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ABSTRACT: Nausea and vomiting are common side effects due to opioid therapy, and may greatly impede the quality of life of cancer patients. A preventive method for nausea and vomiting has not yet been established. We developed a clinical pathway(CP) for cancer pain management in which prochlorperazine is used for the prevention of nausea and vomiting caused by opioids. We have shown that this CP is effective for relieving cancer pain. In this study, we investigated the efficacy prochlorperazine has for preventing nausea and vomiting caused by opioids in patients treated with the CP. The incidence of nausea and vomiting of those patients was 15. 8% which was lower than the results of other previous clinical trials. However, we could not show the effectiveness of prochlorperazine. Prochlorperazine, which is a dopamine D2 receptor antagonist, may show limited utility for the prevention of nausea and vomiting; however, in opioid therapy, histamine receptor(H1)prevention is also important.
Gan to kagaku ryoho. Cancer & chemotherapy 10/2012; 39(10):1517-21.
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ABSTRACT: The indications for endoscopic treatment have expanded in recent years, and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection (ESD), even if they measure over 20 mm in size. However, ESD requires complex maneuvers, which entails a long operation time, and is often accompanied by complications such as bleeding and perforation. Many technical developments have been implemented to overcome these complications. The scope, cutting device, hemostasis device, and other supportive devices have been improved. However, even with these innovations, ESD remains a potentially complex procedure. One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection. Recently, countertraction devices have been developed. In this paper, we introduce countertraction techniques and devices mainly for gastric cancer.
World journal of gastrointestinal endoscopy. 06/2012; 4(6):231-5.
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ABSTRACT: The collagen gel droplet-embedded culture drug sensitivity test (CD-DST) is one of the best chemosensitivity tests owing to its high success rate. However, CD-DST is often a culture method, and contamination is a serious problem, especially in the case of colorectal cancer, which is contaminated by enteric bacteria. It has been reported that the success rate of CD-DST is 64.0% in the case of colorectal cancer. Therefore, the sampling and washing of specimens before culture are extremely important. By washing specimens carefully with normal saline containing antibiotics, we achieved a success rate of 85.3% in the case of colorectal cancer. To improve the success rate, we started specimen irrigation with a large amount of normal saline in January 2007. As a result, a success rate exceeding 90% was acquired. For the success of CD-DST for colorectal cancer, it is important to irrigate specimens many times with a large amount of normal saline.
Journal of Nippon Medical School 01/2012; 79(2):163-5.
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ABSTRACT: To evaluate the efficacy of S-1 for Stage IV gastric cancer, we retrospectively examined 124 patients with Stage IV gastric cancer. We classified patients into two groups based on the presence or absence of S-1 administration: the S-1 therapy group (n= 56) and the non-S-1 therapy group (n=68). Basically, patients received S-1 orally at 40 mg per square meter of body surface area twice daily for 4 weeks, followed by 2 weeks without chemotherapy. When side effects appeared, we tried dose reduction or cut short the administering period according to the dose modification criteria. Major patient characteristics were as follows: gender (male/female: 76/48), and age (median[range]: 63[24-83]). The median S-1 dosage was about 5 courses, and the median of the S-1 total dosage was 10. 08 g, based on the amount of tegafur. The relative dose intensity (RDI) was well maintained (average: 74. 9%). The survival rate in the S-1 therapy group was significantly higher than in the non-S-1 therapy group. The median survival time (MST) was 308 days in the S-1 group and 157 days in the non-S-1 group. In the S-1 therapy group, the MST was 629 days for those receiving 10 g or more, while that of those receiving less than 10 g was 209 days. The MST of patients administered 10 g or more was significantly longer than that of those receiving less than 10 g (p<0. 0001). Therefore, we consider that S-1 therapy improves survival in patients with Stage IV gastric cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 10/2011; 38(10):1619-22.
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ABSTRACT: Exposure to nitroso compounds and the activity of cytochrome P450 2E1 (CYP2E1), an activation enzyme for these carcinogens, are important factors in gastric carcinogenesis. Here, we investigated the potential correlation between genetic variation in CYP2E1 and its enzyme expression as detected with immunohistochemical (IHC) staining and cancer susceptibility in unoperated and remnant stomach.
