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ABSTRACT: PURPOSE: The imaging factor predicting the response to bevacizumab (BV) as concomitant chemotherapy has yet to be determined. This study examined correlation between response to chemotherapy with concomitant BV for hepatic metastasis of colorectal cancer and degree of contrast enhancement (CE) using contrast-enhanced computed tomography (CT). METHODS: Data were analyzed retrospectively for 35 patients treated with oxaliplatin-based chemotherapy as the first-line chemotherapy. Patient data were divided according to treatment with concomitant BV (BV group: n = 20, non-BV group: n = 15). Using an image control system, the degree of CE was evaluated by the ratio of the contrast-enhanced CT value of hepatic metastatic lesions to plain CT value, whereby patients were classified into the high-CE and low-CE group. RESULTS: After completion of chemotherapy treatment, the degree of enhancement of hepatic metastasis in the BV group was significantly lower than that in the non-BV group (p = 0.03). In the BV group, a significant correlation between higher contrast enhancement and higher tumor shrinkage rate was observed (R (2) = 0.25, p = 0.03), whereas no such correlation was noted in the non-BV group. In the high-CE group (n = 18), the tumor shrinkage rate increased to 29.6 % in the BV group compared with -1.46 % in the non-BV group (p = 0.03), whereas in the low-CE group, no significant difference was noted between patients in the two groups. CONCLUSION: Pretreatment evaluation of the degree of CE correlated with the response to concomitant chemotherapy with BV.
Cancer Chemotherapy and Pharmacology 05/2013; · 2.83 Impact Factor
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Shunichi Shiozawa,
Dal Ho Kim,
Takebumi Usui,
Akira Tsuchiya,
Toshio Masuda,
Satoshi Inose,
Masaki Aizawa, Kazuhiko Yoshimatsu,
Takao Katsube,
Yoshihiko Naritaka,
Kenji Ogawa
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ABSTRACT: To evaluate the reliability of a screening method in patients with common bile duct (CBD) stones before laparoscopic cholecystectomy (LC) based on predictive factors, and to determine the cases for which preoperative therapeutic endoscopic retrograde cholangiography (ERC) is indicated.
Alkaline phosphatase, total bilirubin, amylase, and dilation of CBD results were defined as predictive factors for CBD stones. In cases in which all these 4 factors were negative, preoperative ERC was omitted, and in cases in which 1 of the 4 factors was positive, ERC was performed before LC.
A total of 323 patients (83.7%) in whom all 4 factors were negative, ERC was omitted. In all the 63 patients (16.3%) in whom 1 of the 4 factors was positive, ERC was performed. In 52 (82.5%) of them, CBD stones were present and in 43 of them, LC was performed after endoscopic choledocholithotomy.
For cases in which any 1 of the 4 factors was positive before LC, it was strongly recommended to perform preoperative ERC.
Surgical laparoscopy, endoscopy & percutaneous techniques 02/2011; 21(1):28-32. · 1.23 Impact Factor
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ABSTRACT: We reported previously that spline interpolation is effective as a pretreatment before analyzing clinical data by time series. However, further improvement is required to understand the detailed tendency of clinical data. In this study, the tendency of interpolated hematological data was investigated in the period between the most tolerated dose (MTD) and low-dose chemotherapy (LDC) for colorectal cancer. All patients were received both MTD and LDC. Hematological data, white blood cell count (WBC), red blood cell count (RBC) and mean corpuscular volume (MCV), were interpolated. The accuracy of interpolation was verified using leave-one-out cross-validation. The difference, Δ(i), was calculated from interpolated data and exhibited as a function of time. The predictions of RBC and MCV were accurate with high correlation coefficients, although the interpolation of WBC data was inaccurate. A marked difference was observed in the trend of Δ(i) between LDC and MTD periods. SD-RBC showed significant differences between LDC and MTD periods. The SD-MCV average in the LDC period was larger than in the MTD period. SD-MCV showed no significant difference. An attractor plot of Δ(i) in RBC clarified the tendency of the interpolated RBC data. There is a possibility that Δ(i) of RBC and/or SD-RBC may contribute to monitoring adverse reactions and decision of medication. Moreover, it is also useful to check on attractor plot of Δ(i) in RBC together with SD-RBC in order to find out untoward reactions and decision of medication.
