Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment

PURPOSE: Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. MATERIALS AND METHODS: Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. RESULTS: Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. CONCLUSION: For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.

A Surgical Case of CABG with Subclavian Steal Syndrome and Bilateral Iliac Type ASO / 日本心臓血管外科学会雑誌

Ischemic heart disease (IHD) may coexist with aorto-iliac occlusive disease, and concomitant revascularization procedures may be required. This study reports our experience with ascending aorta to left femoral bypass grafting (Ao-ltFG) to prepare for intra-aortic balloon pumping (IABP). A 73-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed coronary aneurysm and IHD. Enhanced computed tomography showed coronary aneurysm, complete left subclavian artery occlusion and bilateral external iliac artery occlusion. We planned a two-stage operation. In the first operation, we chose coronary artery bypass grafting, excision of the coronary aneurysm and simultaneously Ao-ltFG to prepare for IABP. In the second operation, we chose axillo-axillo bypass grafting and Ao-ltFG to right femoral artery bypass grafting. Although in the operative findings no coronary aneurysm was recognized, we performed the other operations and the postoperative course was uneventful without IABP.

A Case Report of Type A Dissecting Aneurysm Occurring after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

We report a case of type A dissecting aneurysm occurring after aortic valve replacement (AVR). The patient was a 67-year-old man with a history of AVR 4 years previously. Preoperative CT scan revealed a type A dissecting aneurysm 10cm in diameter, close to the sternum. Under preparation for selective cerebral perfusion (SCP), re-do median sternotomy was safely performed using partial extracorporeal circulation (ECC) via a femoral artery and vein. Because of severe adhesion in the upper part of the ascending aorta and aortic arch, a graft replacement of the ascending aorta was impossible. Under SCP via bilateral common carotid arteries exposed in the neck, the entry of the dissection, which was located in the previous aortotomy line, was closed with an ePTFE patch. SCP via bilateral common carotid arteries exposed in the neck appeared to be very useful and safe for such patients at risk for injury to the aorta during re-do median sternotomy and with severe adhesion, which made it difficult to establish SCP via the usual operative field. Although graft replacement is the standard operation for the treatment of the ascending aortic dissection, patch closure of the entry should be considered as a second-choice method in some case.