[Show abstract][Hide abstract] ABSTRACT: Background:
Neoadjuvant chemotherapy (NAC) with taxanes followed by fluorouracil, epirubicin, and cyclophosphamide (FEC), and concurrent trastuzumab is a potent regimen for HER2 over-expressing breast cancer. A high pathological complete response (pCR) rate has been achieved using this regimen; however, the predictive factors and prognostic effects of pCR currently remain unclear. In the present study, we determined whether pCR was related to histological grade (HG) and several biological factors including p27(Kip1). We also assessed the prognosis of the pCR and non-pCR groups, and expected differences between those positive and negative for lymph node metastasis after chemotherapy.
A total of 129 Japanese women with HER2-positive invasive breast cancer received either paclitaxel or docetaxel followed by FEC, with the concomitant administration of trastuzumab. The statuses of HG, ER, PgR, Ki67, and p27(Kip1) were evaluated to determine their relationship with pCR. Relapse-free survival (RFS) and overall survival (OS) were also analyzed for their relationship with pCR and pathological nodal involvement.
pCR was obtained in 84 out of 129 patients and the pCR rate was 65.1 %. The pCR rates related to 5 factors were as follows: HG (grade 3, 70.0 % vs. grades 1-2, 36.8 %), ER (negative, 78.6 % vs. positive, 40.0 %), PgR (negative, 75.3 % vs. positive, 38.9 %), Ki67 (high, 72.0 % vs. low, 47.2 %), and p27(Kip1) (low, 71.0 % vs. high, 50.0 %). RFS was significantly better in the pCR group than in the non-pCR group (p = 0.018). Patients with remaining nodal disease in the pCR group had worse OS (p = 0.0002).
High-HG, low-ER, low-PgR, high-Ki67, and low-p27(Kip1) were identified as predictive factors of pCR in NAC with trastuzumab, while pCR and negative nodes were predictive of better survivals.
[Show abstract][Hide abstract] ABSTRACT: Paclitaxel therapy often causes musculoskeletal pain, and some clinical studies have indicated that this pain is due to nerve injury, rather than muscle or joint lesion. We report four clinical cases in which controlled-release oxycodone improved pain intensity in breast cancer patients with severe musculoskeletal pain caused by nab-paclitaxel therapy. In each case, oxycodone was well-tolerated and the symptoms of peripheral neuropathy were quite mild, indicating that oxycodone exhibited a preventive or therapeutic effect on peripheral neuropathy. Therefore, oxycodone may have favorable efficacy and tolerability against cancer therapy-related pain with a neuropathic element in breast cancer patients.
No preview · Article · Aug 2013 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: We report the case of a woman with a giant phyllodes tumor who successfully underwent a mammaplasty after breast-conserving surgery (BCS). The patient was a 40-year-old woman with a 25-cm lump in the left breast. The lesion was diagnosed as a phyllodes tumor by core needle biopsy. The patient was informed about the risks and benefits of BCS and total mastectomy. She selected BCS, and a mammaplasty using an inverted-T technique was performed after the complete resection of the tumor. The skin was expanded, and the nipple–areola was transplanted as a free graft to achieve breast symmetry. The mass was histopathologically diagnosed as a benign phyllodes tumor. The patient was satisfied with the cosmetic results. This method is considered to be one of the options for the treatment of giant phyllodes tumors.
[Show abstract][Hide abstract] ABSTRACT: Background:
Various studies have indicated a worldwide increase in the number of immediate breast reconstruction surgeries. However, breast reconstruction should not delay or prevent postoperative cancer therapeutics such as adjuvant chemotherapy and radiotherapy. In response to these developments, our team researched the impact of immediate breast reconstruction on postoperative adjuvant chemotherapy.
From April 2006 to March 2011, 116 patients at Saitama Cancer Center underwent postoperative adjuvant chemotherapy following mastectomy with or without immediate breast reconstruction. Fifty patients received postoperative adjuvant chemotherapy following mastectomy with immediate breast reconstruction (IBR group), and 66 patients received the same treatment but without immediate breast reconstruction (non-IBR group). The outcomes were studied retrospectively by chart review. Patients' average age, body mass index, postoperative complication rate, and days to adjuvant chemotherapy were calculated.
