Kamakura, Japan
Kamakura, Japan

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Chen I.-P.,Tokyo Women's Medical University | Ariizumi S.-I.,Tokyo Women's Medical University | Nakano M.,Ofuna Chuo Hospital | Yamamoto M.,Tokyo Women's Medical University
Journal of Gastroenterology | Year: 2014

Background: Glypican-3 (GPC3) is a new prognostic factor after curative hepatectomy in patients with hepatocellular carcinoma (HCC), and the expression of GPC3 is known to be associated with postoperative metastasis. However, the role of GPC3 in patients with early HCC remains unknown. Methods: We retrospectively studied 55 patients with early HCC (total 99 nodules) who underwent initial hepatectomy between 1995 and 2010. Clinicopathological features and surgical outcomes were compared in relation to GPC3 expression. Results: The GPC3-positive expression was seen in 28 of 55 patients (50.9 %) with early HCC (44 of 99 nodules). The GPC3-positive expression was significantly associated with hepatitis C virus (HCV) infection (P = 0.0019) and with multiple early HCCs (P < 0.0001). The 5-year disease-free survival rate was significantly lower in patients with GPC3-positive early HCC (27 %) than in patients with GPC3-negative early HCC (62 %, P = 0.0036). The GPC3 expression was a significant independent prognostic factor for disease-free survival. However, it showed no significant difference in overall survival. Conclusions: The GPC3 expression is capable to be a new prognostic factor for disease-free survival in patients with early HCC. © 2013 The Author(s).


Ariizumi S.-I.,Tokyo Women's Medical University | Kotera Y.,Tokyo Women's Medical University | Katagiri S.,Tokyo Women's Medical University | Nakano M.,Ofuna Chuo Hospital | Yamamoto M.,Tokyo Women's Medical University
Annals of Surgical Oncology | Year: 2012

Background. We evaluated the surgical outcomes of combined hepatocellular-cholangiocarcinoma (CHC) in relation to Allen and Lisa class and the predominance of intrahepatic cholangiocarcinoma (ICC) cells within the tumor. Methods. We retrospectively studied 44 patients with CHC who underwent hepatectomy between 1987 and 2010. Clinicopathologic characteristics and surgical outcomes were compared in relation to Allen and Lisa class (33 combined type, 11 mixed type) and the predominance of ICC cells within the tumor (cases in which ICC cells accounted for 50% or less of all cells within the tumor, n = 22; cases in which ICC cells accounted for more than 50%, n = 22). Results. The survival rate for 42 patients with CHC who underwent curative surgery was 24% at 5 years, and median survival was 15.4 months. According to Allen and Lisa class, the number of cases with portal invasion was far higher in patients with the mixed type than in patients with the combined type. The 5-year survival rates of patients with the combined type and mixed type who underwent curative surgery were 27% and 13%, respectively, showing no statistically significant difference. According to the predominance of ICC cells, there was no difference in clinicopathologic findings between the groups. The 5-year survival rates of patients with ≤50% and >50% ICC cells within the tumor who underwent curative surgery were 21% and 26%, respectively, showing no statistically significant difference. Conclusions. CHC had poor outcomes after hepatectomy regardless of Allen and Lisa class or the predominance of ICC cells within the tumor. © Society of Surgical Oncology 2011.


Takeda A.,Ofuna Chuo Hospital | Sanuki N.,Ofuna Chuo Hospital | Fujii H.,Research Center for Innovative Oncology | Yokosuka N.,Yuai Clinic | And 5 more authors.
Journal of Thoracic Oncology | Year: 2014

