Choichiro Kido

Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system

SummaryBetween 1985 and 1990, 50 patients with unresetable liver metastases from colorectal cancer and 34 subjects with metastases from gastric cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable prot system. A catheter was inserted into the hepatic artery via the left subclavian artery and was connected to the implantable injection port in each patient. 5-Fluorouracil (5-FU) at 330 mg/m2 per week (167 mg/m2 daily given continuously over the initial 3 months for colorectal cancer), Adriamycin (ADR) at 20 mg/m2 every 4 weeks and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to all 34 patients with gastric cancer and to 31 of the colorectal cancer patients. The remaining 19 patients with colorectal cancer received 5-FU at 1.000 mg/m2 every week. As a rule the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (23%), hepatic arterial occlusion (21%), and gastroduodenal mucositis (12 %), although no major toxicity was encountered. The response rate (CR+PR) among the evaluated patients as detemined using CT scans was 67% for colorectal cancer and 73% for gastric cancer. The overall median survival was 12 months and 15 months, respectively. Good local control of liver metastases from the colorectal and gastric cancers was achieved by repeated hepatic arterial infusion chemotherapy employing an implantable port system without the need for hospitalization and without producing major toxicity. Thus, the implantable port system is very useful for the management of patients with unresectable liver metastases.

Mass Screening for Breast Cancer: Comparison of the Clinical Stages and Prognosis of Breast Cancer Detected by Mass Screening and in Out-patient Clinics

To establish the criteria for assessing the life‐prolonging effect of mass screening for breast cancer, clinical stage and prognosis of breast cancer detected by mass screening in 11 regions of Japan were compared with those for matched patients in out‐patient clinics. A total of 728 patients detected by mass screening and 1,450 found in the out‐patient clinics were reviewed. The stage of the disease was Tis or I in 40.9% of the patients detected by mass screening, and 28.7% of those found in the out‐patient clinics. In contrast, stage III was found in 9.3% and 14.6%, respectively, indicating that early stages were significantly more common in the patients detected by mass screening. The overall survival curve for the patients detected by mass screening was compared with that for those found in the out‐patient clinics. The 5‐year survival rate was significantly higher in the patients detected by mass screening (91.7% vs. 85.6%; P<0.01), while the 10‐year survival rate was slightly higher in the same group of patients, but the difference from the other group was not significant (80.5% vs. 78.1%). Women who had conducted breast self‐examination (BSE) showed a higher survival rate than those who had not conducted BSE.

Hepatic arterial infusion chemotherapy for liver metastases from breast cancer

Between 1985 and 1992, 56 patients with unresectable liver metastases from breast cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable port system. 5-Fluorouracil (5-FU) at 330 mg/m2 per week, Adriamycin (ADR) at 20 mg/m2 every 4 weeks, and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to 42 patients. The remaining 14 patients received 5-FU at 330 mg/m2 per week and epirubicin (EPIR) at 20 mg/m2 every 2 weeks. As a rule, the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (41%), hepatic arterial occlusion (23%), and gastric mucositis (20%), but no major toxicity was encountered. The response rate (CR+PR) of the evaluated patients as determined from CT scans was 81%. The overall median survival period was 12.5 months. Only 14% of the patients died due to regrowth of liver metastases, and in 70% of the total cases, death due to liver metastases was avoided by this treatment. Thus, repeated hepatic arterial infusion chemotherapy for liver metastases from breast cancer might be capable of prolonging the survival of patients via avoidance of death due to the liver metastases.

Endoscopic MRI Using 3D-Spoiled GRASS (SPGR) Sequence for Local Staging of Rectal Carcinoma

Objective Magnetic resonance imaging was performed with an MR endoscope to evaluate the depth of invasion of rectal carcinomas. Materials and Methods Twenty-two patients with rectal carcinomas were studied prior to surgery with MRI using a 3D-fast spoiled GRASS (SPGR) sequence, a nonmagnetic endoscope and an antenna probe. Results The MR images on 3D-fast SPGR sequence showed that the normal bowel mucosa had a high signal intensity, the submucosal layer had a low signal intensity, and the muscularis propria had moderate signal intensity. Small tumors had moderate signal intensity similar to the muscularis propria. Advanced tumors with considerable volume revealed heterogeneous findings with intermediate and low signal intensities. The depth of wall invasion by rectal carcinoma was correctly staged with endoscopic MRI in 16 of 22 patients. Conclusion This technique may be useful for the accurate staging of the depth of invasion by rectal carcinomas.

The Effect of Breast Self‐examination on Early Detection and Survival

To investigate the effect of breast self‐examination (BSE), we compared the stages, survival, and the risk of death for 355 patients with breast cancer detected by BSE with those for 1,327 patients with breast cancer detected by chance. The early stages of the disease were found to be more common among the symptomatic breast cancer patients detected by BSE than those by chance. The 5‐year overall survival rate was 94.4% for the symptomatic patients detected by BSE, and was significantly higher by 8.7% than that (85.7%) for patients detected by chance (P< 0.001). The 10‐year survival rate was 81.6% for patients detected by BSE, and 76.6% for cases detected by chance (the difference was not significant). The overall difference between the two survival curves was statistically significant by the Iogrank test (P<0.01). A multivariate analysis using the Cox proportional hazards model showed that the risk of death for patients detected by BSE was smaller by 0.570 times than that for patients detected by chance, which was statistically significant (P< 0.05). The effect of biases inherent to BSE in the survival analysis cannot be controlled completely even after conducting multivariate analysis. These results suggest that BSE may contribute to the reduction of the risk of death through early detection of breast cancer. However, further examination should be conducted by other methods to obtain conclusive evidence.