YAKUGAKU ZASSHI 01/2011; 131(5):765-73. · 0.37 Impact Factor
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ABSTRACT: We reported two cases of colorectal cancer patients with EGFR-positive unresectable synchronous liver metastasis effectively treated by cetuximab after the progression of the prior chemotherapy. Case 1: A 49-year-old female with unresectable synchronous liver metastasis from colon cancer received cetuximab monotherapy as fifth-line therapy. Then, abdominal CT showed shrinkage of the liver metastasis (PR) and the performance status was improved from 3 to 0 as upper abdominal pain reduced. Case 2: A 67-year-old female with unresectable liver metastasis from colon cancer received cetuximab with CPT-11 combined therapy as fourth-line therapy. After that, liver metastasis also decreased (PR), and upper abdominal pain and PS were improved from 2 to 0. These two cases of KRAS status on cancer tissue also showed wild-type, and in these cases cetuximab proved effective.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(11):2189-91.
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ABSTRACT: We report here the experience of the treatment with cetuximab in our department. Thirteen patients were treated with cetuximab. Median age was 65-year-old including 8 males and 5 females. Six cases were treated with single administration, and seven were with CPT-11. Median number of treatment was 13 times. In evaluable 9 cases, partial response (PR) was obtained in 3 cases and stable disease (SD) and progressive disease (PD) were in 2 and 4 cases, so that the response rate and disease control rate were 33% and 56%, respectively. Median survival after initiation of cetuximab was 219 days. Skin toxicity was observed in 91% including only one case with grade 3. We think that it is important to control skin toxicity for a continuation of cetuximab.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2249-51.
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ABSTRACT: We report a case of multiple lung and liver metastases from colon cancer treated with clinical benefit by hepatic arterial infusion chemotherapy plus cetuximab mono-therapy after a standard chemotherapy was failed. A 61-year-old female who had sigmoid colon cancer with unresectable multiple lung and liver metastases underwent sigmoidectomy. Bevacizumab plus mFOLFOX6 was performed as first-line therapy. Partial response was obtained temporarily. After the first-line therapy failed, bevacizumab plus FOLFIRI as second-line, and cetuximab plus CPT-11 as third-line therapy were performed. Since these regimens did not work, her performance status got worse by cholangitis due to progressive liver metastases and anemia. Hepatic arterial infusion chemotherapy for liver metastases and cetuximab for lung metastases as fourth therapy were chosen because we thought her liver metastases should be critical for the maintenance of her QOL and diagnosis. After that, serum CEA was reduced from 14,715 to 6,940 ng/mL during the 3 month period. And her performance status got better as cholongitis and anemia were improved. Additionally, lung metastases were controlled by cetuximab.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2526-8.
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Takebumi Usui,
Shunichi Shiozawa,
Dal Ho Kim,
Akira Tsuchiya,
Toshio Masuda,
Satoshi Inose,
Masaki Aizawa, Kazuhiko Yoshimatsu,
Takao Katsube,
Yoshihiko Naritaka,
Kenji Ogawa
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ABSTRACT: Transcatheter arterial chemoembolization (TACE) was performed as the initial therapy for advanced hepatocellular carcinoma (HCC). However, no effective chemotherapy has been established for patients who did not respond to TACE, and for those the therapy was not suitable. Since 2004, transcatheter arterial infusion (TAI) chemotherapy using fine-powder cisplatin has been applied at our department to such cases mentioned before. This report described the therapeutic results of TAI therapy and presented a case of HCC accompanied by portal vein tumor thrombus (PVTT) for which the therapy was effective.
TAI was performed using cisplatin in 16 patients with inoperable advanced HCC between 2004 and 2010. Cisplatin was infused into the proper hepatic artery at a dose of 65 mg/m2 for 30 minutes.
TAI was performed in each patient 1.8 times on average, ranging from 1 to 8 times. Therapeutic Effect 4 (TE4) was obtained in 1 case, TE3 in 2, TE2 in 1, and TE1 in 11 cases. The only severe adverse event rated as grade 3 or above during the study were nausea and anorexia reported in 6.3% of the patients, and adverse events rated as less than grade 2 were increased serum hepato-biliary enzyme levels in 68.8%, nausea in 68.8% of the patients. The overall 1-year survival rate was 31.2%, and the 50% survival period was 314 days.
As a treatment option following the initial TACE therapy for advanced HCC, TAI using cisplatin can improve the prognosis of HCC.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2702-4.
