Nihon Gan Chiryo Gakkai shi最新文献

OK-432 and etoposide were administered intravenously to a patient with liver metastasis of ovarian cancer. OK-432 induced IFN-gamma and TNF. SuPS and PPD skin reaction became positive after the therapy. The size of metastatic lesions was reduced significantly (partial response). It is suggested that the combination therapy of OK-432 and etoposide may be effective to the liver metastasis of ovarian cancer.

Thirty-nine previously untreated patients with squamous cell carcinoma of the tongue were treated by irradiation or a combination of irradiation and surgery, with or without chemotherapy, between January 1971 and December 1980. All of the patients had a follow-up period of at least nine years. Twenty-two patients were men and 17 were women. The average age was 50.1 years, with a range of 30 to 74 years. The absolute five-year survival rate was 82.1% and the cumulative ten-year survival rate 76.9% for these 39 patients. Cervical node metastases were clinically found on admission in 14 patients whose five-year survival rate was 64.3%, whereas it was 92.0% for 25 patients without metastasis. The absolute five-year survival rate decreased from 92.3% for patients with stage I lesions to 90.9%, 87.5% and 42.9% for those with stage II, stage III and stage IV lesions, respectively. Most of the patients received external irradiation and intraoral electron beam therapy. External irradiation was administered to the upper neck in all but one of 25 patients with TxN0 lesions. Subsequently partial glossectomy was performed in 12 of the 25 patients. Hemiglossectomy and hemimandibulectomy were used for 5 of 16 patients with TxN1-3 lesions. No patients with TxN0 lesions developed neck lymph node metastasis. Twenty-nine of the 39 patients had no tumor recurrence either locally or regionally for five years and 27 for nine years. None of the patients had major post-irradiation complications.

Recently, high aged patients with malignancies have increased in number. When cancer chemotherapy is applied for the high aged patients, kinds or doses of anti-cancer drugs must be more carefully selected or decided than for younger patients, because it is said that the side effects of anti-cancer drugs would easily induce irreversible organ disorders and death in high aged patients. The effects of cancer chemotherapy were compared between high aged patients (over 75 years) and younger patients (5 decade years) with special reference to side effects. The patients underwent cancer chemotherapy were 79.7% of high aged patients and 93.6% of younger. The reasons why cancer chemotherapy was not carried out were high age (5.6% of high aged patients), poor general conditions (7.0% in high aged, 2.3% in younger) and post operative complications (7.0% in high aged, 3.2% in younger). The proportion of patients suffered side effects was almost same in both groups. Dead cases caused by side effects of anti-cancer drugs were 5 in high aged patients (4.4%) and 7 in younger (3.4%). The reason why the proportion of side effects in both groups was not different was that the doses of anti-cancer drugs given for high aged patients were reduced to 80-90% of those for younger patients.

Of 342 breast cancer patients radically operated on in the Second Department of Surgery, School of Medicine, Chiba University during 1965-1988, treatment for 75 recurrent patients were evaluated by the initial modes of recurrence. The modes of recurrence were classified into distant metastases, local lymph node recurrence (axillary, parasternal and supraclavicular nodes) and chest wall recurrence according to the General Rules for Clinical and Pathological Recording of Breast Cancer. Of 75 recurrent patients, distant metastases were seen as common as 77.3%, followed by recurrences of local lymph nodes (14.7%) and chest wall (8.0%). The number of patients in each mode of recurrence increased in relation to increase in the size of tumor and the number of metastatic lymph nodes at the time of the first operation. Histologically, scirrhous carcinoma was most common in chest wall recurrence. 2-year disease-free survival rates of distant metastases, local lymph node recurrence and chest wall recurrence were 44.6%, 24.2% and 16.7%, respectively. 5-year survival of bone metastasis with chemo-endocrine therapy was as significantly favorable as 60%, compared to chemo- or radiotherapy alone (p less than 0.01). However, 5-year survival of lung metastasis with or without endocrine therapy revealed no significant difference. Local lymph node recurrence with the combination of resection, radio- and/or chemotherapy produced a trend toward showing more favorable survival than that without resection.

