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Kensuke Kumamoto,
Keiichiro Ishibashi,
Satoshi Hatano,
Kunihiko Amano, Kouki Kuwabara,
Tomonori Ohsawa,
Norimichi Okada,
Yoichi Kumagai,
Hiroyuki Baba,
Yoshitaka Tsuji,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Recent advances in chemotherapy for stage IV colorectal cancer have improved clinical outcome. According to the seventh edition of the TNM classification of colorectal cancer, stage IV is classified into stage IVA and stage IVB. In this study, we assessed the clinical validity of this classification as a prognostic factor. The subjects were 170 patients with stage IV colorectal cancer(stage IVA, n=78; stage IVB, n=92)treated between January 2006 and December 2011 at our institute. Of 92 patients with stage IVB, peritoneal carcinomatosis alone was recognized in 21 patients. The median survival periods for patients with stage IVA and IVB were 29.2 and 16.1 months, respectively( p=0.13). The median survival period for patients with peritoneal carcinomatosis alone was 37.6 months, and there was no difference between survival in patients with stage IVA and those with peritoneal carcinomatosis alone. Our present results suggest that it may be reasonable and useful to classify peritoneal carcinomatosis alone into stage IVA instead of stage IVB in clinical practice.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2164-6.
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Norimichi Okada,
Keiichiro Ishibashi,
Tomonori Ohsawa,
Jun Sobajima, Kouki Kuwabara,
Kunihiko Amano,
Satoshi Hatano,
Okihide Suzuki,
Kensuke Kumamoto,
Yoichi Kumagai,
Hiroyuki Baba,
Norihiro Haga,
Yoshitaka Tsuji,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Purpose: This retrospective study was undertaken to examine the usefulness of Köhne's index(KI) for predicting the efficacy of first-line oxaliplatin-based chemotherapy for unresectable liver metastases of colorectal cancer. Patients and methods: The subjects were 84 patients with unresectable liver metastases of colorectal cancer in whom first-line oxaliplatin- based chemotherapy was administered. The outcome of treatment was analyzed in relation to the KI. Results: The patients were classified into 3 groups: high risk group (n=12), intermediate risk group (n=20), and low risk group (n=52). There were no significant differences between the groups with regard to response rate, disease control rate, disease-free survival, overall survival, and the rate of conversion to hepatic metastatectomy. Conclusion: Our results suggest that KI might not be useful for predicting the efficacy of first-line oxaliplatin-based chemotherapy for unresectable liver metastases of colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2195-7.
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Keiichiro Ishibashi,
Norimichi Okada,
Yusuke Tajima,
Kunihiko Amano,
Satoshi Hatano, Kouki Kuwabara,
Jun Sobajima,
Toru Ishiguro,
Tomonori Ohsawa,
Kensuke Kumamoto,
Yoichi Kumagai,
Hiroyuki Baba,
Yoshitaka Tsuji,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: The aim of this retrospective study was to analyze the predictive value of Köhne's index on the efficacy of FOLFIRI regimen in the treatment of unresectable liver metastasis of colorectal cancer. The subjects were 44 patients with unresectable liver metastasis from colorectal cancer treated with FOLFIRI regimen as second-line, for all of whom oxaliplatin-based regimen had previously failed. Bevacizumab was concomitantly used in 23 patients. Classification of the Köhne's index revealed high risk in 22 patients, intermediate risk in 7 patients, and low risk in 15 patients. The response rate was 13.6% in the patients with high risk(H group) and 27.3% in the patients with intermediate or low risk(non-H group)(p=0.45). The disease control rate was 50% in the H group and 68.2% in the non-H group (p=0.36). In the H group, the median progression -free survival time was 4.1 months and in the non-H group it was 7.1 months (p=0.33). Compared with the H group, the non-H group showed significantly better overall survival (10.8 months vs 23.9 months, p=0.03). None of the patients has received hepatectomy (conversion therapy). These results suggest that the predictive value of Köhne's index is limited in terms of the effect of shrinkage of liver metastases, including conversion therapy.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2182-4.