Expression of CYP2E1 in the stomach (n=117) was detected with IHC staining using a polyclonal anti-CYP2E1 antibody. Interindividual variation in CYP2E1 enzyme activity was then compared with genetic polymorphisms in the transcriptional flanking region of the CYP2E1 gene by restriction fragment length polymorphism (RFLP) detection using the Rsa I restriction enzyme. Genetic polymorphisms of Rsa I RFLP in CYP2E1 were investigated in 499 patients with gastric cancer (466 unoperated stomachs and 33 remnant stomachs) and 553 control patients with benign gastroduodenal diseases.
Mucosal IHC staining for CYP2E1 was stronger in areas of intestinal metaplasia, particularly in endocrine cells, which stained consistently and strongly. Expression of CYP2E1 enzyme in areas of IHC staining were confirmed with Western blot analysis and showed a significant association between the degree of staining and the CYP2E1 genotype (p<0.01) in cancer tissues and in the foveolar epithelium of normal gastric mucosa. No association between specific CYP2E1 genotype and gastric cancer risk in the unoperated stomach was found in either the large study or the age- and gender-matched case-control study. However, the frequency of rare alleles (C1/C2 or C2/C2) was significantly higher in patients with cancer in the remnant stomach following gastrectomy than in controls subjects without cancer (odds ratio=2.8, 95% confidence interval=1.3-5.8) or those with primary gastric cancer (odds ratio=2.6, 95% confidence interval=1.3-5.5).
CYP2E1 genetic polymorphisms might correlate with CYP2E1 enzyme expression levels in normal and cancerous gastric tissues. These polymorphisms do not influence the development of primary stomach cancer but may do so in specific conditions, such as the remnant stomach after gastrectomy.
Journal of Nippon Medical School 01/2011; 78(4):224-34.
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ABSTRACT: The response rate of Irinotecan for gastric cancer is reported to be 18. 4%. The rate is improved by combination with 5-FU. However, it remains unclear whether or not the effect of the two drugs is synergy or antagonistic. The purpose of this study is to clarify whether the effect of Irinotecan and 5-FU in gastric cancer is synergy or antagonistic. We performed study using 13 specimens removed surgically and 2 specimen collected from ascites. We performed the Collagen Gel Droplet Embedded Culture Drug Sensitivity Test (CD-DST) with 3 assumptions. In the first assumption, we let 5-FU come in contact with a tumor at a level of 1 mg/mL for 24 hours. The second assumption was SN-38 at a level of 30 mg/mL for 24 hours and the 3rd assumption was SN-38 at a level of 30 mg/mL and 5-FU at a level of 1 mg/mL for 24 hours. If the combination index was more than 1, the combination therapy was judged as synergic; if less than 1, it was considered antagonistic. RESULTS: The inhibition rate of combination therapy was significantly higher than that of monotherapy. The inhibition rate of combination therapy was significantly correlate with that of monotherapy (Irinotecan; r=0.704, p=0.003, 5-FU; r=0.746, p=0.001). The combination index was antagonistic in only 6 of 15 cases. However, it was synergic in all well-differentiated adenocarcinomas (4/4). DISCUSSION: We conclude that combination therapy is antagonistic in most cases of gastric cancer in vitro. However, it may be synergic in well-differentiated adenocarcinomas.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(11):2125-9.
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ABSTRACT: A 56-year-old woman visited our hospital because of high fever and right hypochondralgia. Abdominal computed tomography showed a liver cyst 10 cm in diameter and dilatation of the intrahepatic bile duct. Percutaneous transhepatic drainage of the cyst guided by ultrasonography disclosed that the cyst contained a brown milky fluid, and cystography showed biliary communication. Thus, the cyst was diagnosed as an infectious hepatic cyst with biliary communication. Treatments for liver cysts include aspiration therapy, alcoholic sclerotherapy, laparoscopic fenestration, fenestration by laparotomy, cystojejunostomy, cystectomy, and hepatectomy. Because a simple liver cyst is benign, treatments should be low-risk and minimally invasive; thus, we performed laparoscopic fenestration. Fenestration should not be performed if the case is complicated by infection or biliary communication. Although cystography showed biliary communication, the cyst was not visualized with endoscopic retrograde cholangiography, and we concluded that the biliary communication was small. Operation time was 95 minutes, and blood loss was 10 g. Pathological findings of the liver cyst were consistent with a simple cyst. The postoperative course was good, and the patient left the hospital 10 days after the operation. Eighteen months have passed since the operation, and no recurrent cysts have been detected with computed tomography. This is the second report of liver cyst with biliary communication successfully treated with laparoscopic deroofing. Laparoscopic fenestration is a useful method for treating simple benign liver cysts because of its minimal invasiveness and may be useful in cases with small biliary communication.
