[A case of an advanced gastric cancer patient on hemodialysis achieving long-term progression-free survival after CPT-11+CDDP therapy].

A 59-year-old male with chronic kidney disease was diagnosed as having advanced gastric cancer(cT2N1P0H1M0), and CPT-11+CDDP therapy was started for him simultaneously with hemodialysis(HD). Serum CDDP concentrations were measured in the 1st course, and free-platinum(f-Pt)showing the anti-tumor effect was found to be eliminated by HD. Serum f-Pt levels, however, re-elevated until 24 hours after HD completion. Serum concentrations measured in the 15th course showed that f-Pt levels became higher than those observed in the 1st course, suggesting that CDDP was not completely removed by HD. Medical treatment was continued until the liver metastases were judged to be a progression disease at completion of the 18th course. When CDDP was administered to patients on HD, it was necessary to pay attention to various CDDP serum concentrations, and to tailor the dose to a tolerable level in each patient. Such an individual therapy might enable CPT-11+CDDP therapy to be one of the medical treatments of choice for advanced gastric cancer patients on HD.

[A case of synchronous multiple liver metastasis of sigmoid colon cancer with a pathological complete response to combination chemotherapy of 5-FU/LV and bevacizumab].

A 73-year-old man was referred to our hospital with sigmoid colon cancer in July 2009. CT and MRI showed synchronous multiple liver metastasis. After a sigmoid colon resection in August, he received convergent chemotherapy in combination with 5-fluorouracil(5-FU)/Leucovorin(LV)(RPMI regimen)and bevacizumab for liver metastasis. After two courses without any major adverse effects, liver metastasis remarkably reduced on CT and MRI examination. We thus performed a liver resection, and pathological examination revealed a complete response in liver. Combination chemotherapy of 5-FU/LV and bevacizumab can be expected to provide safe and effective treatment for liver metastasis of colon cancer.

[A case of liver metastases from rectal cancer showed a complete response by FOLFIRI and bevacizumab chemotherapy].

A 62-year-old man had undergone anterior resection of rectum for rectosigmoid colon cancer with liver metastases. Postoperatively, the FOLOFOX6 regimen was performed in three courses. Metastatic liver tumors showed progressive disease(PD) on CT scan. The treatment was then changed to the FOLFIRI regimen for three courses. Metastatic liver tumors showed a partial response(PR)on CT scan. After six courses of the FOLFIRI regimen, the patient was given seven courses of the FOLFIRI +BV regimen. Hepatic resection of S2, S3, S4 and S6 segment was performed. The histological effect of chemotherapy was complete response(CR).

Phase II study of weekly paclitaxel and cisplatin combination therapy for advanced or recurrent gastric cancer.

BACKGROUND/AIMS: This study was performed to assess the efficacy and safety of weekly paclitaxel and cisplatin combination chemotherapy in patients with advanced or recurrent gastric cancer. METHODOLOGY: Patients with advanced or recurrent gastric cancer were required to have ECOG performance status of 0 to 2, to be over 20 years of age, and to have adequate organ function. Paclitaxel 80 mg/m2 was administered intravenous over 1.5 h, followed by cisplatin 25 mg/m2 on day 1, 8 and 15 every 4 weeks. RESULTS: All of the 52 patients enrolled, 49 patients were eligible. One patient had complete response. Nineteen had partial response, 13 had stable disease, 8 had progressive disease and 8 had not been evaluated. The median progression-free survival time was 166.5 days and median survival time was 323 days. The most common grade 3 to 4 hematological toxicies were leucopenia (14.3%), neutropenia (32.7%), and anemia (16.3%). The most common grade 3 non-hematological toxicities included anorexia (6.1%), nausea (4.1%), vomiting (2.0%) and fatigue (2.0%). No grade 4 non-hematological toxicities were reported. CONCLUSIONS: Combination chemotherapy of weekly paclitaxel and cisplatin was highly active and well tolerated in patients with advanced or recurrent gastric cancer.

[A case of mediastinal pancreatic pseudocyst with pancreatic pleural effusion in which internal fistula was diagnosed by magnetic resonance image].

