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Hidenari Hirata,
Katsumasa Nakamura,
Naonobu Kunitake,
Yoshiyuki Shioyama,
Tomonari Sasaki,
Saiji Ohga,
Takeshi Nonoshita,
Tadamasa Yoshitake,
Kaori Asai,
Kouji Inoue,
Akira Nagashima, Minoru Ono,
Hiroshi Honda
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ABSTRACT: Aim: To clarify how patients with epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma with acquired resistance to EGFR-tyrosine kinase inhibitors (TKIs) respond to radiotherapy (RT) for brain metastases.
Forty-seven patients were divided into the following three groups: a TKI-naïve group with EGFR mutation (n=11), a TKI-resistant group with EGFR mutation (n=10), and an EGFR-wild-type group (n=26). Patients received stereotactic RT (n=23) or whole-brain RT (n=24).
The response rate for patients with TKI-resistant tumor at three months after RT tended to be lower (11%) than that of those who were TKI-naïve (82%, p=0.006) and for patients with wild-type EGFR (48%, p=0.10). On univariate analysis, central nervous system progression-free and overall survival were significantly shorter for patients with TKI-resistant tumors than for those who were TKI-naïve (p=0.018 and p=0.005, respectively). Multivariate analysis showed that TKI resistance was an independent predictor of poorer overall survival (p=0.011).
Acquired resistance to TKIs appears to be associated with low efficacy of brain RT.
Anticancer research 04/2013; 33(4):1649-55. · 1.73 Impact Factor
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ABSTRACT: INTRODUCTION: Endoscopic surgery is reportedly associated with smaller scars and greater patient satisfaction. Herein we evaluate the early results of endoscopy-assisted breast-conserving surgery(E-BCS). METHODS: Between May 2009 and October 2010, 61 women with breast cancer underwent E-BCS. We performed E-BCS on patients with tumors measuring less than 2 cm, without skin or pectoralis muscles invasion. Any patients with microcalcified lesions or axillary lymph node metastasis were excluded. We used an endoscopic vein retractor to dissect the dorsal layer of the mammary gland from a small axillar incision. We dissected the subcutaneous layer and cut the mammary gland vertically from a periareolar incision. We evaluated the clinicopathological characteristics, the surgical outcomes, and early cosmetic results. RESULTS: The mean age of the patients was 58.5 years, and the mean tumor size was 1.4 cm. Sentinel node biopsy was positive in seven patients, all of whom underwent axillary node dissection. An additional intraoperative resection of the breast was performed in 12 patients. The mean length of the operation was 167 min, and the mean blood loss was 27 mL. Eight patients received a boost to the tumor bed. The cosmetic results were satisfactory, and the wound scar was inconspicuous in most patients. CONCLUSION: Herein we demonstrate that E-BCS is a feasible and safe procedure for patients with early breast cancer. It allows for a better cosmetic scar location and offers patients favorable aesthetic results in the short-term follow-up results.
Asian Journal of Endoscopic Surgery 02/2013;
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ABSTRACT: We herein report an extremely rare case of ductal carcinoma in situ (DCIS) arising in tubular adenoma of the breast. A 33-year-old female first noticed a mass in her right breast when she was 15 years old. The tumor had not changed in size subjectively for 18 years. She finally visited the hospital one and a half years before this presentation for an examination of her breast mass. Ultrasonography (US) showed a circumscribed mass suggesting a benign tumor, and mammography (MMG) revealed the well-defined high-density mass with a focal region of microcalcification. It was suspected to be adenosis based on a core-needle biopsy (CNB). During the regular follow-up, the microcalcification in the mass increased. She was therefore referred to our hospital for further examination. US and MMG showed a well-demarcated mass with a focal microcalcified area. US-guided CNB diagnosed it as DCIS with tubular adenoma. The patient underwent tumorectomy. Histologically, the tumor was diagnosed to be DCIS in tubular adenoma with negative surgical margins.
Breast Cancer 06/2012; · 1.36 Impact Factor
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ABSTRACT: Invasive micropapillary carcinoma of the breast (IMPC) has been considered to have no specific image finding. The purpose of this study was to correlate the ultrasonographic findings of IMPC, especially internal echogenicity, with histological findings and to discuss the histological factor that influenced the internal echogenicity.
Six patients who had undergone surgery at our institute between October 2005 and February 2010 and had been subsequently diagnosed with IMPC were enrolled in this study. Internal echogenicities were correlated with the presence or absence of the central lumens within tumor cell clusters, and with the size of the spaces around these tumor cells.