Journal of Nippon Medical School 05/2009; 76(2):103-8.
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ABSTRACT: We report on a patient with male choriocarcinoma. The patient was a 31-year-old male patient with jejunal choriocarcinoma that metastasized from the mediastinum. He was admitted complaining of melena and severe anemia. Upper and lower gastrointestinal endosocopy was performed, but no source of bleeding was seen. Chest X-ray and CT revealed a mediastinal tumor 7 cm in size anterior to the arotic arch. Superior mesenteric arteriography showed irregularities and macular opacity in the jejunal artery. An emergency laparatomy was performed because of massive gastrointestinal bleeding. A jejunal tumor approximately 4 cm in size was resected and numerous metastases were observed in the liver and mesentery. Histopathological examination showed metastatic jejunal choriocarcinoma. Gynecomastia was not present and the testes were normal. Serum beta-human chorionic gonadotropin (HCG) was at an abnormally high level of 4,396 ng/mL. Because of metastases to the brain and invasion to the trachea, he died on postoperative day 20. We report this rare case of a male patient with metastases of choriocarcinoma to the gastrointestinal tract from the mediastinum, together with a review of the literature.
Journal of Nippon Medical School 05/2008; 75(2):116-21.
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ABSTRACT: Orotate phosphoribosyl transferase (OPRT), dihydropyrimidine dehydrogenase (DPD), and thymidylate synthase (TS) are initial key enzymes in the 5-fluorouracil (5-FU) metabolic pathway. The expression levels and activities of these three enzymes play important roles in the response of cancer patients to 5-FU-based chemotherapy.
The purpose of this study was to investigate the relationship between the activities of 5-FU metabolic enzymes and clinicopathologic factors in colorectal cancer.
We measured the activities of OPRT, DPD, and TS in colorectal cancer tissues. We also investigated the correlations between the activities of these three enzymes and clinicopathologic factors (histological type, depth of tumor invasion, extent of lymph node metastasis, Dukes' stage, lymphatic invasion, and vascular invasion). We examined 100 patients with surgically resected colorectal cancer.
Poorly differentiated adenocarcinoma showed significantly higher DPD activities than did moderately differentiated or well-differentiated adenocarcinoma. In patients with lymph-node metastasis, OPRT activity was significantly lower than in patients without lymph-node metastasis. No significant relation was found between TS activity and histological type, depth of tumor invasion, extent of lymph node metastasis, Dukes' stage, lymphatic invasion, or vascular invasion.
The response to 5-FU may be poor in patients with lymph-node metastasis, because of low OPRT activity, and in patients with poorly differentiated adenocarcinoma, because of high DPD activity.
Journal of Nippon Medical School 03/2008; 75(1):23-7.
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Takeshi Yamada,
Noritake Tanaka,
Kiyonori Furukawa,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Tomoko Seya,
Kouji Horiba, Yoshikazu Kanazawa,
Takashi Shirakawa,
Hidenori Kudoh,
Michihiro Koizumi,
Masato Yoshioka,
Seiichi Shinji,
Miwako Katsuta,
Yoshiharu Ohaki,
Takashi Tajiri
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ABSTRACT: Paclitaxel (PTX), which is used for ovarian cancer, lung cancer, breast cancer and gastric cancer, is administered at a dose of 210 mg/m(2) once every three weeks. However, WHO grade 3-4 hematological and non-hematological toxicity occurred frequently in this manner. In recent studies about ovarian cancer and lung cancer, a schedule in which PTX was given weekly could have the same or better efficacy, with fewer side effects. The response rate of PTX administered every three weeks for gastric cancer, was 23.3 to approximately 28.0%, while that of PTX administered weekly was 24.0 to approximately 25.8%. Because of fewer adverse events, weekly PTX is widely used for gastric cancer in Japan. To prove the validity of PTX weekly administration, we performed a study using six specimens removed surgically and one specimen collected from ascites. A chemosensitivity test was performed on the basis of two assumptions: a high concentration for a short time, and a low concentration for a long time. A similar PTX effect was obtained when the AUC was equal. In this study, we demonstrated that the effect of low-dose PTX was equal to the effect of high-dose PTX in gastric cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 03/2008; 35(2):251-3.