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Hideko Imaizumi,
Keiichiro Ishibashi,
Norimichi Okada,
Yusuke Tajima,
Kunihiko Amano,
Satoshi Hatano, Kouki Kuwabara,
Jun Sobajima,
Toru Ishiguro,
Tomonori Ohsawa,
Kensuke Kumamoto,
Yoichi Kumagai,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: The clinical outcomes, including adverse events, in 34 unresectable advanced colorectal cancer patients with wild-type K-ras, who were treated with bevacizumab and oxaliplatin-based chemotherapy as a first-line treatment, were analyzed for confirmation of the effectiveness and safety of this treatment. The response rate of the patients was 44% (complete remission, 2 patients; and partial remission, 13 patients). The median progression-free survival and overall survival in these patients was 11.1 and 25.1 months, respectively. Adverse events of greater than grade 3 were observed in 18 patients. Of these patients, 10 exhibited grade 3/4 neutropenia, and 6 had peripheral neuropathy. Our results were similar to those of randomized phase III trials from abroad, including those using anti-epidermal growth factor receptor antibody, with respect to effectiveness and safety. Furthermore, patients with liver metastasis had poor prognosis compared to those with metastasis to organs other than the liver. Further analysis will be required to better understand these results.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2185-8.
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Kunihiko Amano,
Kensuke Kumamoto, Kouki Kuwabara,
Toru Ishiguro,
Tomonori Ohsawa,
Norimichi Okada,
Yoichi Kumagai,
Hiroyuki Baba,
Keiichiro Ishibashi,
Yoshitaka Tsuji,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: We examined alterations in the level of serum anti-p53 antibody(S-p53 Ab) in colorectal cancer patients who underwent curative resection and analyzed the usefulness of S-p53 Ab as a monitoring marker for postoperative observation. The measurement of S-p53 Ab was performed preoperatively and postoperatively in 16 stage II/III colorectal cancer patients with a high level of S-p53 Ab. A time course analysis of both S-p53 Ab and CEA levels was performed in 6 of these patients who were carcinoembryonic antigen (CEA) positive. The median S-p53 Ab level was 29.9 U/mL and the half-life of the S-p53 Ab level was 40.3 days. In 4(25%) cases, the level of S-p53 Ab recovered to within normal limits by 79-142 days. When the half-lives of S-p53 Ab and CEA were analyzed in 6 patients who were both S-p53 Ab and CEA positive, the half-lives of S-p53 Ab and CEA were 32.3 and 13.2 days, respectively. In the case of recurrence with liver metastasis after resection of ascending colon cancer, the S-p53 Ab level did not respond quickly while the CEA level increased. Therefore, it is difficult to use the level of S-p53 Ab as a marker for monitoring treatment, and priority should be given to the examination of CEA and imaging modality.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2170-2.
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Satoshi Hatano,
Keiichiro Ishibashi,
Kunihiko Amano,
Toru Ishiguro, Kouki Kuwabara,
Jun Sobajima,
Tomonori Ohsawa,
Norimichi Okada,
Yoichi Kumagai,
Kensuke Kumamoto,
Hiroyuki Baba,
Yoshitaka Tsuji,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Purpose: This retrospective study evaluated the outcome of adjuvant chemotherapy comprising modified FOLFOX6 (mFOLFOX6) after potentially curative metastasectomy from colorectal cancer. Patients and methods: The subjects were 40 patients with colorectal cancer who underwent potentially curative metastatectomy without any prior chemotherapy between December 2003 and November 2011. Patient background, type of adjuvant chemotherapy, and prognosis were examined. Results: Adjuvant chemotherapy was given in 30 patients (mFOLFOX6, n=26; oral fluoropyrimidines, n=4). The median relapse-free survival tended to be longer in patients treated with mFOLFOX6 compared to those treated with fluoropyrimidines (28.5 months vs 14.8 months; p=0.11). The median overall survival did not differ significantly between the 2 groups (37.9 months vs 31.3 months, p=0.56). When the analysis was restricted to patients treated with mFOLFOX6, no significant differences were found in relapse-free survival (p=0.46), overall survival (p=0.29), and frequency of adverse events during chemotherapy(Grade 3, p=0.32) between patients with synchronous metastasis(n=11) and those with metachronous metastasis (n=15). Conclusion: These results suggest that mFOLFOX6 might contribute to prolonging the time to relapse and that the timing of developing metastasis(synchronously or metachronously) may not have any effect on the outcome of adjuvant mFOLFOX6.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2192-4.
