Kazuhisa Fujiwara

Bronchial artery embolization for hemoptysis: Immediate and long-term results

The purpose of this study was to evaluate the immediate and long-term results in 63 patients who underwent transarterial embolization for control of hemoptysis. Overall immediate success rate was 86.1%. At long-term follow-up 50% of patients showed complete remission, 22% partial remission, and 28% recurrent hemoptysis. Hemoptysis remained controlled for a mean of 22 months and a median of 14 months. The long-term results among four disease groups differed substantially. Patients with bronchiectasis showed the best results, followed by those with idiopathic disease and with inflammation; patients with neoplasm showed the worst results.

Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results

AbstractPurpose: To evaluate the clinical effects of transcatheter arterial embolization (TAE) on malignant bone and soft tissue tumors. Methods: TAE was performed in 10 patients with primary bone and soft tissue sarcomas and in 31 patients with metastatic bone tumors. The embolized arteries were the internal iliac artery in 30 cases, the intercostal artery in six cases, the lumbar artery in five cases, the suprascapular artery in three cases, and the iliolumbar artery, the internal pudendal artery, and the lateral sacral artery in one case each. The embolized material was gelatin sponge particles. The chemotherapeutic drugs were usually 20–40 mg of doxorubicin for primary and metastatic tumors and 50–100 mg of cisplatin only for primary tumors. In addition, 50–60 Gy of 10-MV radiotherapy with or without radiofrequency (RF)-capacitive hyperthermia in four sessions was administered before TAE for primary tumors only. Results: Even though the pain score increased immediately after TAE, 30 of 38 (79%) patients with pain (8 of 9 with primary tumors, and 22 of 29 with metastases) achieved pain control after TAE. A necrotic low-density area shown by computed tomography (CT) after TAE was found in 31 of 41 (76%) tumors [8 of 10 (80%) with primary tumors, and 23 of 31 (74%) with metastatic tumors]. The tumor size decreased in 14 of 25 (56%) primary and metastatic tumors after 3 months. Osteosclerotic changes appeared in two cases of metastatic tumors after 6 months. In five tumors resected after TAE, large areas of necrosis within the tumor were confirmed histologically. Transient local pain and numbness appeared after TAE, but were relieved by drug treatment within 1 week. No severe complications except a case of gluteal muscle necrosis were encountered after TAE. The 1-year survival rate of the patients with primary tumors was 38.1%, and the median survival was 18 months. The longest survival was 84 months. The 1-year survival rate of the patients with metastatic bone tumors was 38.9%; the median survival was 12 months. The longest survival was 24 months. Conclusion: TAE could be an effective treatment for pain control and local control of malignant bone and soft-tissue tumors.

Laser projection system for radiotherapy and CT-guided biopsy

We devised a laser projection system combined with a CT scanner and radiotherapy treatment planning computer (CT stimulator). The irradiation field can be projected over a range of 180 degrees on the skin of a patient lying on the CT couch. For CT-guided biopsy, the system can project the skin entry point and needle direction.

A randomized phase II study of cisplatin/5-FU concurrent chemoradiotherapy for esophageal cancer: Short-term infusion versus protracted infusion chemotherapy (KROSG0101/JROSG021)

PURPOSE A randomized phase II study was conducted to compare the toxicity and efficacy of combining short-term chemotherapy (CT) or protracted CT with radiotherapy (RT) for esophageal cancer. MATERIALS AND METHODS Eligible patients were <75 years and with performance status (PS) of 0-2, and had stages II-IVA esophageal cancer. Two cycles of cisplatin 70 mg/m(2) for 1 day and 5FU 700 mg/m(2) for 5 days (arm A) or cisplatin 7 mg/m(2) for 10 days and 5FU 250 mg/m(2) for 14 days (arm B) were given with RT of 60Gy/30 fractions/7 weeks (1-week split). RESULTS Of 91 patients enrolled, 46 were randomized to arm A and 45 to arm B. Two cycles of CT were given concurrently with RT for 89% in arm A and for 71% in arm B with significant difference (P=.031). The 2- and 5-year overall survival rates for arm A were 46% and 35%, while those for arm B were 44% and 24%, respectively, without significant difference. The 2- and 5-year progression-free survival rates for arm A were 30% and 30%, while those for arm B were 29% and 12%, respectively. CONCLUSIONS Protracted infusion CT with RT provides no advantage over standard short-term infusion CT with RT for esophageal cancer.

Experimental embolization of rabbit renal arteries to compare the effects of poly L-lactic acid microspheres with and without epirubicin release against intraarterial injection of epirubicin.