The internal echogenicities of three IMPCs were isoechoic compared with subcutaneous fat tissue, and those of the other three IMPCs were hypoechoic. All three isoechoic IMPCs had central lumens, while no central lumen was seen in the three hypoechoic IMPCs. There was no relation between the size of spaces around the tumor cells and internal echogenicity. All tumors showed either posterior enhancement or no posterior acoustic feature.
Half of the IMPCs in our study showed isoechogenicity on ultrasonography. The existence of a central lumen in the tumor cell clusters might have contributed to relatively high internal echogenicity of these IMPCs.
Breast Cancer 07/2011; 19(4):349-52. · 1.36 Impact Factor
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Keisei Anan,
Shoshu Mitsuyama,
Kenichirou Koga,
Reiko Tanabe,
Michiyo Saimura,
Yoshitaka Tanabe,
Masato Watanabe,
Nobuhiro Suehara,
Hiroaki Matsunaga,
Kazuyoshi Nishihara,
Yuji Abe,
Toru Nakano,
Keiyoshi Tamae, Minoru Ono,
Satoshi Toyoshima
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ABSTRACT: The therapeutic advances in breast cancer have improved the survival of patients with early disease; however, survival improvement of patients with recurrent disease remains ambiguous. In this retrospective study, we examined whether disparities in survival improvement exist in patients with recurrent breast cancer with distant metastasis.
The survival time of 126 patients who experienced recurrence at distant sites from 1990 through 1996 was compared to that of 195 patients who did from 1997 through 2003.
A significant survival improvement was observed in the patients who experienced recurrence in the period of 1997-2003 in comparison to the other period in the subsets with estrogen receptor (ER)-positive disease, those who received adjuvant hormonal therapy, and those with a disease-free interval (DFI) of 24 months or more. However, no significant survival improvement was observed in each counterpart. The median survival time (MST) from the first relapse of patients with ER-positive disease in the recurrence period of 1997-2003 was 18.8 months longer than that in the recurrence period of 1990-1996 (46.6 months vs. 27.8 months). The MST of patients with a DFI of 24 months or more in 1997-2003 was 20.3 months longer than that in the other time period (47.2 months vs. 26.9 months).
The survival of recurrent breast cancer has improved with disparities. The ER status and the DFI are associated with a survival improvement of women with recurrent breast cancer with distant metastases.
Breast Cancer 05/2009; 17(1):48-55. · 1.36 Impact Factor
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ABSTRACT: This study aimed to evaluate the efficacy and toxicity of concurrent chemoradiotherapy and adjuvant chemotherapy for T2N0 glottic squamous cell carcinoma. Between May 1993 and March 2004, 32 patients with T2N0 glottic squamous cell carcinoma received concurrent chemoradiotherapy as the primary treatment modality for larynx preservation. Radiotherapy was delivered five days a week using a once-daily fractionation of 2.0 Gy (median total dose: 70 Gy). The chemotherapy regimen comprised carboplatin in 4 patients, carboplatin and tegafur and uracil in 7, carboplatin and futraful in 2, and futraful in 19 patients. Twenty-four patients received adjuvant chemotherapy with tegafur and uracil. Initial local tumor control was achieved in 30 patients (94%). The 5-year overall survival and 5-year local control rates were 97% and 70%, respectively. Univariate analysis revealed adjuvant chemotherapy as a significant prognostic factor for the local control rate (P = 0.038). The 5-year local control rate in patients treated or not treated with adjuvant chemotherapy was 82% and 42%, respectively. No significant differences in the local control rate were noted in overall treatment time, total radiation dose, age, and disease extension to the subglottis. With regard to adverse reactions, grade 3 neutropenia and grade 3 hepatotoxicity were observed in 1 and 2 patients, respectively. We observed no severe late complications (RTOG/EORTC criteria Grade 3-4) related to this combination therapy. Concurrent chemoradiotherapy and adjuvant chemotherapy was effective but with mild toxicity, and adjuvant chemotherapy significantly improved local control. We suggest the use of this combination therapy for achieving a local control of T2N0 glottic squamous cell carcinoma.
Fukuoka igaku zasshi = Hukuoka acta medica 02/2009; 100(1):26-31.
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ABSTRACT: Angiomyofibroblastoma-like tumor is a rare mesenchymal tumor involving the male genital tract. We report a case of an angiomyofibroblastoma-like tumor that arose in the subcutaneous tissue of the left inguinal region in a 50-year-old man. Ultrasonography of the region demonstrated a well-circumscribed subcutaneous mass. Intralesional fat was revealed on magnetic resonance images. Although these imaging features are nonspecific, radiological findings enable considering the diagnosis of angiomyofibroblastoma-like tumor.