INTRODUCTION: The maximum standardized uptake value (SUVmax) on F-fluorodeoxyglucose positron emission tomography is a predictor for overall survival (OS) in non-small-cell lung cancer (NSCLC) after resection. We investigated the association between SUVmax and outcomes in NSCLC after stereotactic body radiotherapy. METHODS: Between 2005 and 2012, 283 patients with early NSCLC (T1a-2N0M0) were treated with stereotactic body radiotherapy; the total doses were 40 to 60 Gy in five fractions. Patients who underwent staging F-fluorodeoxyglucose positron emission tomography scans by a single scanner and were followed up for more than or who died within 6 months were eligible. The optimal threshold SUVmax was calculated for each outcome. Outcomes were analyzed using the Kaplan-Meier method and log-rank test. Prognostic significance was assessed by univariate and multivariate analyses. RESULTS: One hundred fifty-two patients were eligible. Median follow-up was 25.3 (range, 1.3-77.4) months. Local, regional, and distant recurrences, cancer-specific deaths, and deaths from other reasons occurred in 14, 11, 27, 21, and 31 patients, respectively. The optimal threshold SUVmax for local, regional, and distant recurrences, and disease-free survival (DFS), cancer-specific survival, and OS were 2.47 to 3.64. Outcomes of patients with SUVmax lower than each threshold were significantly better than those with higher SUVmax (all p<0.005): 3-year DFS rates were 93.0% versus 58.3% (p<0.001) and 3-year OS rates were 86.5% versus 42.2% (p<0.001), respectively. By multivariate analysis, higher SUVmax was a significantly worse predictor for DFS (p<0.01) and OS (p=0.04). CONCLUSIONS: SUVmax was a predictor for DFS and OS. A high SUVmax may be considered for intensive treatment to improve outcomes. Copyright © 2013 by the International Association for the Study of Lung Cancer.


Ueno F.,Ofuna Chuo Hospital | Matsui T.,Fukuoka University | Matsumoto T.,Hyogo College of Medicine | Matsuoka K.,Keio University | And 2 more authors.
Journal of Gastroenterology | Year: 2013

Crohn's disease is a disorder of unknown etiology and complicated pathogenesis. A substantial amount of evidence has accumulated recently and has been applied to clinical practice. The present guidelines were developed based on recent evidence and the formal consensus of experts relevant to this disease. Here we provide an overview of these guidelines, as follows. Target disease: Crohn's disease Users: Clinical practitioners in internal medicine, surgery, gastroenterology, and general practice Purpose: To provide appropriate clinical indicators to practitioners Scope of clinical indicators: Concept of Crohn's disease, epidemiology, classifications, diagnosis, treatment, follow up, and special situations Intervention: Diagnosis (interview, physical examination, clinical laboratory tests, imaging, and pathology) and treatment (lifestyle guidance, drug therapy, nutritional therapy, surgery, etc.) Outcome assessment: Attenuation of symptoms, induction and maintenance of remission, imaging findings, quality of life (QOL), prevention of complications and harm of therapy Methods for developing these guidelines: Described in the text Basis of recommendations: Integration of evidence level and consensus of experts Cost-benefit analysis: Not implemented Evaluation of effectiveness: Yet to be confirmed Status of guidelines: Updated version of the first Guidelines published in 2010 Publication sources: Printed publication available and electronic information in preparation Patient information: Not available Date of publication: October 2011 These guidelines were intended primarily to be used by practitioners in Japan, and the goal of these guidelines is to improve the outcomes of patients with Crohn's disease. © 2012 The Author(s).


Nishimura S.,Ofuna Chuo Hospital | Takeda A.,Ofuna Chuo Hospital | Sanuki N.,Ofuna Chuo Hospital | Ishikura S.,Juntendo University | And 4 more authors.
Journal of Thoracic Oncology | Year: 2014