Mean age and body mass index of patients were 47.0 ± 9.0 years, 22.2 ± 3.0 kg/m(2) and 55.5 ± 10.1 years, 23.0 ± 3.6 kg/m(2) in IBR group and non-IBR group, respectively. Postoperative complication rate was 10.0 % in IBR group and 6.1 % in non-IBR group. Days to adjuvant chemotherapy was 61.0 ± 10.5 days in IBR group and 58.0 ± 12.3 days in non-IBR group.
Although complication rate and days to adjuvant chemotherapy were slightly increased in IBR group, the delay was not critical to the initiation of adjuvant chemotherapy in these patient groups.
[Show abstract][Hide abstract] ABSTRACT: Background
It is still controversial whether axillary lymph node (ALN) dissection (ALND) can be omitted after negative sentinel lymph node (SLN) biopsy (SLNB) in breast cancer (BC) patients with clinically positive ALNs at presentation treated with neoadjuvant chemotherapy (NAC). The study aim was to analyze whether SLNB could be useful in these patients.
In a retrospective study, eligible patients were women with invasive BC with clinically positive ALNs at presentation, treated with NAC then a total or partial mastectomy, with an intraoperative histological examination of SLNs and non-SLNs suspicious for metastasis followed by ALND. Non-SLNs suspicious for metastasis were defined as hard or large nodes located in the same level of the axilla where clinically positive ALNs had been initially identified. The results of SLNB and clinicopathological characteristics were analyzed for correlation with pathological ALN status.
In a consecutive series of 105 women with 107 BC cases, 81 (75.7 %) had at least 1 SLN, and the remaining 26 (24.3 %) had at least 1 non-SLN suspicious for metastasis. The intraoperative (or final) histological examination of these nodes revealed that the false-negative (FN) rate and accuracy were 8.2 (or 6.3) % and 95.1 (or 96.3) %, respectively. Estrogen receptor status at presentation, pathological tumor response, lymphovascular invasion after NAC, and NAC regimen were correlated with pathological ALN status.
The histological examination of SLNs and that of non-SLNs suspicious for metastasis are useful for predicting pathological ALN status in BC patients with clinically positive ALNs at presentation who are treated with NAC.
No preview · Article · May 2012 · International Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: A gallstone was found in a 69-year-old woman during an upper gastrointestinal tract imaging test in April 2008, and she consulted the Department of Gastroenterology at Ojiya General Hospital. Laparoscopic cholecystectomy was performed in May, and symptoms of a hypoglycemic attack were seen postoperatively. Therefore, she received a detailed examination. The Turner index was elevated at 535. Enhanced computed tomography(CT)showed a 0.5-cm hypervascular lesion in the pancreatic tail. An insulinoma was strongly suspected. Percutaneous transhepatic portal venous sampling (PTPVS)showed a rapid rise in insulin concentration in the splenic vein from a point 1/3 distal to a point 1/3 proximal. Dynamic CT showed a 1.5-cm hypervascular lesion in the pancreatic tail. Angiography and endoscopic retrograde pancreatography revealed no abnormalities. Enucleation of the tumor was performed in July. Pathological examination revealed an islet cell tumor(typical case). Immunohistochemical staining for insulin, glucagon, somatostatin, and synaptophysin was performed. Insulin and synaptophysin were positive. The patient has had no recurrence in the 28 months after surgery.
No preview · Article · Jan 2011 · The Kitakanto Medical Journal
[Show abstract][Hide abstract] ABSTRACT: A 71-year-old man visited a medical clinic complaining of vomiting, and was referred to our hospital for examination. Blood examination showed leukocytosis (white blood cell count 17,480 /μl) and his serum CA19-9, DUPAN-2, and Span-1 levels were elevated (2,804, 841, and 134 U/ml, respectively). Abdominal computed tomography revealed a heterogeneously enhanced tumor with a diameter of about 6 cm in the third portion of the duodenum. Upper gastrointestinal endoscopy revealed a submucosal tumor at the same location. The endoscopic biopsies showed duodenitis (group 1). From these findings, a diagnosis of duodenal tumor was made and partial resection of the duodenum and jejunum was performed. On macroscopic observation, the duodenal tumor had ulcerated, forming an extramural mass 6 cm in diameter. Histologically, there were areas of adenocarcinoma forming tumor glands and areas of squamous cell carcinoma with keratinization. The histological examination confirmed the diagnosis of adenosquamous carcinoma of the small intestine. The patient underwent postoperative chemotherapy. However, he died 10 months postoperatively, after local recurrence was found in the 8th postoperative month and liver metastases were found in the 9th postoperative month. Adenosquamous carcinoma of the small intestine is rare; including this case, there have been only 26 cases reported in the Japanese literature.