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Tomoko Seya,
Noritake Tanaka,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Koji Horiba, Yoshikazu Kanazawa,
Takeshi Yamada,
Michihiro Koizumi,
Seiichi Shinji,
Hirotake Okazaki,
Yoshiharu Ohaki,
Toshiyuki Ishiwata,
Zenya Naito,
Takashi Tajiri
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ABSTRACT: Here we report the case of a patient with advanced gastric cancer with esophageal invasion who was treated with chemotherapy using S-1 and cisplatin (CDDP) preoperatively. The patient was a 72-year-old woman who was diagnosed with advanced gastric cancer (T3N2M0) with esophageal invasion. S-1 was orally administered at 80 mg/day (60 mg/m(2) per day) on days 1-14 and CDDP was infused at 80 mg/day (60 mg/m(2) per day) on day 8, followed by a 1-week rest. Marked reductions in the sizes of the primary tumor and metastatic lymph nodes around the stomach were observed after two cycles of the therapy. Adverse reactions occurring during the therapy were only grade 2 gastrointestinal disorder and grade 1 leukocytopenia. Radiological and endoscopic examinations before surgery showed that a partial response (PR) had been achieved. The patient underwent curative surgery consisting of total gastrectomy, D2 lymph node dissection, and splenectomy. Her postoperative course was uneventful, without surgical complications. No gastric cancer cells were detected in the primary lesion or lymph nodes by immunohistochemical staining with cytokeratin, confirming a histological complete response (CR). As Epstein-Barr virus-encoded small RNA (EBER) had been detected by in-situ hybridization in the gastric cancer cells of a biopsy specimen, this tumor was diagnosed as an Epstein-Barr virus (EBV)-associated gastric carcinoma (EBVaGC), which was effectively treated with S-1 and cisplatin chemotherapy.
International Journal of Clinical Oncology 01/2008; 12(6):472-7. · 1.41 Impact Factor
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ABSTRACT: We report on a patient with rectal malignant melanoma. The patient was a 40-year-old man who complained of anal bleeding. His grandmother had died of pancreatic cancer and his mother had been operated for rectal cancer. Physical examination revealed a hard mass at the 12 o'clock position, 2 cm from the anal verge. A colonoscopic examination revealed an irregular surface mass, approximately 4.0 cm in size, located on the anterior wall of the lower rectum. A biopsy of the rectal tumor showed the proliferation of epithelioid cells with pleomorphic features. Immunohistochemical analysis was performed. S-100 protein, CD-56, and KIT expression were positive, but HMB-45 expression was negative. Abdominopelvic computed tomography (CT) revealed multiple liver and lymph node metastases. With the diagnosis of neuroendocrine carcinoma of the rectum, abdominoperineal resection was performed. After the operation, the serum lactate dehydrogenase level had rapidly increased. An abdominal CT showed progressive liver metastases. Thirteen days after the surgery, abdominal angiography was performed, which showed multiple hypervascular tumor stains in the liver. The reservoir was implanted transcutaneously with the aid of angiography and the catheter was fixed to the proper hepatic artery. Neoadjuvant chemotherapy using cisplatin and irinotecan via the subcutaneous reservoir port was performed and a partial response was obtained. However, the final pathological diagnosis of the surgically resected specimen was malignant amelanotic melanoma of the rectum. Immunohistochemical expression differed between rectal biopsy specimens and surgically resected specimens. HMB-45 expression was positive and KIT expression was negative in the resected specimen. As preoperative pathological diagnosis showed rare rectal tumor, we measured the chemosensitivity of the rectal tumor using the collagen gel droplet-embedded culture drug sensitivity test (CD-DST) to determine the most appropriate chemotherapy regimen for the patient. However, there were no anticancer drugs tested by CD-DST for malignant melanoma. With informed consent, the patient received two cycles of immunochemotherapy consisting of dacabazine, nimustine hydrochloride, vincristine sulfate, and interferon -beta. Although the patient was treated with immunochemotherapy for metastatic liver tumor, he died because of progression of metastases.
Journal of Nippon Medical School 11/2007; 74(5):377-81.
