Kazuo Minakuchi

Clinical evaluation of intermittent arterial infusion chemotherapy with an implanted reservoir for hepatocellular carcinoma

SummaryA total of 45 patients with advanced hepato-cellular carcinoma were treated at Osaka City University Hospital by intermittent arterial infusion chemotherapy with an implanted reservoir. The treatment consisted of intermittent infusion of doxorubicin (5–20 mg/body), mitomycin C (4–10 mg/body) or degradable starch microspheres (600–1200 mg/body) plus doxorubicin (30 mg/body). In all, 26% of the patients received this treatment for disease recurrence following transcatheter arterial embolization (TAE). Among 43 evaluable patients, 4 showed a complete remission (CR) and 16 showed a partial response (PR) on computed tomograms and angiograms. For all 45 patients, the 1-year survival value was 41% and the 2-year value was 14%. Of the 20 patients who showed a CR or PR, 77% survived for 1 year and 29% survived for 2 years. Tumor regression showed a close relationship with the duration of survival. Intermittent arterial infusion with an implanted reservoir caused the least adverse reactions and seems to be appropriate for use in patients with advanced tumor extension or stenosis of the hepatic artery caused by repeated TAE.

Hepatocellular carcinoma associated with polyarteritis nodosa with symptoms appearing after intra-arterial chemotherapy

A 57-year-old man presented with pain in his right hypochondrium. There was no history of blood transfusions, prolonged fever, or pain of the muscles or joints. The patient reported that he had never taken methamphetamine and had not taken sulphonamides or penicillins for a long time. The physical examination revealed a hard elastic mass in the right hypochondrium. Laboratory tests (Table I) showed the presence of a chronic liver disorder, but hepatitis B surface antigen and antibody were not detected. Serum α-fetoprotein (AFP) was 14100 ng/ml. An ultrasound examination of the liver showed a large mass hypoechoic in parts and hyperechoic in other parts in the right lobe. Enhanced computed tomography (CT) revealed a large mass with a diameter of about 6 cm and a low density region in the anterior segment of the right lobe. There were multiple low density nodules throughout the right lobe and the medial segment of the left lobe, and a tumour thrombus in the portal vein and superior mesenteric vein. There wa...

Whirl sign as CT finding in small-bowel volvulus

In three patients with ileus CT showed a whirl sign in which the bowel and mesenteric folds encircled the superior mesenteric vein in a whirl-like pattern. Two patients were confirmed surgically to have small-bowel volvulus arising from postoperative adhesions. The whirl sign is useful in decision-making about the need for surgery. A CT examination should be performed for patients with ileus of unknown cause.

Phase I study of weekly cisplatin, vinorelbine, and concurrent thoracic radiation therapy in patients with locally advanced non-small-cell lung cancer

BackgroundThe combination of chemotherapy and thoracic radiation therapy (TRT) is considered as a standard treatment for locally advanced non-small-cell lung cancer (NSCLC). Although the frequent interaction of anticancer agents and irradiation may produce stronger radio-sensitizing effects, the daily administration of these agents is complicated. We therefore used weekly administration of these agents, and conducted a phase I study of weekly cisplatin, vinorelbine, and concurrent TRT. The purpose of this study was to identify the maximum tolerated dose (MTD), the dose-limiting toxicity (DLT), and the recommended dose of this treatment.MethodsPatients with locally advanced NSCLC were enrolled in this study. Both cisplatin and vinorelbine were given intravenously on a weekly schedule for 6 weeks, starting on the first day of TRT, i.e., on days 1, 8, 15, 22, 29, and 36. The total dose of TRT was 60 Gy. The dose of cisplatin was fixed at 20 mg/m2 per week. The starting dose of vinorelbine was 15 mg/m2 per week (dose level 1).ResultsNine patients were enrolled in this study. All three patients at dose level 1 experienced DLTs. We decreased the dose of vinorelbine to 10 mg/m2 per week (dose level 0). Two of the six patients at dose level 0 experienced DLTs. Therefore, dose level 1 was considered as the MTD, and dose level 0 as the recommended dose. The DLTs of this treatment were esophagitis, fatigue, infection, and hyponatremia.ConclusionThe recommended dose of cisplatin is 20 mg/m2 per week and that of vinorelbine is 10 mg/m2 per week with standard TRT. A phase II study of this treatment is warranted.