Automated detection of masses and clustered microcalcifications on mammograms

We are developing automated-detection schemes for the masses and clustered microcalcifications on laser-digitized mammograms (0.1 mm, 10-bit resolution, 2000 X 2510) by using a conventional workstation. The purpose of this paper is to provide an overview of our recent schemes and to evaluate the current performance of the schemes. The fully automated computer system consists of several parts such as the extraction of breast region, detection of masses, detection of clustered microcalcifications, classification of the candidates, and the display of the detected results. Our schemes tested with more than 200 cases of Japanese women achieved an about 95% (86%) true-positive rate with 0.61 (0.55) false-positive masses (clusters) per image. It was found that the automated method has the potential to aid physicians in screening mammograms for breast tumors. Initial results for the mammograms digitized with the pixel sizes of 25, 50, and 100 micrometers are also discussed, in which a genetic algorithm (GA) technique was applied to the detection filter for the microcalcifications. It was indicated from the experiment with a breast phantom that 100- micrometers pixel size is not enough for the computer detection of microcalcifications, and it seems that at least 50-micrometers pixel size is required.

The Effect of Mass Screening for Breast Cancer: Results of a Multivariate Analysis

To evaluate the life‐prolonging effect of mass screening for breast cancer, we compared the risk of death for the patients detected by mass screening with that for the patients diagnosed in out‐patient clinics, after adjusting for other relevant factors simultaneously by using the Cox regression model. A multivariate analysis using the Cox regression model in which clinical staging of disease was taken as one of the independent variables, showed that the risk of death for patients detected by mass screening was smaller by 0.765 times than that for patients found in out‐patient clinics although the reduction was not statistically significant. This small reduction might be partly due to the effect of mass screening through early detection even within the same stage, and partly due to length bias, lead time bias and self‐selection bias. When clinical staging of disease was removed from the independent variables, the risk of death for patients detected by mass screening was reduced from 0.765 times to 0.677 times that for patients diagnosed in out‐patient clinics, which was statistically significant (P < 0.01). For asymptomatic patients detected by mass screening, such a reduction of the risk of death was from 0.789 times to 0.555 times that for patients found in out‐patient clinics (P < 0.05). These results suggest that mass screening for breast cancer may contribute to the reduction of the risk of death, although the effect of biases inherent in periodic screening was not removed completely in the present analysis.

Comparison of anamnestic history, alcohol intake and smoking, nutritional status, and liver dysfunction between thorotrast patients who developed primary liver cancer and those who did not.

In order to clarify the differences in past history, nutritional condition and, consumption of alcohol and tobacco, and liver dysfunction between the thorotrast patients who developed primary liver cancer and those who did not, 103 persons who had no primary liver cancer in January 1980 were studied. All subjects were military men who had undergone angiography with thorotrast between 1943 and 1946. Twenty persons developed hepatocellular carcinoma and 16 developed intrahepatic bile duct carcinoma by April 1987, whereas 67 are still alive without any cancer. There was no difference in age or period after thorotrast infusion between those two groups of patients in January 1980. A difference in history of hepatitis and/or jaundice and presence of hepatic dysfunction was found between the subjects who developed primary liver cancers and those who did not. These findings suggest that an anamnestic history of hepatitis and liver dysfunction are risks for development of thorotrast-induced liver cancer. On the basis of the above findings, early detection of liver dysfunction offers a possibility of early diagnosis of primary liver cancer.

Effect of Mass Screening for Breast Cancer from the Aspect of Psychosocial Assessment of the Quality of Life

To assess the quality of life (QOL) in patients with breast cancer receiving mass screening, a collaborative matched case‐control study was conducted in nine hospitals throughout Japan. A total of 122 patients detected by mass screening (study group) and 226 patients found in out‐patient clinics (control group) were assessed psychosocially on the basis of questionnaire information. The incidence of patients with early stage breast cancer was significantly higher in the study group than in the control group (P<0.05). Chest wall pain was observed in 35.2% of the study group and in 46.5% of the control group (P<0.05). Although control patients were more optimistic than study group patients, disturbed daily life and anxiety about recurrence were a little more frequent in the former group than in the latter. In particular, shoulder stiffness was frequently seen in the control group (P<0.05). Early detection and information do not create anxiety in mass screening patients (P<0.01). We should recommend mass screening to patients to detect early stage breast cancer and provide better QOL.

Cancer mortality in Thorotrast-exposed patients in Japan: Aichi series

AbstractBackground. To evaluate the late effect of internally deposited alpha emitters in humans, we performed, during the period 1979–1992, a follow-up study of patients who had received intravascular injections of Thorotrast (thorium dioxide) 30–50 years previously. The study was performed independently of and with no overlap of subjects in the previous Japanese study by Mori and coworkers. Methods. The patients were 198 war-wounded veterans with intrahepatic and splenic Thorotrast deposits that were detected by abdominal X-ray examination during the period 1975–1978. Results. During our observation period (1979–1992), 143 of 198 patients (1526 person-years) who had had Thorotrast injections died. Conclusion. Compared with 1113 war-wounded veterans with no history of Thorotrast injection, the Thorotrast-exposed patients had a 3.1-fold greater risk of death from all causes (95% confidence interval, 2.6–3.8), a 45.3 times greater risk of liver cancer (95% confidence interval, 24.8–82.5), and a 5.1 times greater risk of liver cirrhosis (95% confidence interval, 1.9–14.1).