Yasuyuki Okudaira

Heat, drugs, and radiation given in combination is palliative for unresectable esophageal cancer

From April 1966 to April 1986, 101 men and women with unresectable squamous cell carcinoma of the esophagus were treated in our clinic. Since 1983, 21 were treated with a combination of hyperthermia, chemotherapy, and radiotherapy (group I). Before 1983, for another 80 patients, radiation plus chemotherapy had been prescribed (group II). Nine of 21 patients in group I had an unresectable carcinoma due to an advanced tumor, 9 had an associated severe clinical status, and 3 refused surgery. Out of 80 in group II, 50 had a far advanced tumor, 21 had a poor clinical condition, and 9 refused operation. With regard to staging, for 21 in group I, 6 were classified as Stage I, 5 as Stage II, 7 as Stage III, and 3 as Stage IV. As to the 80 in group II, those in Stage I, II, III, and IV accounted for 8, 22, 39, and 11, respectively. The median doses of each modality, for patients in group I, were 6 times of hyperthermia at 42-45 degrees C for 30 minutes, 40 Gy of X ray and 30 mg of bleomycin. For patients in group II, a median dose of 56 Gy of X ray was given. Response rates determined by esophagograms and endoscopies for the patients in groups I and II were 76.2% (16/21; 4 CRs, 12 PRs) and 39.2% (31/79; 2 Crs, 29 PRs), respectively (p less than 0.001). The effective rates determined by improvement in quality of life (relief of pain and dysphagia) for groups I and II were 61.9% and 37.2%, respectively. A longer survival was obtained for patients in group I (median survival: 9 months vs 6 months). Especially for the patients classified as Stage I, a significantly longer survival was obtained with a combination of hyperthermia, chemotherapy, and radiotherapy (p less than 0.01).

Postoperative long-term immunochemotherapy for esophageal carcinoma - 5 year survival

Two groups of patients with esophageal carcinoma were studied retrospectively: Group I as controls, included 50 patients who underwent esophageal resection mainly combined with preoperative radiation therapy during the period from 1965 to 1971; and Group 2 included 83 patients who were given the same treatment plus post-operative radiation and adjuvant postoperative long-term cancer immunochemotherapy during the period from 1972–1979. The one, two and five-year survival rates were 32.0, 14.0 and 12.0 per cent in Group 1, and 55.4, 35.8 and 21.5 per cent in Group 2 respectively. There were significant differences in one-year (p<0.02) and two-year (p<0.05) survival rates between the two groups. We also found that adjuvant therapy was effective in patients with no lymph node metastasis, while it was less effective in those with lymph node metastases.

Use of intragastric balloons for weight reduction: An experimental study

The effect of intragastric balloons as a noninvasive method for weight reduction was observed in nine castrated Yorkshire pigs. None of the animals lost weight. The appetites of the experimental animals were inhibited for only a short period of time. A significant dilatation of the stomach after balloon insertion was noted which resulted from increased food intake and obliterated the effect of the intragastric balloons. A long-standing lower blood glucose level played an important role in the increments in food intake and dilatation of the stomach. At the same time, ulceration was seen in 83.3 percent of the animals that received balloons. We conclude that intragastric balloon therapy may not be an effective approach for managing morbid obesity in human subjects.

Clinical Efficacy of the Stapled Anastomosis in Esophageal Reconstruction

We have clinically evaluated Russian and American stapling devices used for esophageal reconstruction and compared the results following stapled anastomosis with those following hand-sutured procedures, both performed by the same surgeon. With the Russian stapler, anastomoses performed in 17 patients with carcinoma of the thoracic esophagus resulted in only one (5.9%) anastomotic leak; in 12 hand-sutured anastomoses and in 11 anastomoses done with an American stapler, no anastomotic complication occurred. Thus, a long gastric tube with good blood supply is of paramount importance, and if the technical details of surgical stapling can be overcome, a stapled anastomosis appears to be as safe as a manual suturing for patients undergoing esophageal reconstruction.