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Yoshihiko Naritaka,
Shinichi Asaka,
Akira Miyaki,
Noriyuki Isohata,
Takeshi Shimakawa,
Kentaro Yamaguchi,
Takao Katsube,
Toko Muraoka,
Shunichi Shiozawa, Kazuhiko Yoshimatsu,
Kenji Ogawa
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ABSTRACT: Nephrotic syndrome associated with a malignant tumor may remit following resection of the tumor. This report documents a case of esophageal cancer with concurrent nephrotic syndrome in which a surgical resection of the tumor resulted in a complete remission of nephrotic syndrome. A 78-year-old male patient noticed edema of his lower legs in February 2009 and was diagnosed with nephrotic syndrome. An endoscopic examination revealed an indented lesion with a nearly semiannular low elevation on the posterior wall of the esophagus at 31 to 34 cm from the upper incisors, and a diagnosis of esophageal cancer was made. A two-stage operation was planned. In March 2009, a subtotal resection of the thoracic esophagus through a right thoracic approach and cervical external esophagostomy were performed, and in April 2009, antethoracic route esophagogastrostomy was performed. The urinary protein levels were negative by the 86th day of hospitalization, and the patient progressively improved and was discharged on the 91st hospital day. There has been no recurrence of esophageal cancer or relapse of nephrotic syndrome at 12 months following the operation. In esophageal cancer patients with nephrotic syndrome, surgical treatment should be undertaken because the remission of nephrotic syndrome may be expected following tumor resection. For this purpose, selecting the appropriate operative procedures and careful perioperative management, including nutritional management, are of profound importance.
Anticancer research 09/2010; 30(9):3763-7. · 1.73 Impact Factor
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Takebumi Usui,
Shunichi Shiozawa,
Dal Ho Kim,
Akira Tsuchiya,
Toshio Masuda,
Satoshi Inose,
Masaki Aizawa, Kazuhiko Yoshimatsu,
Takao Katsube,
Yoshihiko Naritaka,
Kenji Ogawa
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ABSTRACT: We report two cases of advanced hepatocellular carcinoma( HCC) with a portal vein tumor thrombus (PVTT) responding to transcatheter arterial infusion chemotherapy (TAI) using cisplatin (CDDP). Case 1: A 65-year-old male patient was diagnosed with unresectable multiple HCCs. After 5 courses of transcatheter arterial chemoembolization (TACE), the tumor became markedly enlarged, and a PVTT (Vp2) and lymph node metastasis were noted. TAI was conducted as the second- line chemotherapy, and the liver tumor, PVTT, and lymph node metastasis shrank. The clinical response was rated as a partial response (PR). Case 2: A 72-year-old female patient was diagnosed with single HCC. After a course of TACE, the tumor became markedly enlarged and was accompanied by a PVTT (Vp4). TAI was performed as the second-line chemotherapy, and the liver tumor and PVTT significantly shrank. The clinical response was also rated as a PR. TAI using CDDP as the second-line chemotherapy for advanced HCC is a promising treatment likely to contribute to the improvement of the patient's prognosis.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2359-61.
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ABSTRACT: Schwannomas occurring in the gastrointestinal tract are rare, and among them, schwannomas of the large intestine are extremely rare. In this paper, we report a case of a macroscopically atypical schwannoma of the transverse colon. The case is a female aged 67. Stool occult blood test was positive, and colonoscopy revealed a protruded lesion resembling a type 1 carcinoma measuring 4 cm with a reddish and uneven surface on the transverse colon. The surface was smooth and lobulated in observation with indigo carmine spray, and granulation tissue was revealed by biopsies. CT of the abdomen showed an irregular mass, and clinical examinations could not rule out malignancy. Therefore, partial transverse colectomy with peripheral lymph node dissection was performed. Histologically, proliferation of spindle cells was observed originating from the muscularis propria, and most of the upper part of the lesion was replaced by granulation tissue. In immunohistochemical staining, S-100 protein and NSE were positive while KIT, CD34, desmin and smooth muscle actin were negative, and the tumor was therefore diagnosed to be a schwannoma. In addition, since the MIB-1 labeling index was low and virtually no mitosis was observed, it was diagnosed as benign tumor.
Case Reports in Gastroenterology 01/2009; 3(1):116-120.