We examined the effects and adverse drug reaction (ADR) of intermittent cisplatin therapy (ICDDPT) on advanced ovarian cancer patients (OCP). Most OCPs had undergone surgical removal of primary lesion and induction chemotherapy, and histopathological analysis indicated epithelial tumors. Five OCPs were stage III, six were stage IV and one stage II (n = 12). After surgical treatment and induction chemotherapy, ICDDPT was initiated with a 25-30 mg/day dose of CDDP for 5 days, every 3 months. During the intervals, maintenance immunochemotherapy of Tegafur and OK-432 was applied. Following ICDDPT, all patients except one are alive. The longest survival, to date is 5 years 7 months, while the decreased case survived 4 years. ADR was analysed according to the total dose of CDDP i.e. under 500 mg, over 500 mg-under 1,000 mg, 1,000 mg-under 1,500 mg, and 1,500 mg and over. Abnormal laboratory findings were observed for WBC, platelet (thrombocytopenia), Hb, GOT and GPT. The abnormal values except for GOT and GPT reverted to normal just before next administration. Thereafter ADR of CDDP with regard to the renal tubulus were studied by observing urinary NAG and urinary and serum beta 2 microglobulin. These values, however, were restored to within normal limits after 1 week of CDDP administration. These ADR were no greater with the increasing dose, such that accumulative toxicity was not observed. Study of the histological concentration of platinum showed a high level in liver tissue. Therefore, liver damage should be noted as on ADR of CDDP. In conclusion, ICDDPT for OCP was seen to be effective because of a good survival rate and low ADR.

Chemoembolization using CDDP, VP-16 and lipiodol was carried out for 7 patients with hepatocellular carcinoma (HCC). CDDP/lipiodol, CDDP/VP-16, CDDP/lipiodol (lipiodol 2-10 ml, CDDP 1-2 mg/kg, VP-16 100 mg/body) and gelatine sponge were administered in that order through the catheter located in the proper, or right or left hepatic artery. Three patients underwent hepatic resection 38-50 days after this treatment. Complete necrosis of the tumor was recognized in the one case, although the portion of necrosis did not exceed 70% in large sized HCC as the diameter of more than 10 cm. In 4 unresectable cases the decreases in tumor size were observed by ultrasonography and computed tomography. The response was: 3 partial responses and 1 no change. One out of 4 cases could undergo hepatic resection 17 months after this treatment. Two patients are alive 20 months after this treatment, although one patient died of HCC after 25 months. Serious side effect was not observed.

Basic and clinical studies were performed to establish the value of Nd:YAG laser therapy for treating cervical intraepithelial neoplasia (CIN) with preservation of the uterus. The basic studies revealed that application of a surgical rod with a 0.4 mm tip at an output of 20 watts was the most suitable. Its use produced an excellent cone specimen, and there was no difficulty in making a histopathological diagnosis of the lesion. The layer of coagulation produced by the contact laser with microchip at a 20 watt output was 0.36 mm thick with 1 second of irradiation. This layer became thicker as the coagulation time became longer. Thus, necrosis of the residual lesion could be produced together with hemostasis. A clinical study was performed in 329 patients with CIN who were treated from September 1983 through December 1988 with Nd:YAG laser therapy. The preoperative diagnosis was mild dysplasia in 94 patients, severe dysplasia in 97, and carcinoma in situ in 138. Contact Nd:YAG laser conization (method A) was used in 272 cases, and Nd:YAG laser vaporization (method B) in 57 cases. After a single treatment, the overall cure rate was 97.6%. This high cure rate was obtained because irradiation technique most suitable for each lesion was chosen from among five techniques at the time of colpo.cervicoscopy. The cure rate was 98.9% with method A, and 91.2% with method B. Using method A, a deeper layer of coagulation necrosis was produced in the cone bed so that any residual was eliminated. In addition, using method A a cone specimen could be obtained to facilitate the histological diagnosis after operation and to determine the adequacy of excision. Accordingly, when there was incomplete excision, the prognosis could still be judged from histological examination of the lesion. The histological appearance of the cone specimen was valuable in planning the follow-up and further treatment where necessary. There were no serious side effects with either method. The average time required for therapy was 11.4 minutes with method A and 12.2 minutes with method B. From the review of the incompletely excised cases using method A, the uterus-preserving therapy is recommended when preoperative biopsy findings agree with or overestimate cytologic and colpo.cervicoscopic findings. Neither method A nor B affected fertility. Cervical healing and the incidence of subsequent pregnancies were very satisfactory with both methods. These results show that Nd:YAG laser therapy is very effective in CIN and can allow the uterus to be preserved.(ABSTRACT TRUNCATED AT 400 WORDS)

