The usefulness of perfusion-weighted magnetic resonance imaging in advanced pancreatic cancer.

OBJECTIVES: Perfusion-weighted magnetic resonance imaging (MRI) can detect the changes of signal intensity in tumors. We evaluated the prognostic value of perfusion-weighted MRI in patients with advanced pancreatic cancer (PC). METHODS: Perfusion-weighted MRI was performed before treatment on 27 consecutive patients with advanced PC. The American Joint Committee on Cancer (AJCC) stages of patients were as follows (8, stage III; 19, stage IV). Imaging acquisition was continually repeated with echo planar sequence every 2 seconds for 2 minutes after a bolus injection of gadolinium. We made a time intensity curve of PC and calculated the signal ratio (SR) on perfusion-weighted imaging. We assessed the relation between SR and clinical factors including tumor stage, lymph node metastasis, liver metastasis, and so on. Patients were divided into low and high SR group and compared SR with the overall survival. RESULTS: All cases showed transient decreases signal intensity (SR, 6.9-55.7%). These patients were classified into 2 groups at cutoff median SR of 22.0% The high SR group significantly correlated with the higher stage (P=0.03) and the presence of lymph node metastasis (P=0.04). The high SR group had significantly shorter overall survival (P=0.04). CONCLUSIONS: Perfusion-weighted MRI may predict the survival in advanced PC patients.

[A resected case of metastatic pancreatic cancer from cecal carcinoma].

A 64-year-old woman underwent an ileocecectomy in July 2002 for ruptured cecal carcinoma, which was a well-differentiated adenocarcinoma, stage II, ss, ly0, v0, n (-). In August 2005, abdominal CT revealed a tumor 20mm in diameter in the pancreatic tail, therefore, a distal pancreatectomy and splenectomy were performed. The pancreatic tumor resembled the moderately differentiated cecal adenocarcinoma, both having p53 and k-ras point mutations in common, and it was diagnosed as a metastasis of the cecal carcinoma.

[A case report of S-1 monotherapy as first-line treatment for metastatic gallbladder cancer].

We experienced a case of advanced gallbladder cancer with a remarkable response treated by oral fluoropyrimidine anticancer drug S-1 (120 mg/day on day 1 through 28 followed by a 14-day recovery period) as first-line chemotherapy. The patient was enrolled in the late phase II trial of S-1 for metastatic biliary tract cancer designed to evaluate efficacy and safety. The anti-tumor effect was observed in both primary lesion of gallbladder and metastatic lesion of liver,and the efficacy was confirmed to be a partial response (Japan Society for Cancer Therapy Criteria). After the first two courses of treatment, the reduction ratio of the tumor volume was 88.1% in the measurable lesions of liver metastasis. No severe adverse event was noted except grade 3 desquamation. The patient continued the outpatient treatment for a total 7 courses. The overall survival time was 470 days,suggesting that S-1 is highly effective and tolerable for metastatic gallbladder cancer.

[Evaluation of biliary stenting therapy for malignant biliary stricture at our hospital].

The clinical results of biliary stenting therapy for non-resectable malignant biliary stricture were assessed for patency periods and survival periods in consideration of the types of stents and disease. The subjects were 51 patients with non-resectable malignant biliary stricture due to disease of the pancreas and biliary tract treated at our hospital between April 2001 and March 2005. No significant differences were observed in the patency periods and survival periods among the various types of stents. In regard to the type of disease, the survival period for biliary tract cancer was longer (616 +/- 246 days) than those for other diseases. There was no difference in the number of times of stenting among the various stents, and jaundice was effectively reduced. No patients in our series died of failure to reduce jaundice. We therefore considered it necessary to choose a proper stent indwelling route and a stent type according to stricture site, disease type and PS (performance status) at the time of stenting. The usefulness of the biliary stenting therapy for non-resectable malignant biliary stricture was suggested.

Noninvasive assessment of tumor vascularity by contrast-enhanced ultrasonography and the prognosis of patients with nonresectable pancreatic carcinoma.

BACKGROUND: Studies have shown that angiogenesis is one of the factors that influences the prognosis of patients with solid tumors, including pancreatic carcinomas. However, none have assessed noninvasively the relation between angiogenesis and prognosis in patients with pancreatic carcinoma. Contrast-enhanced ultrasonography (US) not only is a convenient, harmless, and noninvasive imaging modality, but it also provides detailed information on tumor vascularity. The objectives of this study were to assess the vascularity of pancreatic carcinoma noninvasively by contrast-enhanced US and to clarify the prognostic value of tumor vascularity in patients with nonresectable pancreatic carcinoma. METHODS: Thirty-five consecutive patients with pathologically confirmed, nonresectable pancreatic carcinoma were examined with contrast-enhanced US before systemic chemotherapy. The correlations among tumor vascularity, clinicopathologic factors, and clinical outcomes then were analyzed statistically to investigate prognostic indicators. RESULTS: The median time to progression (TTP) was longer in patients who had avascular tumors compared with patients who had vascular tumors (110 days vs. 28 days, respectively; P=0.0072; log-rank test). The median survival also was longer in patients who had avascular tumors (267 days vs. 115 days, respectively; P=0.0034; log-rank test). A multivariate analysis using a Cox proportional hazards model revealed that tumor vascularity was a significant, independent factor that influenced TTP (P <0.001) and survival (P=0.022) along with primary tumor size and serum lactate dehydrogenase (LDH) level, which are well known as prognostic factors in patients with pancreatic carcinoma. CONCLUSIONS: The current results indicated that contrast-enhanced US may be useful in assessing the prognosis of patients with nonresectable pancreatic carcinoma who receive systemic chemotherapy.