A 53-year old man with a history of heavy alcoholic drinking was admitted for progressive cough and dyspnea. Chest radiography revealed a left-sided massive pleural effusion, and CT showed a pancreatic pseudocyst occurred from the body of the pancreas to mediastinum. MRI images clearly delineated the internal pancreatic fistula that extended to the mediastinum. A distal pancreatectomy with splenectomy was performed and the postoperative course was uneventful without recurrent pancreatitis or pleural effusion. MRI is a useful noninvasive imaging method to assess mediastinal pancreatic pseudocysts.

[Biweekly docetaxel and weekly trastuzumab treatment in HER 2-overexpressing metastatic breast cancer patients].

Docetaxel and trastuzumab can be considered to be active drugs for HER 2-overexpressing metastatic breast cancer (MBC). This study was conducted to determine the activity of combination therapy with docetaxel and trastuzumab in MBC patients by assessing the response rate (RR), time to progression (TTP) and safety. We administered the combination of docetaxel 30-40 mg/m(2) biweekly and trastuzumab using a 4 mg/kg loading dose and thereafter 2 mg/kg weekly. Between October 2001 and December 2004, 14 patients with HER 2 positive (3+ by immunohistochemistry) MBC were enrolled in this study. The overall RR was 50.0% (7/14), with 1 CR, 6 PR, 3 NC and 4 PD. Median follow-up time was 15.0 months, while the median TTP was 10.8 months,and the median OS 21.8 months.

Studies on post-transplant dyslipidemia in kidney transplant patients.

This study was performed to retrospectively compare changes in the levels of total cholesterol, non-HDL cholesterol, triglycerides, and immunosuppressive drugs, cyclosporine A and steroids in patients with living-relation renal transplants with those from non-heart-beating donors. We experienced 11 cases of kidney transplants from non-heart-beating donors during the period from April 1995 to May 2003. We evaluated 13 cases of kidney transplants from living-relation donors during the same period. The immunosuppressants used included mainly cyclosporine A as well as mycophenolate mofetil or azathioprine, steroid and ALG, or basiliximab. Over-night fasting lipids (total cholesterol, triglycerides and HDL cholesterol) were studied before renal transplantation and repeated after renal transplantation at 1, 3, 6 and 12 months. The levels of total cholesterol and triglycerides remained in the normal range before transplantation. However, the levels of total cholesterol increased siginificantly 1 and 3 months after transplantation from non-heart-beating donors and remained at higher levels up to 12 months after transplantation. A similar pattern in the levels of triglycerides was observed. The levels of HDL cholesterol remained unchanged and stayed in the normal range before and 1, 3, 6, and 12 months after transplantation from non-heart-beating donors. On the other hand, significant increases in non-HDL cholesterol were observed 3 and 6 months after transplantation from non-heart-beating donors. After transplantation from living-relation donors, levels of total cholesterol, triglycerides, and non-HDL cholesterol remained unchanged and remained in the normal range up to 12 months after transplantation. Although there were no significant differences in the total dosage of cyclosporine A between the patients with living-relation donors and those with non-heart-beating donors, a significant increase in the total dosage of methylprednisolone was observed in patients with non-heart-beating donors compared with those in the patients with living-relation donors. Renal function recovery in patients with living-relation donors was better than in those with non-heart-beating donors. These results may suggest that significant increases in total cholesterol, especially non-HDL cholesterol and triglycerides, were probably partly due to an increased use of immunosuppressants, steroids. It is necessary to aggressively control post-transplant hyperlipidemia and important to reduce or withdraw steroids in the selected, low-risk recipients as early as possible from the viewpoint of preventing post-transplant hyperlipidemia.

[Combined systemic and intraarterial chemotherapy with gemcitabine and concomitant external-beam radiotherapy in patients with liver metastasis from pancreatic cancer--report of two cases].