AbstractPurpose: We performed a basic investigation using white rabbits of the sustained release and embolizing effects of poly L-lactic acid microspheres (PLA) to determine their usefulness for chemoembolization. Methods: Fifteen male Japanese white rabbits were used. Sustained release of an embolizing material, EPI-PLA was accomplished with l m g of PLA containing 0.03 mg of epirubicin hydrochloride (EPI). Embolization with 50 mg of PLA (total dose of EPI l.5 mg) was performed after the renal artery of the rabbits was selected (Chemo-TAE group). A group in which a bolus of 1.5 mg EPI alone was injected through the renal artery (TAI group) was established as a control group. Furthermore, a group in which embolization was performed with 50 mg of PLA alone (TAE group) was also established. These three groups, each consisting of five rabbits, were compared. Results: Blood EPI levels were serially measured. The blood EPI level in the TAI group rapidly reached a peak more than 30 min after injection, then decreased to almost zero 24 hr after injection. In the Chemo-TAE group, the blood EPI level was transiently increased 30 min after embolization, but remained low thereafter until 24 hr after embolization. EPI levels in kidney tissue isolated 24 hr after embolization were measured. In the Chemo-TAE group, the tissue EPI level was significantly higher than that in the TAI group. When isolated kidneys were macroscopically and histologically examined, atrophy of the entire embolized kidney, as well as infarction and necrosis in the renal cortex, were observed in both the TAE group and the Chemo-TAE group. However, there were no such findings in the TAI group. The area of the infarction in the renal cortex did not significantly differ between the Chemo-TAE group and the TAE group; however, there was vascular injury in the Chemo-TAE group and none in the TAE group. Conclusion: It was demonstrated that EPI-PLA, a chemo-embolizing material, maintained high local concentrations of the anticancer drug, while maintaining low blood levels of the anticancer drug.

Neoadjuvant Chemotherapy by Transcatheter Arterial Infusion Method for Uterine Cervical Cancer

PURPOSE The effects of transcatheter intraarterial infusion of anticancer drugs on the prognosis of cervical cancer were retrospectively studied. MATERIALS AND METHODS Two or three sessions of transcatheter arterial infusion therapy were performed in 97 patients with primary uterine cervical cancer. The number of patients in stage I, II, III, or IV were 15, 37, 34, and 11, respectively. The drugs infused were cisplatin (60-70 mg/m2), doxorubicin hydrochloride (30-40 mg/m2), mitomycin (15 mg/m2), and 5-fluorouracil (500 mg/body). They were infused via the bilateral internal iliac arteries. Seventy-five patients of the 97 (78%) underwent radical hysterectomy after arterial infusion: stage I (14 of 15), stage II (31 of 37), stage III (25 of 34), and stage IV (5 of 11). Three stage II and nine stage III patients received radical radiation therapy. The other 10 patients (one with stage I, three with stage II, and six with stage IV) did not receive an operation and radiation therapy after arterial infusion because of their distant metastases at the time of operation. Thirty-eight patients of 75 (51%) received postoperative radiation therapy. RESULTS The complete histologic response rates (no active cancer cells) after arterial infusion were four of 14, four of 31, six of 25, and one of five for stages I, II, III, and IV. The histologic response rates, which showed no parametrial invasion after arterial infusion, were 12 of 14, 24 of 31, and 15 of 25 for stages I, II, and III. The histologic response rates, which demonstrated no lymph node metastases after arterial infusion, were 12 of 14, 24 of 31, and 19 of 25 for stages I, II, and III. The overall 5-year survival rates of the patients with stages I, II, and III were 93.3%, 58.7%, and 69.7%, respectively. The 5-year survival rates of the operated patients with stages I, II, and III were 100%, 60.5%, and 63.6%, respectively. The 5-year survival rates of the irradiated patients with stage III was 87.5%. Leukocytopenia and thrombocytopenia occurred as an acute complication in 75% and 79% of the patients, respectively. As a late complication, ileus occurred in 7%. CONCLUSION Arterial infusion may improve the prognosis of patients with cervical cancer without increasing the incidence of late complications.

Clinical results of transcatheter arterial infusion for uterine cervical cancer.