Radiation Medicine 06/2007; 25(4):173-7.
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Keisei Anan,
Shoshu Mitsuyama,
Hirotaka Kuga,
Michiyo Saimura,
Yoshitaka Tanabe,
Nobuhiro Suehara,
Hiroaki Matsunaga,
Kazuyoshi Nishihara,
Yuji Abe,
Toshimitsu Iwashita,
Takaaki Ihara,
Keiyoshi Tamae, Minoru Ono,
Satoshi Toyoshima
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ABSTRACT: The optimum sentinel node biopsy (SNB) mapping method for breast cancer remains to be determined. No matter which mapping agents are used, 2-site injection may be superior to 1-site injection in limiting the false-negative rate.
We examined whether a double-mapping method with subareolar injection of blue dye and peritumoral injection of green dye would decrease the false-negative rate of dye-only SNB in 145 patients with early breast cancer.
The identification rate for blue-dyed and/or green-dyed (including mixed color-dyed) lymph nodes was 96.6% (140/145). Sensitivity and specificity were 95.1% (39/41) and 100% (99 of 99), respectively. Accuracy was 98.6% (138/140) with a false-negative rate of 4.9% (2/41). There were 4 patients in whom nodes of each color were found, but nodes of only 1 color were shown to be positive. The primary tumors of these 4 patients and of the 2 patients with false-negative results were located in the upper-outer quadrant of the breast. When only blue-dyed or green-dyed nodes (including mixed color-dyed nodes) were counted, the false-negative rates were 10.3% (4/39) for the subareolar mapping technique and 10.0% (4/40) for the peritumoral mapping technique.
The double-mapping method based on subareolar and peritumoral injections decreases the false-negative rate of dye-only SNB for early breast cancer. Variations in lymphatic channels may exist in the lateral half of the breast and thus may influence identification of positive sentinel nodes. This finding should be taken into account in cases of multicentric breast cancer.
Surgery 06/2006; 139(5):624-9. · 3.10 Impact Factor
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ABSTRACT: We report a case of isoechoic axillary lymph node metastasis of mucinous carcinoma (so-called pure mucinous carcinoma) of the breast. A 47-year-old premenopausal woman was referred to our hospital with a 2 years history of mass and distortion of her left breast and with recent worsening of her symptoms. Ultrasonography demonstrated a well-circumscribed mass, about 5 cm in diameter, which was isoechoic compared to the surrounding fat tissue. Distal enhancement was also recognized. A left axillary ultrasonographic scan demonstrated four nodules, which were indistinct because of their isoechogenicity compared to the surrounding tissue. Based on a preoperative diagnosis of mucinous carcinoma of the left breast with left axillary lymph nodes metastases, left mastectomy and left axillary nodal dissection were performed. Mucinous carcinoma with axillary lymph node metastases was diagnosed histologically. The lymph node metastases showed histological findings identical to those of the primary tumor, which was considered to be the reason for their isoechogenicity. Although lymph node metastasis of mucinous carcinoma of the breast is rare, ultrasonographers should perform careful scanning when the primary breast mass is suspicious for mucinous carcinoma, because lymph node metastases of mucinous carcinoma can be more indistinct and difficult to detect than those of other types of breast cancer.
Breast Cancer 02/2006; 13(4):382-5. · 1.36 Impact Factor
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ABSTRACT: A 51-year-old woman underwent pectoralis-preserving mastectomy for right breast cancer (squamous cell cancer, f, T1c, ly0, v0, N2 (18/33), p53 (3+), HER2 (2+), ER (-), PgR (-), T1cN2M0 (Stage IIIA) in March 2001, and received systemic chemotherapy using doxorubicin combined with cyclophosphamide, followed by paclitaxel. After chemotherapy, radiotherapy was added to the chest wall, supraclavicular and parasternal regions. In March 2002 (disease-free interval of one year), liver metastasis was revealed. Systemic therapy using docetaxel, and hepatic artery infusion therapy with epirubicin following docetaxel, failed. Since June 2003, capecitabine monotherapy (2,400 mg/day) was initiated for the liver and lymph node metastases in the mediastinum and retroperitoneum. After 3 cycles, all metastases responded and a marked response has been maintained for 15 months. This therapy is being continued (18 cycles), and no serious side effects have been encountered. Capecitabine monotherapy is safe and very useful for recurrent breast cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 09/2005; 32(8):1153-7.
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ABSTRACT: Breast cancer has received much less investigative attention in Asian men than in Caucasian men. We examined whether the prognosis of Japanese men with breast cancer differs from that of Japanese women with the disease.