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Yuki Hiramatsu, Kazuhiko Yoshimatsu,
Hajime Yokomizo,
Takashi Fujimoto,
Taisuke Otani,
Atsuo Matsumoto,
Gakuji Osawa,
Kiyo Watanabe,
Arihiro Umehara,
Noriyuki Isohata,
Kenji Ogawa
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ABSTRACT: We herein report a case of successful treatment with OK-432 administration into lymphatic cyst formed after resection of rectal cancer. A 61-year-old male patient underwent a very low anterior resection with D3 lymphadenectomy for locally advanced rectal cancer. Four months after the surgery, he arrived at our department with lower abdominal fullness. He was diagnosed as having bilateral intra-pelvic abscess by CT scan, and underwent a tube-drainage. After drainage, abscess lesions were shrunk, but a serous discharge remained. Because we diagnosed lymphatic cysts caused by the delayed lymphatic discharge after lymphadenectomy, an administration of OK-432 into cysts was performed. After administration, the discharge was decreased, and then fistula was closed.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2008; 35(12):2162-4.
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ABSTRACT: We analyzed the relationship between A-L score classified by serum albumin level and lymphocytes/white blood cells ratio and clinicopathological features in patients with Stage IV colorectal cancer. Seventy-nine patients were classified by the A-L score. In lower-scored cases, the populations of elderly patients, patients with emergency operation and patients with poorer PS were increased. Additionally, the 2-year survival rate was decreased as low as A-L score. In the multivariate analysis, the A-L score was independent prognostic factor in Stage IV colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2008; 35(12):2256-8.
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ABSTRACT: Phase I study of combination therapy with peptide vaccine and anti-cancer drug for colorectal cancer has been performed in our hospital. The purpose of this study was to evaluate the safety and immune response of different dose of RNF43-721 emulsified with Montanide ISA 51 in combination with S-1/CPT-11 chemotherapy. The study design was a dose escalation of peptide (0.5, 1.0, 3.0 mg) with three patients' cohort. Nine patients were enrolled. All patients were treated with peptide subcutaneously every week and two courses with S-1/CPT-11 chemotherapy. Vaccinations were well tolerated without any major adverse events. Immunological reactions are not analyzed yet. We herein report a case who has been evaluated to be long SD with this intervention for para-aortic LN metastasis from sigmoid colon cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2008; 35(12):2268-70.
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ABSTRACT: We are performing a phase I clinical trial of combination-therapy with gemcitabine and epitope peptide derived from human vascular endothelial growth factor receptor (VEGFR) for advanced pancreas cancer. The aim of this study was to evaluate the safety, immunological response and tumor response. Six patients have been enrolled at present. During the clinical course, no major adverse events were observed. Additionally, two out of 6 cases showed a minor shrinkage of the tumor. Immunological response has not been analyzed yet. These results indicated that a combination-therapy with gemcitabine and epitope peptides derived from VEGFR could be tolerable.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2008; 35(12):2271-3.
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ABSTRACT: Bevacizumab, a humanized monoclonal antibody to VEGF for advanced recurrent colorectal cancer, has been known for complications of gastrointestinal perforation, hemorrhage, thromboembolism and proteinuria, as adverse effects. These findings must be taken care as well as adverse drug reactions (ADR) caused by combination chemotherapy. We here in present a clinical experience in treatment with bevacizumab for unresectable colorectal cancer. Six patients treated with bevacizumab for over two courses until April 2008 were analyzed for this study. PR was obtained in one case with mFOLFOX6. Even though, grade 3 neutropenia was observed in only one case with FOLFIRI, the other cases had grade 2 or less in ADR. In addition, there were no any specific ADRs related with bevacizumab, so we concluded that combination chemotherapy for advanced recurrent colorectal cancer with bevacizumab was well-tolerated.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2008; 35(12):2274-6.
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ABSTRACT: Granulysin is a cytotoxic granule protein of cytotoxic T-lymphocytes and natural killer cells. Gastric cancer patients of stage II and stage III were reported to have pre-operative serum granulysin, which is a good prognostic factor. Activated T lymphocytes produce a lot of granulysin in the cell. We hypothesized that activated T lymphocytes transfer therapy may increase in serum granulysin leveles of stage IV and relapsed patients.
Between April 2002 and December 2007, the patients received a standard therapy with activated lymphocytes transfer therapy. Peripheral blood samples were taken from the patients. Serum granulysin concentrations were measured using a granulysin-specific ELISA kit.
The average serum granulysin level for Stage IV (n=29) and relapsed patients (n=13) was 3.3 ng/mL. The gastric cancer patients were classified into two groups based on their concentration of serum granulysin level: high group (> or = 3.3 ng/mL); low group (< 3.3 ng/mL). There were no significant differences between these two groups in gender and age. The stage IV high group had a longer survival time than the stage IV low group. After 60 days from the activated T lymphocytes transfer therapy, the average pre-treatment serum granulysin had increased. However, there was no significant difference to note. It is noteworthy that serum granulysin is a novel parameter of patients cancer immunity.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2008; 35(12):2262-4.