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[show abstract]
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ABSTRACT: We investigated the usefulness of serum anti-p53 antibody (anti-p53) measurement for the diagnosis of colon cancer. carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and anti-p53 were measured by enzyme-linked immunosorbent assay in 375 colorectal cancer patients and 115 healthy volunteers(control group). When the cut-off level of the serum anti-p53 antibody was set to 1.3 U/mL, 114 (30.4%) of the colorectal cancer patients tested positive. Twelve positive cases(10.4%) were recognized in the control group. The median levels of anti-p53 were 0.69 U/mL(0.69- 10,610) and 0.69 U/mL (0.69-19.5) in the colorectal cancer patients and control group, respectively. The positive rates of CEA level (cut-off value 6.7 ng/mL) and CA19-9 level (cut-off value 37 U/mL) were 40.0% and 18.9%, respectively. Of these tumor markers, positive cases with only anti-p53 were observed in 60 patients (16%). The positive rate of all markers examined was 61.6%. No significant correlation was observed between the level of anti-p53 and other markers. The positive rates of anti-p53 in each stage of the colon cancer patients were as follows: stage 0 and I, 19.4%; stage II, 27.0%; stage III,36.1%; and stage IV,61.0%. The positive rate of anti-p53 was higher than that of CEA and CA19-9 in the early stages of colorectal cancer. Furthermore, a combination of these markers improved the diagnosis of colorectal cancer by approximately 60%. These results suggest that the measurement of anti-p53 is useful for diagnosis of colorectal cancer in clinical practice.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2167-9.
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Keiichiro Ishibashi,
Kensuke Kumamoto, Kouki Kuwabara,
Naoko Hokama,
Toru Ishiguro,
Tomonori Ohsawa,
Norimichi Okada,
Tatsuya Miyazaki,
Masaru Yokoyama,
Yoshitaka Tsuji,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: We retrospectively evaluated the usefulness of sennoside as an agent for mechanical bowel preparation prior to elective colon cancer surgery.
A total of 86 patients were given 12 mg of sennoside on the evening prior to resective surgery for colon cancer, followed by intravenous antimicrobial prophylaxis used on the day of surgery or until postoperative day 2.
The incidence of surgical site infection in the study group was 4.7%, which was comparable to that in the historical control patients (3.5%, p>0.99), who had received polyethylene glycol for mechanical bowel preparation prior to colon surgery. On multivariate logistic regression analysis, only body mass index (p=0.04) was an independent significant factor affecting the surgical site infection. The intraoperative spillage was not influenced by the presence of stenosis, although the amount of fecal matter was higher in the upstream colon segment (p<0.01) and downstream segment (p=0.07) in patients with a stenotic lesion occupying more than two-thirds of the lumen (n=29) than in those without such severe stenosis (n=57).
Sennoside seems to be an acceptable agent for mechanical bowel preparation even in patients with stenosis.