The clinicopathological features of 14 Japanese men with breast cancer were reviewed and age- and stage-matched case-control analysis of these men and 140 female patients was performed.
Disease-free survival (p=0.94) and overall survival (p=0.62) did not differ significantly between the sexes. Five-year disease-free survival was 77% for the men and 75% for the women, and the 5-year overall survival was 92% for the men and 86% for the women. The disease recurred in 2 men but none died of breast cancer, although 3 died of other causes during the median follow-up period of 7 years. There were no significant differences in p53 mutation (p=0.20) or erbB-2 oncoprotein overexpression (p=0.33) between the men and women studied.
Survival rates of Japanese male and female breast cancer patients are similar when age and stage of the disease are taken into consideration. However, comorbid disease mortality is likely the major contributor to clinical outcome in Japanese male breast cancer.
Breast Cancer 02/2004; 11(2):180-6. · 1.36 Impact Factor
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Akihiro Nishie,
Kengo Yoshimitsu,
Hiroyuki Irie,
Hitoshi Aibe,
Tsuyoshi Tajima,
Kenji Shinozaki,
Tomohiro Nakayama,
Daisuke Kakihara,
Seiji Naito, Minoru Ono,
Toru Muranaka,
Hiroshi Honda
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ABSTRACT: OBJECTIVE: Our purpose was to describe the radiologic findings in five abnormalities in three patients with Castleman's disease occupying the renal sinus. CONCLUSION: Common findings such as mild homogeneous enhancement passing through the mass of the collecting system with mild hydronephrosis on contrast-enhanced CT and hypointense signal on T2-weighted images were obtained. Castleman's disease may be considered in a differential diagnosis of a mass occupying the renal sinus, although it is difficult to differentiate from malignant lymphoma.
American Journal of Roentgenology 11/2003; 181(4):1037-40. · 2.78 Impact Factor
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ABSTRACT: The authors reviewed the computed tomographic (CT) scans and pathologic specimens of 57 histologically proved bronchogenic carcinomas (35 squamous cell carcinomas, 12 small cell carcinomas, and 10 adenocarcinomas) in 47 patients with diffuse pulmonary fibrosis. The patients ranged in age from 61 to 87 years (mean age, 72 years; 42 men and 5 women). On radiography and CT, most tumors (82%) were located in peripheral areas of honeycomb lung. In 50 of the 57 lesions, the tumors were round or lobulated with sharp margins. In seven tumors, including six squamous cell carcinomas and one small cell carcinoma, the tumor invaded the adjacent honeycomb lung and lacked distinct margins. Intratumor lucency was seen in 13 tumors (five solitary and eight multiple). The CT findings, including high-resolution CT scans, were compared with the histologic findings in a subgroup of 29 lesions in 25 patients with available surgical or autopsy specimens. Invasive growth of tumors with unclear margins (four lesions), septal thickening of the contiguous/surrounding honeycombed areas (16 lesions), and discrete masses (nine lesions) with solitary (four of nine) or multiple (five of nine) intratumor lucencies. The lucencies in six of nine patients (67%) with intratumor lucencies were found to represent engulfed cystic airspaces histologically. CT revealed that bronchogenic carcinoma associated with diffuse pulmonary fibrosis has distinct morphologic characteristics that correlate histologically with a specific pattern of tumor growth.
Journal of Thoracic Imaging 05/2003; 18(2):67-71. · 0.98 Impact Factor
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ABSTRACT: We treated a patient with breast cancer associated with McCune-Albright syndrome. A 40-year-old woman with a history of precocious
puberty visited our hospital complaining of a mass in the upper lateral quadrant of the right breast. Although bone scintigraphy
revealed multiple high uptake of99mTc, plain X-ray demonstrated ground-glass appearance, suggesting fibrous dysplasia rather than bone métastases. Serum levels
of tumor markers and alkaline phosphatase were within the normal range. Breast cancer associated with McCune-Albright syndrome
was diagnosed, and she subsequently underwent breast conserving surgery, excision of abdominal wall myxoma and bone biopsy
of the left clavicula. The bone lesion was histologically confirmed as fibrous dysplasia. Although McCune-Albright syndrome
is a rare clinical entity, it should be considered as a possible differential diagnosis of bone metastasis in patients with
breast cancer. As recent molecular studies have suggested genetic mutations in McCune-Albright syndrome, this syndrome may
possibly predispose patients to breast cancer.