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Takeshi Yamada,
Noritake Tanaka,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Tomoko Seya,
Kouji Horiba, Yoshikazu Kanazawa,
Takashi Shirakawa,
Keiichi Ohkawa,
Hidenori Kudoh,
Michihiro Koizumi,
Masato Yoshioka,
Takashi Tajiri
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ABSTRACT: Cytotoxic drug-induced emesis is the side effect most feared by cancer patients. The Acute emesis has become well controlled by the emergence appearance of 5-HT3 receptor antagonist, but control of delayed emesis (DE) is insufficient. The mechanism of DE is different from acute emesis,and the existence of a mediator different from serotonin is contemplated. There were some reports suggesting the role of substance P (SP) and its receptor, neurokinin receptor 1 (NK 1), in the development of emesis.
We investigated the relationship between DE and SP in patients treated with anticancer agents.
Digestive cancer and breast cancer patients, who were administered cytotoxic agents, were the objects of this study. We measured plasma levels of SP for 20 cases on the day before administration of anticancer agents and for five days after administration.
Plasma levels of SP increased significantly on the first and third days after administration. In the patient who experienced DE, the difference in plasma levels on the day before and the first day after chemotherapy was higher than that of who never experienced.
The plasma levels of SP were transiently increased by chemotherapy. The difference in plasma levels between the day before and the first day after chemotherapy is important.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2007; 34(6):903-6.
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Takeshi Yamada,
Noritake Tanaka,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Tomoko Seya,
Kouji Horiba, Yoshikazu Kanazawa,
Takashi Shirakawa,
Keiichi Ohkawa,
Hidenori Kudoh,
Michihiro Koizumi,
Masato Yoshioka,
Seiichi Shinji,
Miwako Katsuta,
Kiyohiko Yamashita,
Takashi Tajiri
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ABSTRACT: We report 3 gastric cancer patients with peritoneal dissemination who were successfully treated with weekly paclitaxel and cisplatin. The patients were 2 men and 1 woman from 57 to 70 years in age. The histological types were 2 poorly-differentiated adenocarcinomas and 1 moderately-differentiated adenocarcinoma. Intravenous infusion of PTX (80 mg/m(2)) and CDDP (25 mg/m(2)) after short premedication was continued for 3 weeks followed by 1 week rest. Ascites improved only after administration of 1 course in all patients.PTX/CDDP is thought to be an effective chemotherapy showing acceptable toxicity against advanced gastric cancer with ascites.
Gan to kagaku ryoho. Cancer & chemotherapy 06/2007; 34(5):769-72.
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Seiichi Shinji,
Zenya Naito,
Toshiyuki Ishiwata,
Nando Nakazawa,
Noritake Tanaka,
Kimiyoshi Yokoi,
Tomoko Seya, Yoshikazu Kanazawa,
Takeshi Yamada,
Yoshiyuki Takahashi,
Michihiro Koizumi,
Nobuhisa Teranishi,
Yoshiharu Ohaki,
Takashi Tajiri
Journal of Nippon Medical School 03/2007; 74(1):87-8.
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Takeshi Yamada,
Noritake Tanaka,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Tomoko Seya,
Kouji Horiba, Yoshikazu Kanazawa,
Takashi Shirakawa,
Keiichi Ohkawa,
Hidenori Kudoh,
Michihiro Koizumi,
Masato Yoshioka,
Seiichi Shinji,
Kiyohiko Yamashita,
Takashi Tajiri
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ABSTRACT: 5-Fluorouracil (5-FU) and its derivatives are widely known as some of the most commonly prescribed anticancer drugs, especially for gastrointestinal cancer. Orotate phosphoribosyl transferase (OPRT), dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) are initial key enzymes in the 5-FU metabolic pathway. The activities of these enzymes may have the potential to affect the chemosensitivity of 5-FU.
This study was designed to investigate the effect of OPRT, DPD and TS in sensitivity to 5-FU.
We measured OPRT, DPD and TS activities in 11 colonic cancer tissues. The Collagen Gel Droplet Embedded Culture Drug Sensitivity Test (CD-DST) was used in an in vitro chemosensitivity assay. In these samples, the correlation between sensitivity to 5-FU and enzyme activities was investigated.
There were no correlations among OPRT, TS activities and sensitivity to 5-FU. In contrast, there was a significant inverse correlation (r=-0.738) between DPD activity and 5-FU sensitivity. With regression analysis, the coefficient of determination of the activity of the three enzymes versus the sensitivity to 5-FU was 0.61.