No preview · Article · Jan 2011 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: A splenic tumor was found in a 39-year-old man through abdominal ultrasonography on April 2008. He then consulted the Department of Gastroenterology at Ojiya General Hospital. Dynamic computed tomography (CT) showed an 8.0-cm hypovascular lesion of the spleen in early phase. But the lesion enhanced to the same degree as the surrounding splenic parenchyma in delayed phase. Since the CT radiologic examination of the tumor was equivocal, and inadequate to rule out malignancy, a splenectomy was performed for diagnostic treatment. Microscopically, the lesion was an admixture of spindle cells and inflammatory cells, chiefly lymphocytes, plasma cells and histiocytes. These tumor cells were immunoreactive to CD35, fascin and clusterin. We made a diagnosis of follicular dendritic cell tumor of the spleen. The test for Epstein-Barr virus, (EBV)-encoded RNA1 (EBER1), was negative. The patient has experienced no recurrence in the 31 months after surgery.
No preview · Article · Jan 2011 · The Kitakanto Medical Journal
[Show abstract][Hide abstract] ABSTRACT: A 68-year-old man underwent total gastrectomy for Type 3 gastric cancer with liver metastasis. The final finding was T3(SE), N1, H1, P0, CY0(class IV), Stage IV, Cur C. After surgery, he was treated with combination chemotherapy of weekly paclitaxel(PTX)/doxifluridine(5'-DFUR). Paclitaxel was administered at a dose of 80 mg/m(2) on day 1, 8 and 15, and doxifluridine was orally administered at a dose of 533 mg/m(2) day for five days followed by withdrawal for two days. This regimen was repeated every four weeks. After 2 courses, the tumor marker level normalized, and the size of the liver metastasis was remarkably decreased. After 5 courses, a CT scan revealed the liver metastasis had disappeared, and he has now survived without recurrence after the disappearance of the liver metastasis. No severe adverse reactions were observed, and the man can be treated as an outpatient. This therapy may thus be effective in the treatment of advanced gastric cancer following non-curative operation.
No preview · Article · Feb 2009 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 74-year-old Japanese man was admitted to our hospital due to repeated episodes of upper gastrointestinal (GI) bleeding, anemia and melena, which he had suffered for the preceding two years. We performed several panendoscopic and angiographic examinations, but could not discover the cause of his anemia. In addition, we performed jejunectomy because arteriovenous malformation (AVM) was suspected to exist in the jejunum. However, we found no evidence of AVM in the resected portion of the jejunum. During an endoscopic GI study on his seventh admission, we found hemorrhaging gastric angiodysplasia (AGD) in the upper body of the stomach. Moreover, we found another small AGD in the lower body of the stomach. We treated these lesions endoscopically using a combination of hemoclip, endoscopic band ligation and argon plasma coagulation. When diagnosing patients presenting with the symptoms described herein, the physician should consider small AGDs and check the GI tract accordingly, to prevent unnecessary resections. In the present subject, there has been no further bleeding and no other lesions have been detected in his upper GI on endoscopic examination during a 12-month follow up.
Preview · Article · Aug 2007 · The Kitakanto Medical Journal
[Show abstract][Hide abstract] ABSTRACT: A case of severe ulcerative colitis of the entire colon, initially diagnosed after the Niigata-ken -Chuetsu earthquake, is presented. A 42-year-old woman underwent a colonoscopic examination after a positive immunochemical test for fecal occult blood in 2003. The colonoscopic examination showed no abnormal lesions. After the Niigata-ken-Chuetsu earthquake in Oct., 2004, she suffered frequent diarrhea. She was transferred to our hospital because of bloody diarrhea, rectal bleeding, abdominal cramps, and fever. Active ulcerative colitis (UC) was diagnosed on colonoscopy, which showed severe ulcers with bleeding from the rectum to the ascending colon, and the diagnosis of severe UC was confirmed microscopically by biopsy. She was treated with intravenous prednisolone (PSL), oral 5 -aminosalicylic acid (ASA), and granulocytapheresis (GCAP). After one course of granulocytapheresis, the colonoscopic findings, abdominal cramps, and fever improved slightly, although the bloody diarrhea continued. Azathioprine as an immunosuppressant was added to the PSL and ASA and a second course of GCAP was performed. She responded to the treatment well, with no adverse events, and this led to disease remission. She has been in remission for one year, and has resumed her job.