Asian Journal of Surgery 04/2012; 35(2):81-7. · 0.57 Impact Factor
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Hiroaki Honjou,
Keiichiro Ishibashi,
Norimichi Okada,
Yusuke Tajima,
Toru Ishiguro, Kouki Kuwabara,
Tomonori Ohsawa,
Kensuke Kumamoto,
Yoshitaka Tsuji,
Norihiro Haga,
Takeo Iwama,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Only a few reports have suggested the efficacy of adjuvant chemotherapy including oxaliplatin based regimens following surgical resection of liver metastases from colorectal cancer. Since an administration of mFOLFOX6 was approved to medical insurance for advanced colorectal cancer as adjuvant chemotherapy, we applied mFOLFOX6 treatment (6 to 12 courses) to the patients who underwent curative resection of colorectal liver metastasis. The subjects were 14 patients who underwent curative resection for synchronous or metachronous colorectal liver metastasis and received mFOLFOX6 treatment postoperatively from January 2006 to January 2011. We retrospectively analyzed the patient's characteristics, relapse free survival, overall survival, and adverse events in these patients. Synchronous liver metastasis was found in 5 patients, while metachronous liver metastasis was observed in 9 patients. There were no significant differences between these patients in terms of clinical characteristics, the relapse free survival and overall survival. All patients had some adverse events including bone-marrow suppression and diarrhea. Especially, grade 3 or higher bone-marrow suppression were recognized in 6 patients (42.8%). Neurologic toxicity (≤ grade 2) was observed in 10 patients (71.4%). Adjuvant chemotherapy with mFOLFOX6 treatment following surgical resection of synchronous or metachronous liver metastasis was safely administered. We will further examine the benefit of mFOLFOX6 treatment for the patients who undergo a surgical resection of liver metastasis in the future.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2216-9.
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Keiichiro Ishibashi,
Norimichi Okada,
Yusuke Tajima,
Toru Ishiguro, Kouki Kuwabara,
Tomonori Ohsawa,
Kensuke Kumamoto,
Yoshitaka Tsuji,
Norihiro Haga,
Takeo Iwama,
Hideyuki Ishida,
Tsuneko Onouchi,
Koji Yakabi
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to determine whether mRNA levels of thymidylate synthase (TS), excision repair cross-complementing -1 (ERCC-1), excision repair cross-complementing-2 (ERCC-2) and methylenetetrahydrofolate dehydrogenase( MTHFD) mRNA in the primary tumor could predict a tumor response in patients with unresectable liver metastasis from colorectal cancer treated with mFOLFOX6 therapy as a first-line treatment. Eighteen patients with unresectable liver metastasis from colorectal cancer treated with mFOLFOX6 therapy as a first-line treatment were enrolled in this study. There were no significant differences between the response rate and these enzymes mRNA levels. In ERCC-1 and MTHFD mRNA expression, the progression-free survival time tended to be longer in patients with low levels than in patients with high levels( ERCC-1: p=0.08, MTHFD: p=0.07). The progression-free survival time was significantly longer in patients with both ERCC-1 and MTHFD mRNA were low levels than in patients with other( p=0.03). The levels of ERCC-1 and MTHFD were low in patients who could perform a conversion therapy. There were no significant differences between an overall survival time and these enzymes mRNA levels. In this study, the ERCC-1 and MTHFD mRNA expression may be useful for the prediction of progression-free survival time in patients with unresectable liver metastasis from colorectal cancer treated with mFOLFOX6 therapy.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2220-3.
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ABSTRACT: It has been reported that thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP), and excision repair cross-complementing-1 (ERCC-1) were useful markers to predict the efficacy of anti cancer agents including 5-fluorouracil (5-FU) and oxaliplatin for unresectable advanced colorectal cancer. In this study, we analyzed the relationship between the expression of these enzymes and the clinical significance in 49 Stage IV colorectal cancer patients who received mFOLFOX6 as a first-line treatment and evaluated the usefulness of these enzymes for predicting the efficacy of mFOLFOX6. There was no relationship between the expression of each enzyme and response rate. The progression-free survival of the patients with low TP expression was significantly longer than that of the patients with high TP expression( p<0.01). In the analysis of overall survival, the patients with low TP or low DPD expression were better than that with high TP expression or high DPD expression (p=0. 04, p=0. 04, respectively). Our results indicated that TP and DPD expression would be a useful marker to predict the efficacy of mFOLFOX6 in the patients with unresectable colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2224-7.
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ABSTRACT: To evaluate the impact of prior abdominal surgery on curative resection of colon cancer via a minilaparotomy approach.
