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Kanazawa-shi, Japan

Ojima E.,Asanogawa General Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

A 65-year-old woman was referred to our hospital for examination of anemia. Colonoscopy showed a type 1 tumor in the ascending colon with nearly complete stenosis that was diagnosed as a tubular adenocarcinoma. Computed tomography (CT) revealed swelling of the regional, periaortic, and celiac lymph nodes and lymphangitis carcinomatosa. The patient was diagnosed as having Stage IV ascending colon cancer, and neoadjuvant chemotherapy was administered to avoid non-curative resection. The patient was treated with cetuximab and oxaliplatin, Leucovorin, and 5-fluorouracil( mFOLFOX6) combination chemotherapy. After 6 courses of chemotherapy, the primary lesion and multiple lymph node swellings greatly reduced in size and lymphangitis carcinomatosa improved. Accordingly, right colectomy with D3 nodal dissection was performed. The patient was recurrence free at her 8-month follow-up examination. Neoadjuvant chemotherapy with molecular targeted drugs is useful in the treatment of patients with unresectable primary cancer.

Usuda K.,Kanazawa Medical University | Sagawa M.,Kanazawa Medical University | Aikawa H.,Kanazawa Medical University | Ueno M.,Kanazawa Medical University | And 6 more authors.
General Thoracic and Cardiovascular Surgery | Year: 2010

Purpose: The aim of this study was to determine if glucose transporter-1 (Glut1) expression correlates with 18F-FDG (18F-fluoro-2- deoxyglucose) uptake on positron emission tomography (PET) in lung cancer and to examine the similarities and differences between them. Methods: A total of 34 patients with resected primary lung cancers were investigated in this study. There were 17 adenocarcinomas, 12 squamous cell carcinomas, and 5 cancers of other cell types. Immunohistochemical Glut1 intensity was categorized into three groups: negative, positive, and strongly positive. Glut1 frequency was defined by the proportion of positive cells among all cancer cells, and it was graded on a semiquantitative scale as 0-100% in 10% increments. The data are expressed as the mean ± SD. Results: Maximum standardized uptake values (SUVmax) were 4.8 ± 6.3 in "negative" Glut1 intensity cases, 4.7 ± 3.1 in "positive" Glut1 intensity cases, and 11.2 ± 5.2 in "strongly positive" Glut1 intensity cases. Although SUVmax correlated significantly with tumor size (correlation coefficient 0.58, P = 0.00033), Glut1 frequency did not correlate significantly with tumor size (correlation coefficient 0.18, P = 0.301). Cell type and cell differentiation correlated significantly with Glut1 expression and 18F-FDG uptake. Conclusion: Glut1 expression correlates significantly with 18F-FDG uptake. There are similarities in cell differentiation and cell type between Glut1 expression and 18F-FDG uptake. 18F-FDG uptake correlates significantly with tumor size, but Glut1 expression does not. © 2010 The Japanese Association for Thoracic Surgery.

Yamamoto M.,Katsuta Hospital Mito Gamma House | Serizawa T.,Tokyo Gamma Unit Center | Shuto T.,Yokohama Rosai Hospital | Akabane A.,Nippon Telegraph and Telephone | And 29 more authors.
The Lancet Oncology | Year: 2014