The effects of transcatheter intraarterial infusion of anticancer drugs on the prognosis of cervical cancer were retrospectively studied. Two or three sessions of transcatheter arterial infusion therapy were performed for 68 patients with primary uterine cervical cancer. The number of patients with stage I, II, III, or IV disease were 13, 22, 24, and 9, respectively. Patients with squamous cell carcinoma comprised 3, 17, 17, and 5 of the respective groups, and the patients with stage I and II disease had either adenocarcinoma or adenosquamous carcinoma, or bulky tumor (>4 cm). The drugs infused were cisplatin (60-70 mg/m2), doxorubicin hydrochloride (30-40 mg/m2), mitomycin (15 mg/m2), and 5-fluorouracil (500 mg/body). They were infused via the bilateral internal iliac arteries. Fifty-eight of the 68 patients (85%) received a radical hysterectomy after transcatheter arterial infusion: 12 of 13 with stage I disease, 21 of 22 with stage II disease, 20 of 24 with stage III disease, and five of nine with stage IV disease. Two patients with stage III disease received radical radiotherapy. The other eight patients (one with stage I disease, one with stage II disease, two with stage III disease, and four with stage IV disease) did not receive an operation after transcatheter arterial infusion because they had distant metastases at the time of operation. Thirty-two of 58 patients (56%) received postoperative radiotherapy. The complete histologic response rates (no active cancer cells) after transcatheter arterial infusion were: 2 of 12 patients with stage I disease, 3 of 21 patients with stage II disease, 5 of 20 patients with stage III disease, and one of five patients with stage IV disease. Tumors with squamous cell carcinoma disappeared at a significantly better rate (10/36, 28%) than did tumors with adenocarcinoma or adenosquamous cell carcinoma (1/22, 5%; p < 0.05). The overall 5-year survival rates of the patients with stages I, II, and III disease were 92.3%, 62.2%, and 71%, respectively. The 5-year survival rates of the patients who underwent surgery with stage I, II, and III disease were 100%, 66.3%, and 71.5%, respectively. Leukocytopenia and thrombocytopenia occurred as an acute complication in 75% and 79% of the patients, respectively. As a late complication, ileus occurred in 7%. Transcatheter arterial infusion may improve the prognosis of patients with cervical cancer without increasing the incidence of late complications.

Evaluation of glass microspheres for intra-arterial radiotherapy in animal kidneys

PURPOSE To evaluate the histologic distribution of nonradioactive microspheres when intra-arterially infused into normal kidneys, and to evaluate the histologic changes after the infusion. MATERIALS AND METHODS The glass microspheres were SiO2 microspheres with a smooth spherical shape measuring 20-30 micrometers in diameter with a specific gravity of 2.2 g/cm3. After the microspheres were mixed with contrast medium, they were infused into the renal artery. Twelve rabbits were sacrificed at 1 day, 3 days, 1 week, and 8 weeks after the treatment, respectively. The specimen was fixed with 10% buffered formalin, specially embedded in methyl methacrylate (MMA) resin and was stained by hematoxylin-eosin. The distribution of the microspheres in the kidney was analyzed microscopically, and histologic changes were also evaluated. RESULTS The microspheres were found in arterioles whose diameters were about 20-30 micrometers, within normal kidneys. All vessels containing microspheres were confined to arterioles or arteries. No migration of microspheres was detected in the normal lung or the contralateral kidney. Severe ischemic changes were observed in kidneys, developing within 8 weeks of the infusion. CONCLUSION Glass microspheres seemed to be a useful embolic material for intra-arterial radiation therapy.

Transcatheter arterial embolization for malignant osseous and soft-tissue sarcomas. I. A rabbit experimental model

AbstractPurpose: To evaluate the effect of transcatheter arterial embolization (TAE) on metastatic bone tumors in an experimental study. Methods: Fifteen Japanese white rabbits were transplanted with VX2 sarcoma cells into the iliac crest. In 10 rabbits, the arterial supply to the iliac bone tumors, internal iliac artery and iliolumbar artery were then embolized with particles of gelatin sponge. The therapeutic effect was evaluated by comparison with the natural course of control tumors in the other five rabbits. Results: After TAE, extensive necrosis, fibrosis, and vacuolization within the tumors were confirmed histologically. In the control rabbits, 19%±7% of the entire tumor was found to be spontaneous tumor necrosis; in contrast, the tumors of the TAE group showed necrosis as 62%±22% of the entire tumor. In one TAE group rabbit, no active tumor cell could be detected in the residual tumor. Conclusion: TAE was found to be an effective treatment for bone tumors in an experimental model.

Transcatheter arterial infusion therapy combined with radical hysterectomy in the treatment of advanced cervical cancer

Two or three sessions of transcatheter arterial infusion (TAI) therapy were performed preoperatively in 13 patients with advanced cervical cancer (stage 3 or more). The efficacy of TAI was evaluated by tumor markers, magnetic resonance imaging (MRI), and postoperative histopathological examination. In all cases, tumor marker levels decreased after TAI therapy, and MRI also showed a decrease in the tumor size in 11/12 patients. The tumor tissue resected at radical hysterectomy showed no viable cancer cells in 6 patients, and no viable extrauterine cancer was detected in 5 more patients. Thus, TAI performed via both internal iliac arteries reduced both tumor size and extension to the parametrium, and it appears to have the potential to be an effective treatment modality for advanced cervical cancer.