We treated two patients of pancreatic tail cancer with liver metastasis combining systemic and intraarterial chemotherapy with gemcitabine and concomitant external-beam radiotherapy. Case 1: A 61-year-old man was treated with systemic chemotherapy with gemcitabine: 200 mg once a week, concurrently with external-beam radiotherapy at a dose of 39.6 Gy in 22 fractions. After radiotherapy, gemcitabine, 200 mg/body intraarterial and 1,000 mg/body systemic, was given weekly for three weeks at every 4-week interval. Despite the shrinkage of both the primary and hepatic lesions, he died from lung metastasis 10 months after beginning chemotherapy. Case 2: A 72-year-old woman was treated with arterial infusion chemotherapy with gemcitabine: 400 mg once a week, concurrently with external-beam radiotherapy at a dose of 41.4 Gy in 23 fractions. After radiotherapy, gemcitabine, 400 mg/body intraarterial and 800 mg/body systemic, was given biweekly. Despite the fact that the hepatic tumor enlarged in size, the primary site was stable and she had good quality of life one year after beginning therapy. Combined systemic and intraarterial chemotherapy with gemcitabine and concomitant external-beam radiotherapy is effective and one of the options in treatment for patients with liver metastasis from pancreatic cancer.

Use of ultrasonically activated shears improves the safety of pancreaticojejunostomy after pancreaticoduodenectomy.

OBJECTIVE: To study whether the use of ultrasonically activated shears (UAS) would improve the safety of pancreatojejunal anastomosis after pancreaticoduodenectomy. DESIGN: Retrospective analysis. SETTING: University teaching hospital. PATIENTS: Seventy patients underwent pancreaticoduodenectomy between April 1997 and May 2001. MAIN OUTCOME MEASURES: Leakage of pancreatojejunal anastomosis as judged from the contents of the drain within 7 days after operation, and defined as a high amylase level of discharge that was 3 times higher than that of serum. RESULTS: Leakage of pancreatojejunal anastomosis was observed in 1 (1.4%) of the 70 cases. Other complications were stomal ulcer, bile leakage, renal failure, and intra-abdominal abscess in one case each. CONCLUSIONS: Use of UAS to perform pancreatectomy eliminates bleeding and pancreatic juice leakage from the branches of the pancreatic duct. Therefore, the cut surface of the pancreas is kept dry, simplifying anastomosis. Use of UAS improves the safety of pancreatojejunal anastomosis after pancreaticoduodenectomy.

Paradoxical effects by preoperative oral low-dose tegafur administration in human gastric carcinomas: enhanced apoptosis and increased intratumoral microvessel density.

This study examined the effect of preoperative low-dose tegafur treatment in human gastric carcinomas. Among 55 patients with gastric carcinoma, 33 received an oral administration of tegafur 600 mg/body/day for 7 days before. Formalin-fixed, paraffin-embedded specimens were immunostained for Ki-67, P53, P21, CD34, Bax, VEGF, and dThdPase and also examined by the terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling procedure. The apoptotic index (AI), Ki-67 labeling index (KI) and intratumoral microvessel density (IMVD) were counted. Mean AI and IMVD were 3.4+/-1.60 and 126.1+/-36.56 in the treated carcinomas, and 2.3+/-0.88 and 98.0+/-44.40 in the non-treated carcinomas, both values being significantly higher in the former (P<0.05). The treatment resulted in a significant increase of mean AI in the intestinal type, in the early, and in the P53-positive carcinomas (P<0.05), while the treatment brought a significant increase of IMVD in the diffuse type, in the early and in the P53-negative carcinomas (P<0.05, respectively). No significant difference was noted on the frequency of P53, P21, BAX, VEGF and dThdPase expressions between the two groups. Ki-67 expression did not correlate with any factors. Preoperative low-dose tegafur treatment resulted in a paradoxical effect; enhanced apoptosis and increased IMVD in human gastric carcinomas.

Studies on eleven kidney transplants from non-heart-beating donors.

This study was performed to analyze postoperative courses and complications, retrospectively, following transplants from non-heart-beating donors and to examine the correlation between early graft function and clinical parameters. We experienced 11 cases of kidney transplants from non-heart-beating donors during the period from April 1995 to May 2003. Warm ischemic time was less than 30 min in all cases, and total ischemic time ranged from 8.4 hours to 27.9 hours. Rejection reactions occurred in seven cases, two of which were vascular rejections. Infectious disease complications included CMV in two cases, interstitial pneumonia in one case and fungal infection in one case. One patient died from interstitial pneumonia, and three patients had to be restarted on dialysis due to loss of function of the grafted kidney. The remaining seven patients all made full recoveries. All of the 16 patients who underwent living related kidney transplantations during the same period made full recoveries. Both the donor's gender and the latest creatinine level of the donor influenced the posttransplant dialysis period. The posttransplant dialysis period significantly influenced the creatinine level one month after transplant. These results suggest that patients who undergo kidney transplants from non-heart-beating donors have higher rates of complications than patients who undergo living related kidney transplantation. It is important that, in cases where the donor's creatinine level is high, especially when the donor is male, the kidney is carefully retrieved and transported to the recipent hospital to shorten the ischemic period as much as possible.