Feasibility, safety, and oncological outcomes were evaluated retrospectively in 263 patients scheduled to undergo curative resection of colon cancer via a minilaparotomy approach, defined as a skin incision of ≤ 7 cm, between September 2000 and March 2009.
Abdominal adhesions were found in 59 (77.6%) of 76 patients who had undergone prior abdominal surgery (PAS group) and in 4 (2.1%) of 187 patients who had not (control group). The success rate of the minilaparotomy approach was 92.1% in the PAS group and 97.3% in the control group (P = 0.08). The incidence of extending the minilaparotomy wound for adhesiolysis was significantly higher in the PAS group than in the control group (6.6% vs 0.5%; P < 0.01). The two groups did not differ significantly in terms of the types of surgery, pathological stage, body mass index, operative time, blood loss, incidence of postoperative complications, length of postoperative hospital stay, and disease-free survival.
These results suggest that prior abdominal surgery might require an extension of the minilaparotomy incision but that it does not seem to contraindicate a minilaparotomy approach for curative colectomy.
Surgery Today 03/2011; 41(3):369-76. · 1.22 Impact Factor
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Keiichiro Ishibashi,
Norimichi Okada,
Toru Ishiguro, Kouki Kuwabara,
Tomonori Ohsawa,
Masaru Yokoyama,
Kensuke Kumamoto,
Norihiro Haga,
Takashi Mori,
Hirofumi Yamada,
Ichiro Miura,
Junichi Tamaru,
Shinji Itoyama,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Thymidylate synthase (TS) and excision repair complementing-1 (ERCC-1) were known to be important biomarkers to predict a tumor response to 5-fluorouracil (5-FU) and oxaliplatin, but the relationship between these expressions and tumor response were still unclear. The aim of this study was to determine whether the expression of TS and ERCC-1 protein predict a tumor response in patients with unresectable colorectal cancer treated with mFOLFOX6 therapy as first-line treatment. Fifty patients with unresectable colorectal cancer treated with mFOLFOX6 therapy were enrolled in this study. The expression of TS and ERCC-1 protein in primary cancer cells were examined using immunohistochemistry. There were no significant differences between response rate and the expression of TS or ERCC-1 protein (TS: p>0.99, ERCC-1: p= 0.50). There were no significant differences between progression-free survival time and the expression of TS or ERCC-1 protein (TS: p=0.60, ERCC-1: p=0.60). In this study, the expression TS and ERCC-1 protein may not be useful for the prediction of tumor response in patients with unresectable colorectal cancer treated with mFOLFOX6 therapy.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2532-5.
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Norimichi Okada,
Keiichiro Ishibashi,
Tomonori Ohsawa,
Jun Sobajima, Kouki Kuwabara,
Toru Ishiguro,
Kunihiko Amano,
Satoshi Hatano,
Naoko Hokama,
Yusuke Tajima,
Masatsugu Ishii,
Youzou Yokoyama,
Azusa Yamamoto,
Kensuke Kumamoto,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Clinical path for executing mFOLFOX6 in an outpatient chemotherapy room was settled on for the aim of standardization and common information with medical staffs about mFOLFOX6. The feature of this clinical path is described doses of drugs, results of laboratory examination, criteria for deciding adverse effects, common adverse effects and management, criteria for reduction and suspension of oxaliplatin and 5-fluorouracil. Patients before induction of the clinical path were compared with patients after that about relative dose intensity (RDI), reasons why treatments were suspended and progression-free survival (PFS). Fifty eight patients after induction were significantly higher RDI of oxaliplatin than 108 patients before induction (p=0.04). There were no significant differences about a frequency of suspension due to adverse effects (p=0.18) and PFS (p=0.74). The clinical path that we settled on was considered useful not only for common information with medical staffs but also for standardization.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2588-90.