Background: We aimed to examine whether stereotactic radiosurgery without whole-brain radiotherapy (WBRT) as the initial treatment for patients with five to ten brain metastases is non-inferior to that for patients with two to four brain metastases in terms of overall survival. Methods: This prospective observational study enrolled patients with one to ten newly diagnosed brain metastases (largest tumour <10 mL in volume and <3 cm in longest diameter; total cumulative volume ≤15 mL) and a Karnofsky performance status score of 70 or higher from 23 facilities in Japan. Standard stereotactic radiosurgery procedures were used in all patients; tumour volumes smaller than 4 mL were irradiated with 22 Gy at the lesion periphery and those that were 4-10 mL with 20 Gy. The primary endpoint was overall survival, for which the non-inferiority margin for the comparison of outcomes in patients with two to four brain metastases with those of patients with five to ten brain metastases was set as the value of the upper 95% CI for a hazard ratio (HR) of 1·30, and all data were analysed by intention to treat. The study was finalised on Dec 31, 2012, for analysis of the primary endpoint however, monitoring of stereotactic radiosurgery-induced complications and neurocognitive function assessment will continue for the censored subset until the end of 2014. This study is registered with the University Medical Information Network Clinical Trial Registry, number 000001812. Findings: We enrolled 1194 eligible patients between March 1, 2009, and Feb 15, 2012. Median overall survival after stereotactic radiosurgery was 13·9 months [95% CI 12·0-15·6] in the 455 patients with one tumour, 10·8 months [9·4-12·4] in the 531 patients with two to four tumours, and 10·8 months [9·1-12·7] in the 208 patients with five to ten tumours. Overall survival did not differ between the patients with two to four tumours and those with five to ten (HR 0·97, 95% CI 0·81-1·18 [less than non-inferiority margin], p=0·78; pnon-inferiority<0·0001). Stereotactic radiosurgery-induced adverse events occurred in 101 (8%) patients; nine (2%) patients with one tumour had one or more grade 3-4 event compared with 13 (2%) patients with two to four tumours and six (3%) patients with five to ten tumours. The proportion of patients who had one or more treatment-related adverse event of any grade did not differ significantly between the two groups of patients with multiple tumours (50 [9%] patients with two to four tumours vs 18 [9%] with five to ten; p=0·89). Four patients died, mainly of complications relating to stereotactic radiosurgery (two with one tumour and one each in the other two groups). Interpretation: Our results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases. Funding: Japan Brain Foundation. © 2014 Elsevier Ltd.

Sasaki S.,Asanogawa General Hospital | Ueda N.,Kanazawa Medical University | Urade M.,Asanogawa General Hospital
Journal of Japanese Society of Gastroenterology | Year: 2011

A 61-year-old man was hospitalized for treatment of portal and superior mesenteric venous thrombosis (PSMVT). We selected interventional radiology (IVR) because there were no signs of intestinal necrosis. The thrombosis was significantly reduced and the patient made progress after we performed thrombectomy via catheter aspiration, and thrombolytic therapy via both the superior mesenteric artery and vein. Even if there are no signs of intestinal necrosis, treatment which prevents intestinal necrosis is vital. In the present case, single-stage IVR therapy via both the superior mesenteric artery and vein improved the therapeutic outcome of PSMVT.

A 74-year-old woman was diagnosed as having lower rectal cancer. Colonoscopy revealed a type 2 circular tumor over 15 cm from the port side close to the dentate line. The patient was diagnosed as having a moderately differentiated adenocarcinoma by biopsy. Computed tomography (CT) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) revealed thickening of the wall from near the anus to the rectosigmoid junction and an increase in the concentration of the surrounding adipose tissue as well as swelling of the left internal iliac lymph nodes with FDG accumulation. The patient was diagnosed as having cSE, cN3, cM0, cStage IIIb rectal cancer. Because the tumor was very close to the anus with advanced extramural invasion and because the patient desired anal sphincter preservation, we performed preoperative chemoradiation therapy( CRT) combined with capecitabine plus oxaliplatin( XELOX) and bevacizumab( BV). Radiation therapy was performed with a linear accelerator( LINAC) for stereotactic radiation therapy( Novalis®). Partial response (PR) was achieved by this therapy. Five weeks after CRT, the patient underwent laparoscopic-assisted intersphincteric resection( total ISR). Pathological examination revealed minimal residual cancer cells( Grade 2, pPR, pA, N0, M0, pPM0, pDM0, pRM0, pStage II). Increased implementation of anus-preserving surgery can be expected owing to the successful control of regional and distant metastases by neoadjuvant CRT. Based on these encouraging findings, we should consider the challenges posed by neoadjuvant CRT for the treatment of lower rectal cancer.

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