Large-cell neuroendocrine carcinoma of the distal bile duct.

Large-cell neuroendocrine carcinoma (LCNEC) in the distal bile duct is very rare and different from common distal bile duct adenocarcinoma. A 77-year-old man was admitted with obstructive jaundice. Severe stenosis of the distal bile duct was revealed by percutaneous transhepatic cholangiography. Subtotal stomach-preserving pancreaticoduodenectomy was performed. A tumor measuring 1.8 cm in diameter was located in the distal bile duct. Both histopathological and immunohistochemical examination of the resected specimen revealed features of LCNEC of the bile duct. The patient developed multiple liver metastases, lung metastases, and local recurrence and died of disease 3 months after the operation. The clinical behavior of LCNEC in the distal bile duct appears to be highly aggressive with early metastases and a fatal outcome.

Allochronic overlapping malignancies after renal transplantation in a patient with p53 gene mutation: report of a case.

We report a rare case of the development of various tumors over a 16-year period after renal transplantation. A 56-year-old woman underwent renal transplantation using a US kidney. Immunosuppressive treatment consisted of a triple regimen of methylprednisolone, azathioprine, and mizoribine. Left breast cancer was diagnosed 9 years after the renal transplantation, then colon cancers and meningeal epidermal meningioma were diagnosed, 10 years and 12 years post-transplant, respectively. During the investigations for the breast and colon cancers, a p53 gene mutation was detected. A deterioration of renal function was found 16 years after the transplant and graft biopsy confirmed chronic rejection. We suggest that the effects of the immunosuppressive drugs combined with the p53 gene abnormality accelerated tumor development in this patient.

Radiofrequency ablation in the treatment of small hepatocellular carcinomas: comparison of the radiofrequency effect with and without chemoembolization.

OBJECTIVE: The purpose of this study was to determine whether a combination of transcatheter arterial chemoembolization using doxorubicin and radiofrequency ablation can increase tumor destruction compared with radiofrequency alone in the treatment for hepatocellular carcinoma. SUBJECTS AND METHODS. Twenty-one patients with 26 nodules smaller than 3 cm in diameter were treated with radiofrequency ablation. Of these, 10 nodules were treated with a combination of radiofrequency ablation and chemoembolization using doxorubicin. All nodules were evaluated for size of induced coagulation, local recurrence, and complication. RESULTS: The therapeutic areas averaged 27.6 x 22.3 mm using an electrode with a 2-cm tip and 37.2 x 29.1 mm using an electrode with a 3-cm tip. With respect to the results for 14 nodules treated using an electrode with a 3-cm tip with or without chemoembolization, the greatest dimension of the area coagulated by combined therapy was significantly larger (longest axis dimension, 39.9 +/- 4.4 mm; shortest axis dimension, 32.3 +/- 5.2 mm; n = 7 nodules) than areas without chemoembolization (longest axis dimension, 34.6 +/- 2.6 mm; shortest axis dimension, 26.0 +/- 3.3 mm; n = 7 nodules) (longest and shortest axis dimensions, p < 0.05). No recurrence occurred in the nodules smaller than 2 cm in diameter. Among the nodules larger than 2 cm in diameter, one local recurrence was observed in seven nodules treated by combined therapy, while two local recurrences were observed in seven nodules treated by radiofrequency alone. Minor complications developed in three patients, two with persistent high fever and one with biliary stenosis. CONCLUSION: The combination of radiofrequency ablation and transcatheter arterial chemoembolization using doxorubicin markedly increased the extent of induced coagulation compared with radiofrequency alone, despite a small number of patients and the preliminary nature of this study.