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Yokosuka T.,Tokyo Metropolitan Hiroo General Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

The prognosis of granulocyte colony-stimulating factor( G-CSF) -producing lung cancer is very poor. We present a case of G-CSF-producing locally advanced non-small cell lung cancer successfully treated with chemoradiotherapy. A 65-year-old man presented with a slight fever, general fatigue, and cough. A mass was detected in the right upper lobe of his lung, and it was diagnosed as squamous cell carcinoma by computed tomography (CT) -guided needle biopsy. Laboratory data indicated marked leukocytosis and elevated serum G-CSF levels, and therefore, the tumor was strongly suspected to be G-CSF-producing lung cancer. After systemic evaluation, the patient was treated with concurrent chemoradiotherapy for cT3N2M0, stage IIIA non-small cell lung cancer. Complete response (CR) was achieved, and he remained well with no recurrence of the cancer for over 3 years after treatment. Although immunohistochemical staining results for G- CSF were negative, clinically, the tumor was diagnosed as G-CSF-producing lung cancer.

Takeda A.,Ofuna Chuo Hospital | Kunieda E.,Tokai University | Ohashi T.,Ofuna Chuo Hospital | Ohashi T.,Keio University | And 3 more authors.
Radiotherapy and Oncology | Year: 2011

Purpose: To analyze local control of oligometastatic lung tumors (OLTs) compared with that of primary lung cancer after stereotactic body radiotherapy (SBRT). Materials and methods: Retrospective record review of patients with OLTs who received SBRT with 50 Gy in 5 fractions. Local control rates (LCRs), toxicities, and factors of prognostic significance were assessed. Results: Twenty-one colorectal OLTs, 23 OLTs from other origins, and 188 primary lung cancers were included. Multivariate analysis revealed only tumor origin was prognostically significant (p < 0.05). The 1-year/2-year LCRs in colorectal OLTs and OLTs from other origins were 80%/72% and 94%/94%, respectively. The LCR in colorectal OLTs was significantly worse than that in OLTs from the other origins and primary lung cancers with pathological and clinical diagnosis (p < 0.05, p < 0.0001 and p < 0.005). Among 44 OLT patients, Grades 2 and 3 radiation pneumonitis were identified in 2 and 1 patients, respectively. No other toxicities of more than Grade 3 occurred. Conclusion: SBRT for OLTs is tolerable. The LCR for OLTs from origins other than colorectal cancer is excellent. However, LCR for colorectal OLTs is worse than that from other origins. Therefore dose escalation should be considered to achieve good local control for colorectal OLTs. © 2011 Elsevier Ireland Ltd. All rights reserved.

Takeda A.,Ofuna Chuo Hospital | Oku Y.,Ofuna Chuo Hospital | Sanuki N.,Ofuna Chuo Hospital | Kunieda E.,Tokai University | And 8 more authors.
Radiotherapy and Oncology | Year: 2012

Purpose: To investigate threshold dose (TD) of focal liver reaction (FLR) following stereotactic body radiotherapy (SBRT) for patients with hepatocellular carcinoma (HCC) and liver cirrhosis. Materials and methods: In consecutive 50 patients receiving SBRT for small HCC, 38 patients receiving SBRT and follow up >6 months, FLR on follow-up CT had been previously studied. Patients with good concordance between FLR and highly irradiated area were eligible. Dose volume histogram (DVH) was used to identify TDs for FLR. Clinical factors were analyzed for correlation with TDs. Results: Of 24 eligible patients, 23 had Child-Pugh score A and 1 scored B. Presence of FLR peaked at a median of 6 (range; 3-12) months. The median and 95% confidential intervals of TDs of pre-contrast and portal-venous phase CT were 32.4 Gy (30.3-35.4) and 34.4 Gy (31.9-36.0), respectively. Each median coefficient representing the concordance was 74.9% (range; 55.8-98.0%) and 80.5% (range; 70.8-92.4%), respectively. No clinical factors significantly correlated with the TDs. Conclusion: We proposed 30 Gy/5 fractions as TD of FLRs following SBRT for patients with HCC and liver cirrhosis. This TD will enable us to predict injured liver volume and to avoid complication beforehand from toxicity. Further pathological and clinical studies, in addition to more practical and precise data of DVH, are needed to clarify the significance of FLRs. © 2012 Elsevier Ireland Ltd. All rights reserved.

Iwasaki H.,Tama Hokubu Medical Center | Fujita Y.,Nihon University | Hara M.,Tokyo Metropolitan Hiroo General Hospital
Pediatrics International | Year: 2015

Background The aim of this preliminary study was to investigate the clinical use of acute-stage susceptibility-weighted imaging (SWI) in children with prolonged convulsive disorder. Methods Ten children with prolonged convulsive disorder who underwent SWI within 2 h after termination of seizure (acute-stage SWI group) and 15 control children who underwent SWI > 2 h after their seizures terminated or for other purposes were enrolled. The cerebral venous vasculature was compared between the groups. The acute-stage SWI group was further divided into three subgroups: normal group, those with regional low signals in the cerebral veins (regional group) and those with diffuse low signals in the cerebral veins (generalized group). Inter-ictal electroencephalography (EEG) and venous blood gas findings during seizure activity were compared between these subgroups. Results All patients in the acute-stage SWI group had low cerebral vein signal. Four patients were assigned to the regional group and six patients to the generalized group. Decrease of venous pH and the increase of venous pCO2 during seizure activity was more prominent in the regional group than in the generalized group. In the regional group, low-signal areas in the cerebral veins were consistent with abnormal areas on EEG; these low-signal areas resolved completely in all patients on follow-up SWI. Ten patients in the control group had normal SWI, and five had a generalized low signal. Conclusions Acute-stage SWI may be a useful alternative for identifying lateralization of seizures in children with prolonged convulsive disorder. © 2015 Japan Pediatric Society.

Saitoh H.,Tokyo Metropolitan Hiroo General Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

A 59-year-old woman complained of impaired vision. She visited an ophthalmologist and glaucoma was diagnosed. In July 200X, she was admitted to our hospital for further examination. Chest radiography and CT showed lymphadenopathy in the mediastinum and bilateral hilum. Bronchofiberscopy revealed mucosal hypervascularity and a polypoid lesion at the orifice of the left B8a. A transbronchial biopsy specimen of the polypoid lesion showed non-caseating epithelioid cell granuloma. On bronchoalveolar lavage, both the proportion of lymphocytes and the CD 4/8 ratio had increased. We diagnosed sarcoidosis with an endobronchial polypoid lesion. The patient has been observed without therapy since, and after a year the polypoid lesion is the same size on 3D CT scans. This is a very rare case of endobronchial sarcoidosis presenting as a polypoid lesion.

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