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Kouki Kuwabara,
Toru Ishiguro,
Tomonori Ohsawa,
Jun Sobajima,
Satoshi Hatano,
Kunihiko Amano,
Norimichi Okada,
Kensuke Kumamoto,
Keiichiro Ishibashi,
Norihiro Haga,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: Since July 2000, we have been performing minilaparotomy as a minimally invasive alternative to laparoscopic surgery for colon cancer, and we reported the technique and short-term oncological results. In the present study, the clinical outcomes of minilaparotomy approach for curative resection of stage 0 and I colon cancer were evaluated. One hundred twenty-seven patients underwent curative resection of stage 0 and I colon cancer via minilaparotomy (skin incision, ≥7 cm) between July 2000 and March 2009. Of the 127 patients, 17 patients underwent an additional resection after EMR. There were 84 men and 43 women with a median age of 67 years. Their median body mass index was 22.6 kg/m2. ASA stage was stage I in 100, stage II in 12, and stage III in 15. Thirty-nine cases had received a prior abdominal surgery. The median operation time was 110 min and median blood loss was 50 mL. The D1, D2 and D3 lymph node dissection was performed in 37, 63 and 27 cases, respectively. The minilaparotomy approach was successfully performed in 120 out of 127 patients. Three of 7 cases failed to affect the adhesion caused by prior abdominal surgery. The ratio of 5-year overall survival rate was 95%, and two cases of stage I had developed a tumor recurrence (metastasis to liver and para-aortic lymph nodes), one patient died of para-aortic lymph nodes recurrence. A minilaparotomy approach to the curative resection for colon cancer is feasible and safe, and would be oncologically an adequate procedure.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2601-4.
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ABSTRACT: This retrospective study was performed to examine the frequency of PSK administration in patients with Stage III rectal cancer in clinical practice, and the effect of PSK on patient outcome. The subjects were 71 patients with Stage III rectal cancer who received postoperative adjuvant chemotherapy comprising fluoropyrimidines between April 1997 and March 2006. The frequency of PSK administration and factors affecting recurrence, disease-free survival, and overall survival were examined. The frequency of concomitant use of PSK with fluoropyrimidines was 79% (56 patients). Among the patients who were given PSK, the frequency of concomitant use of UFT alone was higher in Stage III a patients, while the rate of concomitant use of fluoropyrimidines and Leucovorin was higher in Stage III b patients (p<0.01). Multivariate analyses revealed that the only predictive factor affecting recurrence, disease-free survival, and overall survival was Stage III b. Although the rate of concomitant use of PSK in adjuvant chemotherapy for patients with Stage III rectal cancer was high, we did not evaluate the effect of PSK because there was a marked bias in relation to the subclassification of Stage III disease and the use of Leucovorin in these subjects. Prospective randomized trials with stratification of Stage III disease will be needed in the future to validate the efficacy of PSK.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):1975-8.
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Norimichi Okada,
Keiichiro Ishibashi,
Masaru Yokoyama, Kouki Kuwabara,
Satoshi Hatano,
Masatsugu Ishii,
Shou Kubota,
Noriyasu Chika,
Jun-ichi Tamaru,
Tatsuya Miyazaki,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: This retrospective study was performed to examine the outcomes of patients with liver metastasis of colorectal cancer, who received mFOLFOX6 regimen prior to hepatic metastatectomy. The reasons for introducing mFOLFOX6 prior to hepatectomy were unresectable hepatic lesions in two patients, presence or suspicion of extrahepatic lesions in four patients, and patient's refusal for hepatectomy in one patient. The mean number of cycles of administering mFOLFOX6 was 12.7 (range 10-18), two patients received additional FOLFIRI regimen after mFOLFOX6 treatment. The therapeutic efficacy revealed complete response in two, partial response in two, and stable disease in two by RECIST criteria. Histological examination revealed that six from 15 resected nodules were classified into grade 3. Histological examination of the non-cancerous liver tissue revealed stage I sinusoidal dilation (Rubbia-Brandt's classification) in five and grade 1 steatohepatitis (Brunt's classification) in two who received additional FOLFIRI regimen. Blood loss and duration of surgery of the subjects were identical to those (n=17) who underwent hepatic metastatectomy without preoperative chemotherapy during the same study period. It does not seem easy to determine the optimal timing of hepatic metastatectomy after FOLFOX treatment in clinical practice. However, our results suggest that preoperative FOLFOX treatment may have little adverse impact on the safety of hepatic metastatectomy.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2028-31.
