M Imamura

Percutaneous microwave coagulation therapy for patients with small hepatocellular carcinoma

The authors compared the efficacy of percutaneous microwave coagulation therapy (PMCT) and percutaneous ethanol injection therapy (PEIT) in the treatment of patients with cirrhosis and a solitary nodular hepatocellular carcinoma (HCC) ≤ 2 cm in greatest dimension.

Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma.

A small number of microwave electrode insertions and microwave irradiations were used to obtain complete tumor necrosis in hepatocellular carcinomas (HCC) measuring > 2.0 cm but ≤ 3.0 cm in greatest dimension. The efficacy of combining transcatheter arterial chemoembolization (TACE) with subsequent percutaneous microwave coagulation therapy (PMCT) was assessed in this study.

Rapid progression of hepatocellular carcinoma after transcatheter arterial chemoembolization and percutaneous radiofrequency ablation in the primary tumour region.

We report one patient who showed rapid progression of hepatocellular carcinoma (HCC) after undergoing transcatheter arterial chemoembolization (TACE) and percutaneous radiofrequency ablation (PRFA) for a small HCC measuring 2.5 cm in diameter. Enhanced magnetic resonance imaging (MRI) following treatment showed complete tumour necrosis and did not reveal the presence of a tumour around the treated area. Furthermore, the serum alpha-fetoprotein (AFP) level decreased at the completion of therapy. However, the HCC advanced in a very short time. Numerous tumours around the treated area were observed on enhanced computed tomography (CT) 50 days after PRFA. It is strongly suspected that the tumour was disseminated through the portal system because of the presence pattern of tumours. We believe this to be the first case illustrating a hepatic cancer that progressed rapidly following TACE and PRFA.

Percutaneous microwave coagulation therapy for solitary metastatic liver tumors from colorectal cancer: a pilot clinical study

Objective:Percutaneous microwave coagulation therapy (PMCT) was performed for metachronous small solitary liver tumors measuring ≤3.0 cm in diameter that had metastasized from colorectal cancer. PMCT was used for local control of the lesions, and the efficacy of this treatment was assessed.Methods:In 15 patients, a microwave electrode (specially designed for this purpose, 25 cm long and 2.0 mm thick) was inserted percutaneously into the tumor area under ultrasonic guidance. Microwaves at 80 watts were used to irradiate the tumor and the surrounding area.Results:Thirteen of the 15 metastatic tumors were radically ablated by 3–10 applications of microwave irradiation. Although the follow-up period was short (9–37 months), 10 patients survived. No recurrence has been detected in the treated area (except two foci where PMCT was insufficient), and no serious side effects or complications were encountered during or after the PMCT. In four of the five nonsurviving patients, death was due to metastases to the bone, brain, lung, or other areas of the liver despite complete local tumor control by PMCT.Conclusion:PMCT is a safe and effective treatment for metachronous small liver tumors that have metastasized from colorectal cancer.

Lewis Y antigen expression in hepatocellular carcinoma. An immunohistochemical study.

Background. The altered expression of the Lewis blood group‐related antigens during malignant transformation can be used clinically as a tumor marker or as a prognostic indicator. The Lewis Y (LeY) antigen, which is one of the Type 2 human blood group‐related antigens, also is thought to behave as an oncodevelopmental cancer‐associated antigen. In this study, the authors examined the association between human LeY antigen expression and the clinicopathologic features of HCC, including its proliferative activity.

Hepatic infarction following percutaneous ethanol injection therapy for hepatocellular carcinoma

We report on two patients who developed hepatic infarction after undergoing percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC). In both cases, liver function parameters deteriorated immediately after the ethanol injection, and enhanced computed tomography images showed a wedge-shaped avascular low-density area due to hepatic infarction. In one patient, PEIT was performed for a nodule treated with transcatheter arterial infusion (TAI) using a suspension of styrene maleic acid neocarzinostatin (SMANCS) 4 weeks before. In the other patient, TAI with SMANCS had been carried out 14 months previously for a different nodule in the same segment where the nodule treated with PEIT was located. When PEIT is used for patients with HCC who have previously undergone TAI, especially with SMANCS, PEIT may induce hepatic infarction.