INTRODUCTION: We investigated tolerable doses to organs at risk (OARs) in the mediastinum and pulmonary hilum following stereotactic body radiotherapy for centrally located lung tumors. METHODS: Between 2005 and 2012, 381 patients with lung tumors were treated with stereotactic body radiotherapy of 40 to 60 Gy in five fractions. From among these patients, we extracted those who received greater than 25 Gy irradiation to OARs and analyzed dosimetric factors in relation to grade 3 to 5 toxicities. RESULTS: In total, 398 OARs in 133 patients were analyzed, with a median follow-up of 33 (range, 3-87) months. The numbers receiving greater than 25 Gy irradiation to the aorta, vena cava, pulmonary artery, pulmonary vein, bronchus, trachea, heart, and esophagus were 72, 33, 73, 60, 55, 13, 69, and 23, respectively. The corresponding median Dmax 0.5 ml were 43.8, 32.0, 32.2, 29.1, 28.4, 28.7, 41.1, and 21.7 Gy. Of these patients, two developed grade 5 and one grade 3 hemoptysis, and two had grade 3 obstructive pneumonia. Two patients with grade 5 hemoptysis received high doses at the pulmonary artery and bronchus (59.2 and 54.4 Gy, and 61.3 and 59.6 Gy, respectively). No other grade 3 to 5 toxicities occurred. CONCLUSION: Therapeutic indications and dose-intensity should be carefully determined for patients with central tumors, especially when doses to the pulmonary artery and bronchus in the pulmonary hilum exceed 50 Gy. Tolerable doses for other OARs might, however, be higher than in this study, though longer follow-up is necessary to assess this possibility. Copyright © 2014 by the International Association for the Study of Lung Cancer.


Takeda A.,Ofuna Chuo Hospital | Sanuki N.,Ofuna Chuo Hospital | Kunieda E.,Tokai University
World Journal of Gastroenterology | Year: 2014

Systemic chemotherapy has enabled prolongation of survival in patients with stage IV colorectal cancer. This has subsequently increased the relative significance of local therapy for patients with oligometastases because they can be cured by removal of oligometastatic lesions. One of the most frequently reported tumor histologies for oligometastases is colorectal cancer. Resection is the standard therapy in most settings of oligometastases. Recently, studies have shown that stereotactic body radiotherapy (SBRT) may become a treatment option that provides high local control with minimal morbidity. Two-year local control rates following SBRT for hepatic and pulmonary oligometastases are almost over 80% and are even higher for patients treated with high-dose regimens. The indications of SBRT for other metastatic sites or conditions include isolated lymph nodes, spinal and adrenal metastasis, and post-surgical pelvic recurrence. Many retrospective studies have indicated that SBRT for various lesions results in good outcomes with low morbidity, both in the curative and palliative setting. However, few reports with a high level of evidence have indicated the efficacy of SBRT compared to standard therapy. Hereafter, the optimal indication of SBRT needs to be prospectively investigated to obtain convincing evidence. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.


Sanuki N.,Ofuna Chuo Hospital | Takeda A.,Ofuna Chuo Hospital | Oku Y.,Ofuna Chuo Hospital | Mizuno T.,Ofuna Chuo Hospital | And 4 more authors.
Acta Oncologica | Year: 2014

Background. Since 2005, we have treated hepatocellular carcinoma (HCC) with stereotactic body radiotherapy (SBRT) uniformly at two dose levels, according to baseline liver function and normal liver dose. We retrospectively examined the outcomes for these patients. Material and methods. Between 2005 and 2012, 221 HCC patients were treated with SBRT. Eligibility criteria for SBRT included a single (either solitary or recurrent) HCC lesion; unfeasible, difficult or refusal to undergo other surgery or percutaneous ablative therapies; Child-Pugh Classification (CPC) A or B; tumors ≤ 5 cm; dose to the bowels < 25 Gy/5 fractions; curative intent. Patients followed up ≥ 6 months were eligible. The prescribed dose depended on liver function and liver dose: 40 Gy for CPC-A and 35 Gy for CPC-B, in 5 fractions, requiring a 5-Gy dose reduction if the proportion of the liver receiving ≥ 20 Gy exceeded 20%. Treatment outcomes and safety were analyzed. Results. A total of 185 patients (n = 48 in the 35-Gy group; n = 137 in the 40-Gy group) were eligible, with a median follow-up duration of 24 months (range 3-80). The three-year local control and overall survival rates were 91% and 70%, respectively. There were no significant differences in outcomes between dose levels: the three-year local control and overall survival rates in the 35-Gy and 40-Gy groups were 91% and 89% (log-rank p = 0.99) and 66% and 72% (p = 0.54), respectively. Acute toxicities ≥ grade 3 were observed in 24 (13.0%) patients, and 19 (10.3%) patients had worsening of CPC score by two points. All but three (1.6%) patients promptly recovered to grade 1-2. Grade 5 liver failure occurred in two patients in the 35-Gy group. Conclusion. SBRT for HCC was safe and provided equivalent outcomes when administered either in 35 or 40 Gy/5 fractions. © 2014 Informa Healthcare.