Though measuring OPRT, DPD, TS activities is valuable for prediction of sensitivity to 5-FU, DPD is considered to be the most important predictive factor of 5-FU sensitivity. To improve its accuracy, the finding of a fourth factor such as P-glycoprotein and multidrug resistance-associated proteins (MRP), to be added to OPRT, DPD and TS, is desired.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2006; 33(11):1603-9.
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Takeshi Yamada,
Nobutaka Tanaka,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Tomoko Seya, Yoshikazu Kanazawa,
Takashi Shirakawa,
Keiichi Ohkawa,
Michihiro Koizumi,
Yoshiharu Ohaki,
Kiyohiko Yamashita,
Takashi Tajiri
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ABSTRACT: Orotate Phosphoribosyl Transferase (OPRT), Dihydropyrimidine dehydrogenase (DPD) and Thymidylate synthase (TS) are initial key enzymes in the 5-FU metabolic pathway. In this study, we measured the activities of OPRT, DPD and TS. We also investigated the correlation between these 3 enzymatic activities and the clinical pathologic factors (Histological typing, extent of tumor invasion,extent of metastasis to the lymph nodes,stage, lymphatic invasion and venous invasion). We had surveyed 79 cases of colorectal cancers surgically removed. Poorly-differentiated adenocarcinoma showed a tendency to lower OPRT and higher DPD, as compared to moderately or well-differentiated adenocarcinomas. In case with metastasis to lymph nodes, OPRT showed a tendency to lower activities, but a significant difference was not noticed. TS showed no relation to any of these pathologic factors. In each application of 5-FU, measuring the activities of these three enzymes is important for estimation of the antitumoral effect. With poorly-differentiated adenocarcinoma, it is estimated that many cases would show high DPD and if the enzyme activities can not be measured, so administration of TS-1, which includes DPD inhibitor, may be considered.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2006; 33(6):789-93.
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Takashi Shirakawa,
Noritake Tanaka,
Kimiyoshi Yokoi,
Noriyuki Ishikawa,
Tomoko Seya,
Kouji Horiba,
Takeshi Yamada, Yoshikazu Kanazawa,
Keiichi Okawa,
Masato Yoshioka,
Yoshiharu Oaki,
Akira Tokunaga,
Takashi Tajiri
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ABSTRACT: A 65-year-old female with unresectable advanced gastric cancer accompanied by multiple lung metastases underwent jejunostomy and was treated with TS-1 and CDDP. One course consisted of TS-1 (80 mg/day) via an intestinal fistula tube from days 1 to 14 followed by 14 days rest and CDDP (80 mg/day) was administered by 24-hour continuous intravenous infusion on day 8. After 3 courses, the primary tumor and lymph node metastases decreased in size (PR), and CT scan showed the multiple lung metastases had disappeared. Total gastrectomy (D 2) and splenectomy were performed after chemotherapy. The final diagnosis was Stage IIIA and the pathological response to chemotherapy was Grade 2. The patient has survived for over 14 months after surgery and has presented no signs of recurrence.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2006; 33(6):811-5.
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ABSTRACT: As no established histopathological criteria exist for assessing the malignant potential of gastrointestinal stromal tumor (GIST), recurrence or metastasis is occasionally observed in lesions diagnosed histopathologically as benign. The present study aimed to clarify the histopathological criteria for assessing the malignancy of GIST, from a clinical standpoint.
The subjects were 22 patients with GIST expressing CD117 (c-kit) and/or CD34, who were followed up for more than 2 years. Clinically, GIST malignancy was diagnosed if any of the following criteria were met: peripheral invasive growth, lymph node metastasis, metastasis to another organ, peritoneal dissemination, recurrence, or death. GIST was also categorized as either benign or malignant by a new histological malignancy classification system, based on the determination of significant factors indicating malignancy in the clinical classification system above.
Significant factors for malignancy identified in the clinical malignancy classification were: tumor hemorrhage/necrosis (present vs absent; P = 0.0053), tumor size (<5 cm vs > or =5 cm; P = 0.0022), and Ki-67 labeling index (<3% vs > or =3%; P = 0.0002). A new histological malignancy classification, based on a combination of these three factors, was developed. A significant correlation existed between the clinical system and the new histological malignancy classification system (P = 0.0008). The recurrence-free survival rate was 100% in the histologically benign cases and 37.5% in the histologically malignant cases (P = 0.0012).
The new histological malignancy classification for GIST was demonstrated to be useful from a clinical standpoint.
Journal of Gastroenterology 06/2005; 40(5):467-73. · 4.16 Impact Factor