New Technique for Mediastinal Temperature Measurement in Hyperthermic Cancer Treatment: Balloon Catheter in the Azygos Vein

The temperature in the mediastinum during hyperthermia is difficult to determine accurately. We measured the temperature in the azygos vein, using a new technique, and compared the measurements with temperatures in the oesophagus. Eight patients with mediastinal tumours resulting from lung cancer or oesophageal cancer were given hyperthermo-radiotherapy. The temperatures in the azygos vein and in the oesophagus were measured before and during blockage of the blood flow of the azygos vein using an angiographic balloon catheter. None of the patients had complications as a result of these procedures, and hyperthermia by capacitative heating was safely performed. The temperature in the azygos vein increased by a mean of 1.7°C (0.2–2.8°C) after blockage of the blood flow. The temperature in the oesophagus was 0.83 ± 1.09°C (mean ± SD) higher than that in the azygos vein. Measurement of the temperature in the azygos vein gives a more accurate estimate of mediastinal temperature than does oesophageal temperature but it is an invasive procedure.

Development of local necrosis and side-effects after hepatic injections of acetic acid solutions

Abstract Acetic acid injection therapy has recently been studied as a treatment for hepatocellular carcinoma. Since trials of this therapy have just begun, both basic and clinical studies of it are presently required. Therefore, the efficacy and safety of this therapy as a treatment for hepatocellular carcinoma were examined in rats. When acetic acid was injected into normal rat liver, the extent of necrosis at the site of injection expanded in a dose-dependent manner. At concentrations of 30% and above, acetic acid began to prove fatal, and mortality increased in a dose-dependent fashion. At a concentration of 45% and above, all rats died within 2 days after injection due to acute multi-organic circulatory failure. On histological examination, distinct thorombus formation was observed in the liver. We conclude that additional detailed examination of the effects of various amounts and concentrations of acetic acid and of the effects of acetic acid injection on other organs should be performed prior to clinical application of this therapy.

Localization of the bronchodilatory effects of isoproterenol and aminophylline in patients with bronchial asthma : An investigation using selective alveolobronchography

The effect of isoproterenol (isoprenaline) and aminophylline on airway calibre in 18 adult patients with bronchial asthma was measured directly using selective alveolobronchography. Isoproterenol caused a significant dilation in the maximal calibre of the central airway from bifurcation numbers 1 – 5 (P < 0.05) and number 6 (P < 0.01). There was no change in bifurcation number 0 (trachea). Aminophylline caused a significant dilatation in bifurcation numbers 3 and 4 (P < 0.01), with no change in bifurcation numbers 0–2 and 5 – 6. In the minimal calibre of the central airway, both drugs displayed a significant dilatory effect only at bifurcation number 3 (P < 0.05). These results indicate that the central airway is the main site of the dilatory effects of these drugs. Although their precise mechanisms of action are not known, these results suggest that mechanisms of action of the two drugs are different. Isoproterenol acts on the whole region of the central airway, while the action of aminophylline tends to be limited to bifurcation numbers 3 and 4.

Long-term results of thermoradiotherapy for superficial, subsurface tumors using a 430 MHz microwave heating system.

Superficial, subsurface tumors of 93 patients were treated with thermoradiotherapy using a 430 MHz microwave heating system (HTS-100). All patients had malignant tumors, and all were treated with a combination of hyperthermia and radiation. Satisfactory temperature data for each thermal parameter were achieved within a 5 cm depth for each tumor. The overall complete response (CR) rate was 39.8%; in the less than or equal to 3 cm (depth of tumor), the CR rate was 66.7%, in the 3-5 cm group, the CR rate was 42.9%. In the multivariate analysis, duration of local control correlated with tumor responses (CR). There were no instances of prominent late complications that were observed for greater than or equal to 6 months. This study suggests that the HTS-100 may improve tumor response and the duration of local control of superficial and subsurface tumors.