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[show abstract]
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ABSTRACT: This retrospective study was performed to clarify whether or not ovarian metastasis from colorectal cancer should be classified into peritoneal metastasis. We compared patient background data and prognosis between patients with ovarian metastasis (ovarian group, n=16) and female patients with peritoneal metastasis without involving ovaries (peritoneal group, n=22) treated between 1998 and 2008. The two groups did not significantly differ in terms of other clinicopathological factors evaluated. The median overall survival period was 13.8 months for the ovarian group and 16.7 months for the peritoneal group (p=0.96). The 3-year overall survival rate was 48.6%, 46.9%, and 11.5% for patients with ovarian metastasis only (P2), those with minute peritoneal metastasis without involving ovaries (P1), and those with multiple (numerous) peritoneal metastasis without involving ovaries (P3) (p=0.13), respectively. These results suggest that it is valid to classify ovarian metastasis as peritoneal metastasis. However, further collection of data may be needed to conclude that solitary ovarian lesion(s) would be classified into P2.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2257-9.
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Norimichi Okada,
Keiichiro Ishibashi, Kouki Kuwabara,
Toru Ishiguro,
Satoshi Hatano,
Naoko Hokama,
Yusuke Tajima,
Masatsugu Ishii,
Shou Kubota,
Noriyasu Chika,
Tatsuya Miyazaki,
Hideyuki Ishida
[show abstract]
[hide abstract]
ABSTRACT: We examined 155 patients who received a first-line modified FOLFOX6 ( mFOLFOX6) regimen for unresectable or recurrent colorectal cancer regarding oxaliplatin-related allergic reactions and prognosis of patients who developed such allergic reactions. Twenty eight patients (18.1%) developed a total of 44 allergic reactions (2.9%): The first allergic reactions were grade 1 in nine, grade 2 in seventeen, and grade 3 in two. The median number of cycles of mFOLFOX6 until the first allergic reaction was 8.5 (range, 1-25). Compared with non-allergic group patients (n=127), allergic group patients (n=28) had mFOLFOX6 regimen more frequently (p=0.01) and higher rate of introduction to second-line FOLFIRI regimen (p<0.01). When analysis was restricted to patients who were given a second-line FOLFIRI regimen, the response rate and disease control rate associated with FOLFIRI treatment did not differ significantly between the two groups. However, the allergic group patients tended to show longer disease-free survival (p=0.16) and showed longer overall survival after the start of second-line treatment (p=0.03). In addition, the allergic group patients showed a longer overall survival after the start of mFOLFOX6 (p=0.03). These results suggest that allergic reactions in the first-line mFOLFOX6 treatment might not be a poor prognostic factor, considering the efficacy of second-line FOLFIRI regimen.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):1985-7.
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[show abstract]
[hide abstract]
ABSTRACT: We performed a prospective randomized study to assess the effectiveness of short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on a surgical site and methicillin-resistant Staphylococcus aureus (MRSA) infection in elective colon cancer surgery.
The patients were administered preoperative oral antibiotics, kanamycin and erythromycin, after mechanical cleansing, which began within 24 h of elective surgery for colon cancer. The patients were randomly assigned to receive the intravenous administration of cefmetazol or cefotiam on the day of surgery (group 1) or for 3 days (group 2). A total of 275 patients (136 for group 1 and 139 for group 2) were eligible for the study.
The incidence of a surgical site infection was 5.1% in group 1 and 6.5% in group 2 (P = 0.80). The incidence of MRSA infection was 2.2% in group 1 and 2.9% in group 2 (P > 0.99). A multivariate logistic regression analysis showed that the American Society of Anesthesiologists physical status score and the duration of surgery were independent significant factors affecting the surgical site infection and MRSA infection.
These findings suggest that short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics may be successfully applied to colon cancer surgery that is generally performed in Japan.
Surgery Today 01/2009; 39(12):1032-9. · 1.22 Impact Factor
