Hirofumi Suzuki

Early Phase Metabolic Bone Disorders After Gastrectomy: Influence of Active Vitamin D Treatment

Metabolic bone disorders are recognized as one of the late complications after gastrectomy. However, the onset time and the extent of bone disorders are still unknown. We examined the influence of active vitamin D treatment on bone metabolism in the early period after gastrectomy. Sixty-three postgastrectomy patients were divided into two groups; active vitamin D treatment group [VD(+)] and no treatment group [VD(−)]. The level of serum calcium and phosphate was increased in the VD(+) group compared with the preoperative level, and parathyroid hormone (PTH-M) was decreased in the VD(+) group. Both 1,25-(OH)2D3 and bone-specific alkaline phosphatase (B-ALP) were increased in the VD(−) group. Cross-linked carboxyterminal telopeptide of type I collagen (I-CTP) was increased in the VD(+) group. There was no change in calcitonin in either group. In conclusion, metabolic bone disorders after gastrectomy have their onset in the early period, and active vitamin D treatment from the early period may be effective in preventing bone disorders.

Dihydropyrimidine dehydrogenase-related enzymes predict efficacy and adverse reactions of UFT1+cisplatin neoadjuvant chemotherapy for gastric cancer.

Dihydropyrimidine dehydrogenase (DPD) and dihydropyrimidinase (DHP) are metabolic enzymes of fluoropyrimidine. UFT containing uracil (U) and Tegafur is the first reported DPD-inhibitory fluoropyrimidine. To clarify the significance of the enzyme activities, we examined the relationships between the effects and adverse reactions, and DPD and DHP activities in gastric cancer treated with UFT1+cisplatin neoadjuvant chemotherapy. Twenty-five gastric cancer patients were administered UFT at 370 mg/m2/day for 21 days and cisplatin at 15 mg/m2/day for 2 days. Dihydrouracil (DU) and U levels in the urine and DPD activities in the resected tumors were measured. Chemotherapeutic effects were classified histologically into non-responder and responder groups. The responder group accounted for 48% of the patients. All six patients with high DPD activities (≥0.08 nmol/min/ww) belonged to the non-responder group and 11 of 19 patients with low DPD activities (<0.08 nmol/min/ww) belonged to the responder group; the difference was significant (p =0.0435). Adverse reactions to UFT occurred in four patients, all of whom were among the six patients with abnormal DU/U values. The incidence of UFT adverse reactions was estimated at 67%. In conclusion, the measured levels of DPD-related enzyme activities appear to be significant for predicting the effects and adverse reactions to chemotherapy.