Hirohisa Katagiri

Clinical results of nonsurgical treatment for spinal metastases

PURPOSE In contrast with many analyses of surgical treatment for spinal metastases, there have been only a few recent well-documented publications assessing nonsurgical treatment. This paper is a study of the outcome of nonsurgical therapy for metastatic tumors of the spine. METHODS AND MATERIALS One hundred and one patients with spinal metastases were treated with radiation therapy and/or chemotherapy without surgical intervention between 1990 and 1995, in prospective analysis, and had follow-up for more than 24 months. This study included 59 men and 42 women with a mean age of 61 years (range: 14 to 81). Mean follow-up periods were 11 months for patients dying of the disease and 53 months for the survivors. Neurological status, pain relief, functional improvement, and cumulative survival rate were assessed. RESULTS Of the total treated, 67 patients (66%) were evaluated as being neurologically stable or improved after treatment. Pain relief was achieved in 67%, and 64% showed functional improvement. Primary lesion responsiveness to nonsurgical therapy influenced the survival, neurological recovery, pain control, and function. Neurological findings before therapy were useful in predicting ambulatory status after treatment. CONCLUSION Nonsurgical treatment was often successful when primary tumors had responsiveness to radiation therapy and/or chemotherapy. We found this to be evident even when neurological deficits were found, particularly in lumbar spines. Spinal metastases of tumors with less responsiveness, unless patients were neurologically intact, responded poorly to therapy. Most of the patients who were successfully treated enjoyed relief lasting nearly until death. Their functional ability was limited by general debility, rather than by local tumor regeneration.

RADIOTHERAPY FOR PATIENTS WITH METASTASES TO THE SPINAL COLUMN: A REVIEW OF 603 PATIENTS AT SHIZUOKA CANCER CENTER HOSPITAL

PURPOSE Long- and short-course radiotherapy have similar outcomes in the treatment of spinal metastases. Long-course radiotherapy is recommended for patients with good predicted survival to reduce the risk of in-field recurrence, whereas short-course radiotherapy is used for those with poor predicted survival. Therefore, prediction of prognosis and local control is required for selecting the optimal course of radiotherapy. METHODS AND MATERIALS The subjects were 603 patients with spinal metastases who received radiotherapy at the Shizuoka Cancer Center Hospital between September 2002 and February 2007. Factors associated with survival and local control were retrospectively investigated by multivariate analyses. Local recurrence was defined as regrowth within the irradiated field or exacerbation of symptoms such as pain and motor deficits. RESULTS Of the 603 patients, 555 (92%) were followed for 12 months or until death. The survival rates after 6, 12, and 24 months were 50%, 32%, and 19%, respectively, with a median survival of 6.2 months. The median survival periods after long- and short-course radiotherapy were 7.9 and 1.8 months, respectively. In multivariate analysis, primary tumor site, good performance status, absence of previous chemotherapy, absence of visceral metastasis, single bone metastasis, younger age, and nonhypercalcemia were associated with good survival. The local control rates after 6, 12, and 24 months were 91%, 79%, and 69%, respectively, and non-mass-type tumor, breast cancer, and absence of previous chemotherapy were predictors of good local control. CONCLUSIONS Identification of factors associated with good local control and survival may allow selection of an optimal radiotherapy schedule for patients with spinal metastases.

New prognostic factors and scoring system for patients with skeletal metastasis.

