Shoichi Takekawa

Combination chemoembolization therapy for hepatocellular carcinoma: mainly, using cisplatin (CDDP).

SummaryChemoembolization therapy, using the arterial injection of mixtures of various anticancer agents and lipiodol along with gelfoam particles, was carried out on 77 cases of hepatocellular carcinoma between January 1985 and March 1987, and an assessment was made on the anticancer effects of this treatment method. For the patients receiving lipiodol, the value of the longitudinal dimension multiplied by the vertical length of the tumor was calculated using a computerized tomograph before and after chemoembolization to determine the rate of tumor regression. (a) Of the 30 patients receiving chemoembolization therapy using a simple mixture of 100 mg cisplatin (CDDP) and lipiodol, the tumor regression rate was 50% or more in 10 cases (31%). (b) Of the 14 patients receiving chemoembolization therapy with a suspension of 100 mg of cisplatin, adriamycin (10–30 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (29%). (c) Of the 31 cases receiving chemoembolization therapy using a suspension of adriamycin (10–40 mg), mitomycin C (10–20 mg) and lipiodol, the tumor regression rate was 50% or more in four cases (13%). (d) From these results, it can be concluded that the antitumor effect of chemoembolization using cisplatin is more significant than with other drugs.

Arterial infusion chemotherapy for advanced hepatocellular carcinoma using EPF and EAP therapies.

SummaryArterial infusion chemotherapy of EPF (etoposide, cisplatin, and 5-fluorouracil) or EAP (etoposide, Adriamycin, and cisplatin) was carried out in 28 cases of advanced hepatocellular carcinoma (HCC) between January 1988 and December 1990, and assessment was made of the anticancer efficacy of each treatment method. In all, 13 patients were treated with EPF therapy and 15 received EAP therapy. The anticancer agents were infused through a catheter inserted into the proper or common hepatic artery. The catheter was inserted via the axillary artery or common femoral artery using Seldingers method or the cut-down method. The results of each therapy were analyzed in relation to the tumor regression rate and the side effects encountered. The tumor regression rate was determined on the basis of two-dimensional evidence obtained by computed tomography performed before and after treatment. The treatment results were also compared with the results of chemoembolization therapy using a mixture of cisplatin (CDDP), Adriamycin (ADM) and lipiodol. Of the 28 patients treated with arterial infusion chemotherapy, 14 (50%) attained a regression rate of 50% (PR). In all, 46% of the EPF group and 53% of the EAP group achieved a PR. These results were superior to those obtained using chemoembolization therapy. In general, the side effects were relatively mild and transient.

Combination therapy consisting of arterial infusion chemotherapy (EPF, EAP) and transcatheter arterial embolization (TAE)

From January 1988 to January 1993, 45 patients with unresectable advanced hepatocellular carcinoma (HCC) were treated with a new combination therapy consisting of arterial infusion chemotherapy and TAE. The combination therapy was performed according to our treatment schedule as follows: two courses of arterial infusion chemotherapy were given first, and then transcatheter arterial embolization (TAE) using a mixture of Lipiodol and cisplatin powder was performed. Two arterial infusion chemotherapeutic regimens were employed: EPF (etoposide, cisplatin, and 5-fluorouracil) and EAP (etoposide, Adriamycin or Epi-adriamycin, and cisplatin). The anticancer drugs were infused through a catheter inserted into the proper or common hepatic artery. Assessment was made of the anticancer effect and survival rate of each treatment method. The response to each therapy was evaluated on the basis of CT performed prior to and after the treatment. In the EPF·TAE group, the response rate was about 46%, whereas in the EAP·TAE group it was 48%. Overall, 21 of 45 patients attained a regression rate of 50% or more. Furthermore, daughter nodules decreased in size or disappeared in about 67% of 15 patients. Additionally, tumor thrombi tended to show a similar response. In all of the cases, the average duration of survival was 30.3 months, and the 1-year survival value was 68%, the 2-year survival value was 44%, and the 3-year survival value was 35%. These results were superior to those obtained with TAE therapy alone.

Study on Feasibility of a New 805nm Semiconductor Laser as a Source in Laser Angioplasty

The authors studied on the feasibility of 805nm Laser produced by a new compact semiconductor laser equipment(Diomed 25, made in UK) to apply to laser angioplasty. The walls of fresh pig aorta and frozen human arteriosclerotic aorta were irradiated by this laser through bare-ended fibers at different power and exposure time, and the size of hole in terms of surface diameter and depth of holes created by vaporization was measured. The power of 25W was needed to vaporize and penetrate the aortic wall of both pig and human specimen. The pig aortic wall was penetrated by this laser irradiation for 1.2 to 18.4 seconds at 25W. The depth of vaporized hole ranged from 0.8 to 1.5mm. The volume of holes ranged from 0.224 to 1.26cmm. The human aortic wall was penetrated when irradiated through bulb type fiber for 2 to 5 seconds at 25 W. The average diameter of a hole was 1.24mm, and the average depth was 2.3mm. The human aortic wall was vaporized when irradiated through a conical type fiber for 1 to 3 seconds at 25W, and the average diameter of a hole was 1.12 mm, and its depth was 1.85 mm in average. Once vaporization of aortic wall occurs, the time necessary to vaporize the wall became shorter for the second time. It is assumed that minute carbon particles sticked or adhered to the surface of the tip of a laser fiber from the first lasing produced more heat to the aortic wall, and thus the necessary time for vaporization was shortened. It seems to be important to keep this phenomenon in mind to apply laser to stenotic arterial wall in order to control optimal laser energy. It seems to be warranted to test the effect of a ceramic tip for contact irradiation of this new type of semiconductor laser before applying to clinical case. 緒 書 レーザ ー血 管 形 成徳 に は ア ル ゴ ン レーザ ー 、 Nd:YAGレ ーザ ー 、エ キ シ マ レー ザー 、 ホル ミ ウ ムYAGレ ーザ ー な どが 使用 され て来 た が、 レーザ ー装 置 が大 型 で あ り、治 療 室 でスペ ー ス を取 るこ と、可 な りの電 力 を必 要 とす る こ と、 従って経費的に高価であることが問題であった。 そこでスペースを取らない小型化且つ低電力の Nd:YAGレ ーザー装置が開発利用されてきた。 半導体レーザーは従来レーザー血管形成術のた めには出力が不足であったが最近応用の可能 性のある装置も発売されるようになったので.