Breast Cancer 04/1998; 5(2):175-178. · 1.36 Impact Factor
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Takeshi Nonoshita,
Yoshiyuki Shioyama,
Naonobu Kunitake,
Katsumasa Nakamura,
Satoshi Nomoto,
Saiji Ohga,
Youichi Toriya, Minoru Ono,
Hiroshi Honda,
豪 野々下, [......],
浩 本田,
タケシ ノノシタ,
ヨシユキ シオヤマ,
ナオノブ クニタケ,
カツマサ ナカムラ,
サトシ ノモト,
サイジ オオガ,
ヨウイチ トリヤ,
ミノル オノ,
ヒロシ ホンダ
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ABSTRACT: This study aimed to evaluate the efficacy and toxicity of concurrent chemoradiotherapy and adjuvant chemotherapy for T2N0 glottic squamous cell carcinoma. Between May 1993 and March 2004, 32 patients with T2N0 glottic squamous cell carcinoma received concurrent chemoradiotherapy as the primary treatment modality for larynx preservation. Radiotherapy was delivered five days a week using a once-daily fractionation of 2.0 Gy (median total dose: 70 Gy). The chemotherapy regimen comprised carboplatin in 4 patients, carboplatin and tegafur and uracil in 7, carboplatin and futraful in 2, and futraful in 19 patients. Twenty-four patients received adjuvant chemotherapy with tegafur and uracil. Initial local tumor control was achieved in 30 patients (94%). The 5-year overall survival and 5-year local control rates were 97% and 70%, respectively. Univariate analysis revealed adjuvant chemotherapy as a significant prognostic factor for the local control rate (P = 0.038). The 5-year local control rate in patients treated or not treated with adjuvant chemotherapy was 82% and 42%, respectively. No significant differences in the local control rate were noted in overall treatment time, total radiation dose, age, and disease extension to the subglottis. With regard to adverse reactions, grade 3 neutropenia and grade 3 hepatotoxicity were observed in 1 and 2 patients, respectively. We observed no severe late complications (RTOG/EORTC criteria Grade 3-4) related to this combination therapy. Concurrent chemoradiotherapy and adjuvant chemotherapy was effective but with mild toxicity, and adjuvant chemotherapy significantly improved local control. We suggest the use of this combination therapy for achieving a local control of T2N0 glottic squamous cell carcinoma. 目的：T2N0声門癌に対する化学放射線療法，補助化学療法の効果，有害事象の遡及的検討．対象・方法：1993年5月から2004年3月に喉頭温存を目的に初回治療として化学放射線療法を施行されたT2N0声門癌の32例．放射線治療は1日1回，1回2Gy，週5回施行され，総線量の中央値は70Gy．化学療法はカルボプラチン単独が４例，カルボプラチンとUFT の併用が７例，カルボプラチンとフトラフールの併用が２例，フトラフール単独が19 例．化学放射線療法終了後24 例にUFTによる補助化学療法を施行．結果：一次治療効果でCRであったのは30例（94％）．５年粗生存率，５年局所制御率はそれぞれ97％，70％．局所制御に関する単変量解析では，補助化学療法の施行により有意な改善を認めた（P=0.038）．５年局所制御率は補助化学療法の有無でそれぞれ，82％，42％．総治療期間，総線量，年齢，病変の声門下への進展の有無では有意差は認めなかった．有害事象に関してはgrade3 の好中球減少を１例，grade3の肝機能障害を２例に認めた．重篤な晩期有害事象は認めなかった．結論：T2N0 声門癌に対する補助化学療法は局所制御に関して統計学的に有意な改善が認められ，また有害事象は軽度であり，有用性が示唆された．
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ABSTRACT: The authors retrospectively reviewed CT findings of unilateral proximal interruption of the pulmonary artery in eight adults.
Patient age ranged from 23 to 65 years (mean, 44 years), and three men and five women (six left-side affected and two right-side affected) comprised the study group. High resolution CT was obtained in five patients. Associated anomalies of great vessels included five cases of right aortic arch and one tetralogy of Fallot.
On the affected side, complete defects of pulmonary arteries were seen in all patients. CT revealed serrated pleural thickening in six patients (75%), subpleural parenchymal bands in five (63%), and mosaic attenuation in three (38%) on the affected lung. Dilatation of bronchial arteries in five patients (71%), internal thoracic arteries in four (57%), and intercostal arteries in three (43%) were also seen. As for other parenchymal changes, cystic bronchiectasis and honeycombing were seen in two (25%) respective cases. On the unaffected lung, mosaic attenuation was seen in four (50%) patients.
The main manifestations of unilateral proximal interruption of the pulmonary artery were complete defects of pulmonary arteries, enlarged bronchial arteries, and formed pleural thickening or some parenchymal changes of the lung.
Journal of Computer Assisted Tomography 26(5):777-83. · 1.22 Impact Factor