The aim of this study was to update a previous scoring system for patients with skeletal metastases, that was proposed by Katagiri et al. in 2005, by introducing a new factor (laboratory data) and analyzing a new patient cohort. Between January 2005 and January 2008, we treated 808 patients with symptomatic skeletal metastases. They were prospectively registered regardless of their treatments, and the last follow‐up evaluation was performed in 2012. There were 441 male and 367 female patients with a median age of 64 years. Of these patients, 749 were treated nonsurgically while the remaining 59 underwent surgery for skeletal metastasis. A multivariate analysis was conducted using the Cox proportional hazards model. We identified six significant prognostic factors for survival, namely, the primary lesion, visceral or cerebral metastases, abnormal laboratory data, poor performance status, previous chemotherapy, and multiple skeletal metastases. The first three factors had a larger impact than the remaining three. The prognostic score was calculated by adding together all the scores for individual factors. With a prognostic score of ≥7, the survival rate was 27% at 6 months, and only 6% at 1 year. In contrast, patients with a prognostic score of ≤3 had a survival rate of 91% at 1 year, and 78% at 2 years. Comparing the revised system with the previous one, there was a significantly lower number of wrongly predicted patients using the revised system. This revised scoring system was able to predict the survival rates of patients with skeletal metastases more accurately than the previous system and may be useful for selecting an optimal treatment.

Prognostic Factors and a Scoring System for Survival After Radiotherapy for Metastases to the Spinal Column A Review of 544 Patients at Shizuoka Cancer Center Hospital

To optimize selection of a radiotherapy schedule for patients with spinal metastases, the authors analyzed prognostic factors and developed a scoring system to predict survival in such patients.

Effects of PEMF on a murine osteosarcoma cell line: drug-resistant (P-glycoprotein-positive) and non-resistant cells

After pulsed exposure of Dunn osteosarcoma cells (nonresistant cells) to Adriamycin (ADR) at increasing concentrations and single-cell cloning of surviving cells, ADR-resistant cells were obtained. These resistant cells expressed P-glycoprotein and had resistance more than 10 times that of their nonresistant parent cells. Compared to the nonresistant cells not exposed to pulsing electromagnetic fields (PEMF) in ADR-free medium, their growth rates at ADR concentrations of 0.01 and 0.02 micrograms/ml, which were below IC50, were 83.0% and 61.8%, respectively. On the other hand, in the nonresistant cells exposed to PEMF (repetition frequency, 10 Hz; rise time, 25 microsec, peak magnetic field intensity, 0.4-0.8 mT), the growth rate was 111.9% in ADR-free medium, 95.5% at an ADR concentration of 0.01 micrograms/ml, and 92.2% at an ADR concentration of 0.02 micrograms/ml. This promotion of growth by PEMF is considered to be a result of mobilization of cells in the non-proliferative period of the cell cycle due to exposure to PEMF. However, at ADR concentrations above the IC50, the growth rate tended to decrease in the cells not exposed to PEMF. This may be caused by an increase in cells sensitive to ADR resulting from mobilization of cells in the non-proliferative period to the cell cycle. The growth rate in the resistant cells exposed to PEMF was significantly lower than that in the non-exposed resistant cells at all ADR concentrations, including ADR-free culture (P</=0.0114). Therefore, this study suggests that PEMF promotes the growth of undifferentiated cells but progressively suppresses the growth of more differentiated cells, i.e., PEMF controls cell growth depending on the degree of cell differentiation. This study also shows the potentiality of PEMF as an adjunctive treatment method for malignant tumors.

Additional wide resection of malignant soft tissue tumors.

Forty-five patients with soft tissue sarcomas received additional wide resections after they were treated with simple excision by a primary physician. Of the patients in the current study, 26 were male and 19 were female; all were treated between 1986 and 1998 for malignant soft tissue tumors. The mean followup was 7.1 ± 3.4 years. The mean time from first excision to additional wide resection was 8 weeks, and for 90% of the patients it was within 12 weeks. In deciding the surgical margin for an additional operation, enhanced computed tomography scans and magnetic resonance images were done. Four (8.8%) patients had local recurrences that required a second resection and had no evidence of disease at latest followup. Four (8.8%) patients had distant metastases but did not have local recurrences. Three patients died of lung metastases. The overall 5-year survival rate of the patients was 93%, and the overall 5-year disease-free rate was 84%. It seems that tumors treated adequately by wide resection in an additional operation have results as good as tumors treated with a primary wide resection.