Assessment of the blood flow in various gastric tubes for esophageal substitutes

Abstract Comparative studies were done on canine gastric tubes of various widths with the objective of obtaining the maximal blood flow at the proposed area of anastomosis, when the gastric tube was to be used as an esophageal substitute. The left and the right gastric arteries and veins and the short gastric artery and vein were divided, and the lesser curvature side was variously dissected in parallel to the greater curvature. The tissue blood flow, as determined by the hydrogen clearance method, revealed the highest value in the 3-cm-wide gastric tube. The vascular network was well preserved in various sized gastric tubes, except in those of 1.5 cm. These findings suggest that a gastric tube of potential length with a sufficient blood supply can be realized by optimal tailoring.

Combined effects of hyperthermia, bleomycin, and X rays on Ehrlich ascites tumor

The combined effects of water-bath hyperthermia at 42.5 degrees C for 30 min, 1/10 LD50 Bleomycin iv, and 200 rad x irradiation were studied in DDD strain male mice with Ehrlich ascites tumor. The objective was to acquire data on the optimum regimen for a combined administration of these three modalities. The treatments were given 10 days after the inoculation of 2 X 10(6) of the cells into the right hind limb. Concomitant application of the three modalities led to an 80% regression. A single modality produced no significant effect and a 30-50% regression occurred when only two modalities were combined. To assess the influence of timing and sequence, hyperthermia was applied at 1, 2, 4, and 6 hr before, after, or simultaneously with the combination of Bleomycin and 200 rad X ray. A significant effect was obtained in the case of concomitant application of the three and hyperthermia was effective when applied within 2 hr before or after administration of Bleomycin plus irradiation. This enhancement disappeared at 4-hr intervals.

Esophageal carcinoma associated with neurofibromatosis-a case report.

An unusual occurrence of esophageal carcinoma in a 58-year-old man with neurofibromatosis is reported. The patient underwent radical surgery, but died of multiple metastases to the bones, lungs, liver kidneys, adrenal glands and heart shortly after the operation. This paper contributes new information to documented cases of the association of malignancies to neurofibromatosis.

Cytophotometric DNA Analysis of Superficial and Advanced Carcinoma of the Esophagus

With the conventional methods of diagnosis of esophageal cancer, it is very difficult to know preoperatively whether or not the lesion is accompanied by lymph node involvement, which aggravates the prognosis. However, if a technique were available making it feasible to acquire information regarding the malignant potential from biopsy material, this would certainly help us to prescribe adequate treatment and assess the prognosis.

Intraoperative local adjuvant cancer chemotherapy for carcinoma of the thoracic esophagus

Two forms of effective, supplemental, intraoperative chemotherapy for carcinoma of the esophagus have been devised, i.e., Bleomycin (BLM)-Spongel aimed at prevention of a local recurrence and trans-lymphnodal administration of BLM for prevention of recurrence in the intramediastinal lymph nodes. Fifty-one patients given one or both of these local cancer chemotherapy had a lower incidence of local and/or lymph node recurrence in twelve months after surgery than did the controls. As both procedures are simple and there are few adverse effects, further application of this form of chemotherapy is warranted.

Promotion by 12–0-Tetradecanoyl, Phorbol-13-Acetate of Esophageal Carcinogenesis Induced in Rats by N-Methyl-N-Amylnitrosamine

The induction of tumors can generally be divided into two stages, initiation and promotion. Experiments have suggested two-stage carcinogenesis in the induction of liver, urinary bladder, and skin tumor [1–3]. Little is known regarding the induction of esophageal cancer. The promoting effects of phorbol diesters on esophageal carcinogenesis have been given little attention, hence the epidemiologic evidence reported by Hecker [4] has not been supported. We found that 12–0-tetradecanoyl, phorbol-13-acetate (TPA), a potent tumor-promoting phorbol diester, promoted the induction of esophageal tumors in rats initiated with N-methyl-N-amylnitrosamine (MAN). The possibility of two-stage carcinogenesis in esophageal cancer is discussed.