No preview · Article · May 2006 · The Kitakanto Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Sentinel lymph node biopsy (SLNB) is an important treatment option for breast cancer patients, as it can accurately predict axillary status. Our previous study using dye with or without radioisotope showed the accuracy and sensitivity of SLNB to be 97% and 94%, respectively. Based on these results, axillary lymph node dissection (ALND) was eliminated starting in January, 1999 in patients with intraoperatively negative SLNB at our institution. The present study shows the results and outcomes of SLNB as a sole procedure for patients with invasive breast cancer.
Three-hundred-fifty-four patients and 358 cases of invasive breast cancer (4 bilateral breast carcinoma) treated with SLNB alone after an intraoperative negative SLNB were studied prospectively from January 1999 to December 2001.
The number of the identified SLNs per case ranged from 1 to 8 (mean, 2.5). Of a total of 358 cases, 297 (83%) were treated with hormone therapy and/or chemotherapy, and 281 (78%) were treated with radiotherapy to the conserved breast (50 Gy+/-10 Gy boost), the axilla (50 Gy), or the both sites. After a median follow-up of 21 (range 6-42) months, no patient developed an axillary relapse. Four cases initially recurred in distant organs and one case in the conserved breast.
Our results indicate that an intraoperative negative SLNB without further ALND may be a safe procedure when strict SLNB is performed. To better assess the safety, however, may require longer follow-up.
[Show abstract][Hide abstract] ABSTRACT: The correlation between ELISA level and immunohistochemical status for thymidine phosphorylase (TP) in invasive breast carcinoma was examined.
Specimens were obtained from 84 patients with invasive breast carcinoma and both the ELISA level and immunohistochemical status for TP of breast carcinoma tissue were determined. The results of ELISA for the 84 cases were categorized into quartiles (E-scores 1 to 4) with every category including an equal number of patients. In addition, both the staining intensity of carcinoma cells and relative number of stained stromal cells identified by immunohistochemistry were classified into 4 degrees (I-scores 1 to 4). We also divided the patients into two groups: a negative group (I-scores 1 and 2) and a positive group (I-scores 3 and 4). Furthermore, sums of scores for carcinoma cells and stromal cells (S-scores 2 to 8) were divided into two groups, a low group (S-scores 2 to 5) and a high group (S-scores 6 to 8). The correlation between the ELISA level and immunohistochemical status for TP was evaluated and the means of the ELISA level of each group were compared.
Scores of ELISA (E-scores) were significantly positively-correlated with scores for immunohistochemical status (I-scores) of only carcinoma cells (lambda=0.158, p<0.05). The means of TP levels determined by ELISA were significantly higher in the carcinoma cell-positive group (p<0.01) and summed-score high group (p<0.0002).
A positive correlation between the results of the ELISA and immunohistochemical status for TP was found only for carcinoma cells and comparison of means of the ELISA level indicated that they reflected total immunohistochemical TP status of carcinoma cells and stromal cells. Immunohistochemical examinations should be performed to clarify the in situ localization of TP in carcinoma tissue and the results obtained from the immunohistochemistry, as well as the ELISA of TP, may be useful in selection of patients for doxifluridine and capecitabine therapy.
No preview · Article · Jan 2002 · Anticancer research
[Show abstract][Hide abstract] ABSTRACT: The efficacy of luteining hormone-releasing hormone (LH-RH) analogue, buserelin, combind with tamoxifen (TAM) on 7,12-dimethylbenz(a)anthracene (DMBA)-induced rat mammary tumors was investigated. Low-dose of TAM (L-TAM), 1 mg/kg daily, significantly suppressed the growth of tumors compared with no treatment group. High-dose of TAM (H-TAM), 10 mg/kg daily, suppressed growth considerably, and there was a significant difference in the antitumor effect between the L-TAM group and the H-TAM group. The combined treatment using buserelin and L-TAM significantly suppressed the tumor growth compared with the treatment using each single agent. LH-RH analogue actually reduced serum estradiol (E2) levels and enhanced the antitumor effect brought by a therapeutical dose of TAM. The reduction of serum cholesterol levels as a beneficial effect of TAM was reserved when combined with buserelin. Insulin-like growth factor 1 (IGF-1) expressions in tumors were significantly decreased in the buserelin and L-TAM group. These results support the usefulness of this combination in clinical use.
No preview · Article · Jan 2002 · Oncology Reports