Intraneural lipomatous tumor of the median nerve: Three case reports with a review of literature

INTRODUCTION Intraneural lipoma and fibrolipomatous hamartoma of the nerve are rare soft tissue tumors that most commonly occur in the forearm and the wrist, and particularly within the median nerve. When the lesions are large enough, they may cause progressive compression neuropathy. They are distinct entities each other with different clinical and radiological findings and thereby need different surgical treatments. PRESENTATION OF CASE We report here 3 cases of intraneural lipomatous tumors of the median nerve (1 case of intraneural lipoma and 2 cases of fibrolipomatous hamartoma). DISCUSSION All patients were surgically treated successfully with complete excision for intraneural lipoma and with carpal tunnel releases for the both fibrolipomatous hamartomas. CONCLUSION A careful preoperative planning is necessary for the optimal treatment by distinguishing whether it is a resectable or non-resectable tumor based on the clinical and radiological findings, because they have characteristic findings each other.

Walking ability and activities of daily living after limb salvage operations for malignant bone and soft-tissue tumors of the lower limbs

Abstract We evaluated the number of steps, activities of daily life (ADL) score, Enneking score, active range of motion and muscle strength by muscle manual testing for function in lower limbs after reconstructive procedures in surgical treatment of tumors. The 56 patients with 20 malignant bone tumors and 36 malignant soft-tissue tumors averaged 7119 ± 3563 steps per day, or 69.8% of the control group. The average ADL score of patients was 14.0 ± 4.1 points (70.0%), and the average Enneking score 20.4 ± 6.0 points (68.0%). The scores of the bone tumor group were lower than those of the soft-tissue tumor group. These scores were not correlated with the range of motion. The number of steps and ADL score were correlated with Enneking score (coefficient 0.52 and 0.84, respectively). The number of steps and the ADL score appear to be useful, as is Enneking score.

Use of adriamycin-impregnated methylmethacrylate in the treatment of tumor metastases in the long bones

Internal fixation or endoprosthetic replacement of a long bone metastatic lesion was performed using adriamycin-containing bone cement (methylmethacrylate) after resection or curettage of the lesion in 25 patients (27 limbs). Survival rate, limb function, and local recurrence rate were retrospectively evaluated in this patient cohort. Survival rate was 53% at 12 months and 30% at 24 months, which was better than in previous reports. One patient showed local recurrence radiographically. Postoperatively, none of the patients developed infection, delayed wound healing, myelo-suppression attributed to adriamycin, and 74% of the patients were able to walk outdoors.

Osteosarcoma of the talus treated successfully with limb-sparing surgery. A case report.

Except for multiple myeloma, osteosarcoma is the most common primary malignant bone tumor. It typically affects the metaphyseal part of the long bones, with the knee being affected in almost 50% of cases1. Osteosarcoma of the foot is rare, and almost half of the reported cases in the foot were found to have arisen from the calcaneus2,3. Osteosarcoma of the talus is very rare; to the best of our knowledge there are only two previous case reports in the literature4,5. Patients with osteosarcoma of the foot are usually not good candidates for limb-sparing surgery. To our knowledge, all patients with osteosarcoma of the talus who have been reported in the literature were managed with below-the-knee amputation2-5. We report the first case of a patient in whom osteosarcoma of the talus was successfully treated with limb-sparing surgery with ankle arthrodesis. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-nine-year-old man presented with a one-year history of pain in the right ankle and no history of any traumatic causative event. Physical examination revealed a slight but diffuse swelling in the right ankle, which was painful with movement and during weight-bearing. All laboratory data, including the serum alkaline phosphatase level, were within normal limits. A plain radiograph demonstrated an ill-defined lucent lesion with cloudy mineralization from the head of the talus to the anterior one-third of the body of the talus (Fig. 1). Fig. 1 Lateral plain radiograph showing an ill-defined osteolytic lesion with cloudy mineralization. The lesion extends from the talar head to the anterior one-third of the talar body. A T1-weighted sagittal magnetic resonance image (Fig. 2, A ) revealed a lesion that had low signal intensity and that …