Eriguchi T.,Ofuna Chuo Hospital | Takeda A.,Ofuna Chuo Hospital | Sanuki N.,Ofuna Chuo Hospital | Oku Y.,Ofuna Chuo Hospital | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose: To evaluate biliary toxicity after stereotactic body radiation therapy (SBRT) for liver tumors. Methods and Materials: Among 297 consecutive patients with liver tumors treated with SBRT of 35 to 50 Gy in 5 fractions, patients who were irradiated with >20 Gy to the central biliary system (CBS), including the gallbladder, and had follow-up times >6 months were retrospectively analyzed. Toxicity profiles, such as clinical symptoms and laboratory and radiologic data especially for obstructive jaundice and biliary infection, were investigated in relation to the dose volume and length relationship for each biliary organ. Results: Fifty patients with 55 tumors were irradiated with >20 Gy to the CBS. The median follow-up period was 18.2 months (range, 6.0-80.5 months). In the dose length analysis, 39, 34, 14, and 2 patients were irradiated with >20 Gy, >30 Gy, >40 Gy, and >50 Gy, respectively, to >1 cm of the biliary tract. Seven patients were irradiated with >20 Gy to >20% of the gallbladder. Only 2 patients experienced asymptomatic bile duct stenosis. One patient, metachronously treated twice with SBRT for tumors adjacent to each other, had a transient increase in hepatic and biliary enzymes 12 months after the second treatment. The high-dose area >80 Gy corresponded to the biliary stenosis region. The other patient experienced biliary stenosis 5 months after SBRT and had no laboratory changes. The biliary tract irradiated with >20 Gy was 7 mm and did not correspond to the bile duct stenosis region. No obstructive jaundice or biliary infection was found in any patient. Conclusions: SBRT for liver tumors adjacent to the CBS was feasible with minimal biliary toxicity. Only 1 patient had exceptional radiation-induced bile duct stenosis. For liver tumors adjacent to the CBS without other effective treatment options, SBRT at a dose of 40 Gy in 5 fractions is a safe treatment with regard to biliary toxicity. © 2013 Elsevier Inc. All rights reserved.


Oku Y.,Ofuna Chuo Hospital
Japanese Journal of Clinical Radiology | Year: 2016

The essential component of respiratory motion management in radiation therapy is to accurately measure target movement to account for internal margins in treatment planning. Then, adequate set-up margins should be created reflecting accuracy of patient fixation and isocenter location. In addition, a special care is needed to verify a clinical process from CT image acquisition for treatment planning to treatment delivery.


Sanuki N.,Ofuna Chuo Hospital | Takeda A.,Ofuna Chuo Hospital | Kunieda E.,Tokai University
World Journal of Gastroenterology | Year: 2014

The integration of new technologies has raised an interest in liver tumor radiotherapy, with literature evolving to support its efficacy. These advances, particularly stereotactic body radiation therapy (SBRT), have been critical in improving local control or potential cure in liver lesions not amenable to first-line surgical resection or radiofrequency ablation. Active investigation of SBRT, particularly for hepatocellular carcinoma (HCC), has recently started, yielding promising local control rates. In addition, data suggest a possibility that SBRT can be an alternative option for HCC unfit for other local therapies. However, information on optimal treatment indications, doses, and methods remains limited. In HCC, significant differences in patient characteristics and treatment availability exist by country. In addition, the prognosis of HCC is greatly influenced by underlying liver dysfunction and treatment itself in addition to tumor stage. Since they are closely linked to treatment approach, it is important to understand these differences in interpreting outcomes from various reports. Further studies are required to validate and maximize the efficacy of SBRT by a large, multi-institutional setting. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

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