Phase II study of concurrent chemoradiotherapy with use of uneven fractionation for the treatment of glioblastoma

BackgroundA phase II one-arm study was performed to evaluate the efficacy and safety of concurrent chemoradiotherapy with the use of uneven fractionation in glioblastoma patients.MethodsA total of 19 glioblastoma patients underwent concurrent chemoradiotherapy with the use of uneven fractionation. Vincristine (VCR) and 3-[(4-amino-2-methyl-5-pyrimidinyl)methyl]-1-(2-chloroethyl)-1-nitrosourea hydrochloride (ACNU) were administered on day 1 and day 2, respectively. Irradiation at a dose of 3 Gy was administered on days 3 and 4, and at a dose of 1.5 Gy from day 5 on. The treatment was repeated at 10 day intervals. The total radiation dose was 57 Gy.ResultsAll 19 patients received full dose irradiation. However, 8 patients required treatment interruption, and 2 patients required decreases in drug dosages due to the effects of acute toxicity such as, myelosuppression, liver function disorder and skin toxicity. The treatment responses were recorded as CR in 5, PR in 1, and NC in 10 patients. The remaining three patients received total removal of the enhancing area on CT or MRI. The 1 year and 2 year survival rates were 73% and 23%, respectively. The median survival times of this study and the historical controls were 16 months and 15 months, respectively.ConclusionThe concurrent chemoradiotherapy failed to prolong the survival of glioblastoma patients.

Angioscopy of the Inferior Vena Cava: Preliminary Observations in Cases with Involvement by Neoplasm Work in Progress

Angioscopy of the inferior vena cava (IVC) was performed in 10 patients. Tumor thrombus extending into the IVC was suspected in six patients, and direct invasion of the IVC wall was suspected in four, based on computed tomographic and venographic findings. In each case, a fiberscope was directed to the area of interest in the IVC via a transfemoral 5-F catheter. Blood displacement by means of a saline infusion enabled angioscopic observation of the IVC wall. The neoplasms were seen clearly in all patients but one. The color and texture of the tumor thrombi surface made it easy to distinguish from the healthy IVC wall. In the four patients believed to have direct invasion of the wall, there were no angioscopic differences between the suggestive areas and adjacent areas of normal IVC wall. In these four cases, the absence of direct invasion was confirmed at surgery. Thus, angioscopy helps make an accurate nonoperative or preoperative diagnosis of tumor thrombi possible and may aid in the exclusion of direct invasion.

Patterns of recurrence after complete remission with definitive radiotherapy in the treatment of malignant glioma

BackgroundIn patients with malignant glioma, neuroimaging studies cannot identify the true tumor margins, and tumor disappearance on neuroimaging studies does not necessarily indicate histologic disappearance of the tumor.MethodsPatterns of recurrence and survival times were studied retrospectively in 21 patients with glioblastoma and 16 patients with anaplastic astrocytoma, whose tumor had disappeared on neuroimaging studies after treatment.ResultThirteen patients with gliobastoma and 8 patients with anaplastic astrocytoma developed a local recurrence alone. Four patients with glioblastoma developed both a local recurrence and seeding metastasis. Five patients with anaplastic astrocytoma were recurrence free. Overall 5-year survivals were 0% and 60% in patients with glioblastoma and anaplastic astrocytoma, respectively.ConclusionLong-term local control was not generally obtainable in glioblastoma; however, it was obtainable in anaplastic astrocytoma.

Radiotherapy and Systemic Chemotherapy for Brain Metastasis in Small Cell Lung Cancer.

脳転移巣では血液脳関門が破壊されている可能性があることから小細胞肺癌脳転移症例に対し全身化学療法が試みられるようになった.従来から行われている放射線治療と化学療法の役割を明らかにする目的で, 小細胞肺癌脳転移症例の治療成績をretrospectiveに検討した.放射線治療, 化学療法の奏効率は55%, 31%であった.放射線治療単独, 化学療法単独および両者併用のMSTは1.6ヵ月, 4.0ヵ月, 6.1ヵ月で, 前2者と後者の間に有意差が見られた.脳転移による死亡は49%, 63%, 42%であった.化学療法の新鮮例, 再発例のうち初回化学療法CR例およびPR例のMSTは6.1ヵ月, 6.1ヵ月, 3.3ヵ月で, 前2者では脳転移の存在が化学療法のcontraindicationにはならないと考えられた.放射線治療は生存期間並びに死因を考慮すると化学療法に併用すべきであり, また奏効率が高く毒性は低いので対症療法としても有用と考えられた.