can occur in various parts of the body, and half of mucosa-associated lymphoid tissue lymphomas occur in the gastrointestinal tract. Gastric mucosa-associated lymphoid tissue lymphoma is the most common lymphoma of the gastrointestinal tract and primary rectal mucosa-associated lymphoid tissue lymphoma is very rare. Because of the high radiosensitivity of mucosa-associated lymphoid tissue lymphomas, this condition can be controlled with radiotherapy of approximately 30 Gy alone. However, ovarian dysfunction as an adverse event of radiotherapy for pelvic lesions can become a problem in girls and women. We report a case of a 28-year-old woman with rectal mucosa-associated lymphoid tissue lymphoma who safely gave birth to a baby following 30.6 Gy radiotherapy to her whole rectum. CASE PRESENTATION: A 28-year-old Japanese woman became aware of bloody stools and was diagnosed as having Lugano I rectal mucosa-associated lymphoid tissue lymphoma. She was referred to our institute and initiated on radiotherapy. However, she expressed a desire to bear children. We used horizontally opposed pair fields for radiotherapy to minimize the irradiation to her endometrium and ovary. A total dose of 30.6 Gy was given in 17 fractions of 1.8 Gy by 10-Megavolt X-ray linear accelerator. As a result, one-third of her uterus and half of her ovary were outside the irradiation field. After approximately 1 year of treatment, positive pregnancy was confirmed and finally she safely gave birth to a baby girl without congenital abnormalities. CONCLUSIONS: This report provides hope for girls and women who have undergone irradiation for pelvic mucosa-associated lymphoid tissue lymphomas and who desire to bear children.


Assuntos
Preservação da Fertilidade , Hemorragia Gastrointestinal/patologia , Linfoma de Zona Marginal Tipo Células B/radioterapia , Neoplasias Retais/radioterapia , Adulto , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/radioterapia , Humanos , Linfoma de Zona Marginal Tipo Células B/patologia , Tratamentos com Preservação do Órgão , Gravidez , Resultado da Gravidez , Neoplasias Retais/patologia
19.
Gan To Kagaku Ryoho ; 43(11): 1405-1408, 2016 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-27899785

RESUMO

A 72-year-old man was diagnosed with acute myeloid leukemia and advanced esophageal cancer(cT3N3M1, clinical Stage IV, high-moderately differentiated squamous cell carcinoma). He was started on remission induction chemotherapy and postremission therapy provided according to the Japan Adult Leukemia Study Group's AML201 protocols. His acute myeloid leukemia showed a complete response. After that, he was administered radiotherapy for esophageal cancer and showed a partial response. One year after treatment, he developed a local recurrence of esophageal cancer. A salvage operation was performed at another hospital, and his postoperative course was uneventful. A case of acute myeloid leukemia with advanced esophageal cancer is rare and has a poor prognosis, but we could improve the prognosis and quality of life.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Leucemia Mieloide Aguda/tratamento farmacológico , Neoplasias Primárias Múltiplas/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Humanos , Leucemia Mieloide Aguda/diagnóstico por imagem , Leucemia Mieloide Aguda/patologia , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Qualidade de Vida , Resultado do Tratamento
20.
Jpn J Radiol ; 34(11): 718-723, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27631882

RESUMO

PURPOSE: The aim was to determine the dose-specific incidence and predictors of seed loss/migration after permanent seed implantation (PI) for localized prostate cancer. MATERIALS AND METHODS: The records of 79 patients with T1c-T3a prostate cancer who underwent prostate brachytherapy with loose iodine-125 seeds were retrospectively reviewed. Of these patients, 33 with low or intermediate risk underwent PI with the prescribed dose of 160 Gy for the clinical target volume (CTV), and 46 with high risk underwent PI with 110 Gy for the CTV followed by external beam radiotherapy (EBRT) with 45 Gy. Each CTV was defined as a contoured prostate. After PI, the incidence of seed loss/migration was assessed by a series of radiographs. RESULTS: Seed migration occurred in 22 (0.479 %) of 4589 implanted seeds 1 month after implantation. In PI alone, the number of needles (P = 0.081) and the number of seeds (P = 0.071) showed a trend for a difference between those with and without seed loss. In PI + EBRT, there was a significant difference in the discrepancy between the seed numbers calculated by the nomogram and actually implanted (P = 0.032). CONCLUSIONS: It is suggested that the discrepancy in seed numbers might be the predictor for seed migration in PI with 110 Gy.


Assuntos
Braquiterapia/instrumentação , Migração de Corpo Estranho/diagnóstico por imagem , Radioisótopos do Iodo/uso terapêutico , Neoplasias da Próstata/radioterapia , Idoso , Relação Dose-Resposta à Radiação , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Estudos Retrospectivos , Fatores de Risco
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