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Masano Sagawa,
Takao Katsube,
Soichi Konno,
Minoru Murayama,
Kentarou Yamaguchi,
Noriyuki Isohata, Kazuhiko Yoshimatsu,
Shunichi Shiozawa,
Takeshi Shimakawa,
Yoshihiko Naritaka,
Kenji Ogawa
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ABSTRACT: We evaluated the role of the prognostic nutritional index reported by Onodera (Onodera's PNI) in patients with gastrointestinal cancer regarding the occurrence of postoperative complications.
Subjects were 324 patients (42 with esophageal cancer, 107 with gastric cancer, and 175 with colon cancer). We classified them into the high risk group (< or = 40) and the non-high risk group (> 40) according to Onodera's PNI. We evaluated the rate of the occurrence of postoperative complications between the high risk group and the non-high risk group.
The rate of postoperative complications occurring in the high risk group was higher than that of the non-high risk group (p=0.04).
Onodera's PNI is useful for patients with gastrointestinal cancer regarding the occurrence of postoperative complications.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2008; 35(12):2253-5.
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ABSTRACT: Non-curative resection for cholangiocarcinoma usually leads to a poor prognosis. We present a case successfully treated with gemcitabine for residual tumor after extra hepatic bile duct resection with positive surgical margin. The patient was a 77-year-old male who was diagnosed as having a common bile duct cancer. Extra hepatic bile duct resection was performed, but intraoperative pathology diagnosed the surgical margin of duodenal-side bile duct was positive for cancer. Although additional resection of bile duct was done, pathological diagnosis resulted in positive margin again. We had to avoid pancreatoduodenectomy in light of the patient's wishes, so a curative resection could not be carried out. Adjuvant chemotherapy with gemcitabine(800 mg/m2 on days 1, 8 and 15 every 4 weeks)was started at the seventh postoperative day. A residual lesion was shown in the pancreas head by abdominal CT after 2 courses of chemotherapy. Follow-up CT was performed every 6 months, and the lesion gradually seemed to become unclear. Finally, CT showed disappearance of the residual lesion 28 months after surgery. The chemotherapy has been continued up to the present(3 years and 5 months after surgery). No evidence of recurrence nor adverse events of WHO grade 2 or more has been observed.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2008; 35(7):1229-31.
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ABSTRACT: We present a case of interstitial pneumonitis induced by gemcitabine. The patient was a 48-year-old male who underwent pancreaticoduodenectomy with portal vein resection for ductal adenocarcinoma of the pancreas head. Twenty-two days after operation, adjuvant chemotherapy with gemcitabine(1,000 mg/m(2) on days 1, 8 and 15 every 4 weeks)was started. During three courses of chemotherapy, no adverse event of WHO grade 2 or more was observed. Seven days after the last infusion, fever and consciousness disorder emerged without respiratory symptoms. Arterial blood gas analysis revealed severe hypoxemia. Chest X-ray and CT showed diffuse bilateral interstitial infiltrates. Oxygenation and respiratory support were immediately given, and steroid pulse therapy with 1,000 mg/day of methylprednisolone was started. His symptoms and radiolographical findings were dramatically improved. The patient could be discharged on the 14th day after admission. Acute pulmonary toxicity induced by gemcitabine is rare, but could lead to severe complications. The review of reported cases showed the effectiveness of corticosteroid therapy for pulmonary toxicity due to the agent.
Gan to kagaku ryoho. Cancer & chemotherapy 02/2008; 35(1):133-6.
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ABSTRACT: We herein report a case of long-term surviving patient who was treated with intravenous administration of activated autologous lymphocytes and low-dose chemotherapy. The patient was an 82-year-old female. She underwent radical resection for sigmoid colon cancer in 1998 and right lobectomy of the liver for metastatic liver tumor in 2001. A follow up CT revealed the metastasis to the bilateral lung on November 2003. Then she received a treatment with UFT plus low-dose CPT-11/CDDP and activated autologous lymphocytes. Although the response of the treatment was SD, the serum CEA level decreased to a normal range. The treatment continued with delayed administration for 30 months while CEA and the size of the tumors increased very slowly. After that, her treatment was changed with a single administration of S-1. She obtained a 3.5 year survival with an inhibition of fast tumor growth by chemo-immunotherapy.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2007; 34(12):1899-901.