The results of second-look operation (SLO) were reviewed in 25 patients with primary ovarian carcinoma and following results were obtained. There were 21 patients in whom SLO was performed to examine whether tumors were present or not. There were 17 patients with negative SLO and remaining four patients were positive SLO. There was a higher tendency for positive SLO with patients of stage III.IV, serous cystoadenocarcinoma, and initial incomplete surgery. It is recommended that SLO is done for the patients with above characteristics. However, there were no cases of positive SLO among patients of stage Ia, so it is suggested that it is not necessary to do SLO. Five years and three years survival of negative SLO were 46% and 68%, respectively and those of positive SLO were 50% and 50%, respectively. Patients with negative SLO were better prognosis than those with positive SLO until four years after SLO. Eight out of 17 patients with negative SLO were recurred. Therefore, some maintenance treatments after negative SLO are needed for attaining further reduction of recurrence, especially patients for serous histology, low grade differentiation, initial incomplete pelvic surgery and stage III.IV. Two out of four patients with positive SLO are alive. Patients with initial complete pelvic surgery and microscopic lesion at SLO tended to be better prognosis. There were four patients in whom tumor debulking was attempted at SLO due to tumor presence after multimodality approach. All patients were eventually recurred and died of disease. However, two patient survived for 44 and 52 months after SLO. It was suggested to be effective for prolongation of life by debulking tumors at SLO.

The human papillomavirus detection and oncogenes amplifications were studied on DNAs from fifteen cervical cancers. We detected HPV16 and HPV18 using Southern blot hybridization and polymerase chain reaction (PCR) technique. The positive subjects of HPVs were eight cases (53%) observed by Southern blot hybridization and fourteen cases (93%) by PCR technique. The gene amplifications of oncogenes (c-myc and N-myc) were analysed by slot-blot method and were observed in c-myc but not in N-myc. The "LARGE" gene amplification (more than five fold) in c-myc was observed in one case (7%) and the "SMALL" gene amplifications (less than five fold) were observed in six cases (40%) in human cervical cancers. Although one of five cases (20%) with HPV16 was present c-myc gene amplification, all of three cases (100%) with HPV18 were found c-myc gene amplifications. In two out of three cases obtained more than three fold c-myc gene amplifications, HPV were not detectable. It is suggested that the negative correlation between gene amplification and numbers of HPV copies exist in advanced cervical cancers.

We have investigated the experimental combined chemo- and endocrine therapy of UFT and tamoxifen (TAM) on two human breast carcinoma xenografts, R-27 and Br-10 with estrogen receptors (ER) serially transplanted into nude mice. When sc inoculated tumor started the exponential growth, the treatments were initiated in four groups which were control, UFT 20 mg/kg (as tegafur) po daily for 18 times, TAM 5 mg/kg im twice a week for 6 times and UFT + TAM groups. The antitumor activity of the agents were assessed by the growth curves, the lowest T/C ratios of the relative mean tumor weight and the actual tumor weights at the end of the experiments. TAM alone was effective on both R-27 and ineffective on Br-10, while UFT alone was ineffective on R-27 and Br-10. The combination antitumor activity was observed in R-27 but not in Br-10. When 5 mg of TAM per kg and 20 mg of UFT per kg as tegafur was administered daily po for 2 wk, there were no statistically significant differences between the concentration of 5-FU in UFT alone and UFT + TAM groups for the two strains. By the assay of ER and progesterone receptors using the same specimen, it was observed that ER was stable by the treatment of UFT, while ER was suppressed by the treatment of TAM in both tumor strains. In addition, this suppression of ER by TAM alone was enhanced by the combined treatment with UFT in both the strains.(ABSTRACT TRUNCATED AT 250 WORDS)