[Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system].

From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p less than 0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significantly). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system.

Treatment of hepatocellular carcinoma by transcatheter hepatic arterial injection of radioactive iodized oil solution.

After 12 days of culture, VX2 carcinoma cells were inoculated into the liver of 16 rabbits; 14 days later, 131I-labeled iodized oil ([131I]-Lp) suspended in lipiodol was injected into the hepatic artery. Selective accumulation of the contrast material in the tumor for an extended time was evident on X-rays and hepatic scintiphotographs. The antitumor effect was remarkable. [131I]-Lp agents warrant further examination for their clinical usefulness. Internal radiation therapy by transcatheter hepatic arterial injection of [131I]-Lp (group A) was evaluated in 9 patients with hepatocellular carcinoma (HCC, tumor stage III or IV) associated with liver cirrhosis (LC) and compared with combination therapy of Lp-TAE (group B) in 18 patients with HCC (tumor stage III or IV) associated with LC. In group A, serum AFP levels dropped rapidly in eight of the nine patients who had an elevated initial level of more than 500 ng/ml. The average reduction in tumor size was 50% in eight cases as determined by computed tomography. Histological examination of one resected liver specimen at 3 months after the third injection of [131I]-Lp revealed microscopic features highly suggestive of a radiation effect in the [131I]-Lp-containing area. The 1-year survival value for patients with HCC was estimated at 49.0% using the Kaplan-Meier method. The survival of patients treated with internal radiation therapy tended to be better than that of those treated with Lp-TAE (P = 0.119).

Treatment response on CT scan in patients with brain metastases treated with irradiation.

To evaluate the role of CT scans in the assessment of response to therapeutic irradiation of brain metastases, CT findings of 64 patients were reviewed retrospectively. Enhanced tumor on CT scans disappeared in 21 patients, who survived significantly longer than those whose CT scans showed less than 50% regression (p less than 0.01). Ring contrast enhancement (ring CE) of the tumor on pre-RT CT scan did not seem to affect the patient's prognosis for survival. Tumors with ring-CE on pre- and post-RT CT scans, however, did not regress as much as those without ring-CE. Patients without ring-CE on pre- and post-RT CT scans tended to survive longer than those with ring-CE. This study suggests that tumor regression and the CE pattern on pre- and post-RT CT scans would be useful prognostic indicators for patients with brain metastases.

Trans-catheter hepatic arterial injection of lipiodol soluble anti-cancer agent SMANCS and ADR suspension in lipiodol combined with arterial embolization and local hyperthermia for treatment of hepatocellular carcinoma.

The clinical effect and safety of Lp-TAE alone and combined with radiofrequency (RF) capacitive hyperthermia (HT) were evaluated in 20 patients with hepatocellular carcinoma (HCC) associated with cirrhosis of the liver. After the oily carcinostatic agents were administered by Lp-TAE, HT, at a temperature of greater than 42.5 degrees C, was induced for 40 min, twice a week by an RF of 8 MHz for a total of 10 to 38 times. The response rate was 40% in the 10 cases that were treated with Lp-TAE combined with HT and 20% in the 10 cases that were treated with Lp-TAE. The patients who were treated with Lp-TAE combined with HT had a tendency to have better survival rates than those of the Lp-TAE group (p less than 0.099). The main side-effects of Lp-TAE combined with HT were low-grade fever, localized pain, myelo-suppression and liver dysfunction, but these were transient and eventually disappeared.

[A case of radiation-induced mucoepidermoid carcinoma of the lung following radiotherapy for pulmonary metastasis of Wilms' tumor].

Radiotherapy is one of the main therapeutic methods for malignant tumors, but on the other hand it can also induce new malignant tumors. Recently, we experienced a case of a 22-year-old woman with triple cancers (Wilms' tumor, thyroid cancer and mucoepidermoid carcinoma of the lung). She had been treated repeatedly for right-sided pulmonary metastases from the Wilms' tumor. The last cancer arose from a different organ in the field irradiated to treat the first cancer, after a latent period of about 20 years. Therefore, this case is classified as highly probable radiation-induced cancer (A-1 group) by the diagnostic criteria for radiation-induced cancer proposed by Sakai et al. Second cancers (radiation-induced cancers) mainly consist of soft tissue sarcomas, leukemias, skin cancers, urinary bladder cancers, large bowel cancers and other tumors. The occurrence of mucoepidermoid carcinoma of the lung as a radiation-induced tumor had not been reported. This patient also showed poor growth of the right breast and marked deformity of the right side of the thorax as late damage from irradiation. We must make efforts to decrease late damage from radiotherapy for pediatric cancers.

[Combined treatment in patients with carcinoma in situ of the urinary bladder using intravesical pirarubicin, irradiation and hyperthermia].

The treatment with hyperthermia in combination with radiation and intravesical pirarubicin (THP-ADM) was preliminary investigated in 5 patients with urinary bladder carcinoma in situ. Following intravesical administration of 30 mg THP-ADM, external irradiation of 3.0 Gy was delivered to the urinary bladder. Immediately then, hyperthermia using Thermotron RF-8 was performed for 50 min (intravesical temperature: 42-43 degrees C for 35 min). After five courses of the treatment, complete response has been maintained for 6, 8, and 9 months in 3 patients. However, in a patient with complete response, urinary cytology became positive in the 6th month after the treatment. In the remaining patient treatment was interrupted after only 3 courses due to urinary irritation, urinary cytology didn't become negative. The side effects of the combined treatment were limited to the transient symptoms of bladder irritation in all patients and thermal burn in 2 patients. These preliminary results suggest that this combined treatment may represent an effective conservative therapy for patients with urinary bladder carcinoma in situ.

[Two cases of hepatocellular carcinoma with omental mass].

Hepatocellular carcinoma rarely causes disseminated metastasis or distant metastasis. We have recently encountered two cases of hepatocellular carcinoma with omental mass. In the first case, we misdiagnosed the omental metastasis as part of the primary tumor. In the second case, omental mass was hypervascular on angiography and this was very useful for an exact diagnosis.

[Computed tomography for the assessment of pelvic lymph node metastasis in cases of uterine cervical carcinoma].

Seventy-six patients with cervical cancers underwent preoperative abdominopelvic computed tomography before a pelvic lymphadenectomy to evaluate the efficacy of computed tomography in assessing pelvic lymph node metastases. The sensitivity and the specificity of computed tomography for detecting pelvic lymph node metastases were judged to be 70.6 and 89.8%, respectively. In 54 patients in stage Ib or IIa of the disease, the sensitivity and specificity were 85.7 and 91.5%, respectively. Although inaccuracies could be caused by normal-sized metastasized lymph nodes and by enlarged lymph nodes with reactive hyperplasia, computed tomography was found to be a useful method of detecting a pelvic lymph node metastasis.

[Transcatheter arterial embolization of hemangiomas in the perioral region].

This paper presents four cases with successful transcatheter arterial embolization (TAE) for oral and perioral hemangiomas. Four TAEs were performed without major complications and the tumors disappeared in one case and decreased in size in the other 3 cases.

Measurement of renal parenchymal volume using computed tomography.

In hydronephrosis, total renal volume is not correlated with renal parenchymal volume. We have used computed tomography (CT) to determine renal parenchymal volume in 17 control patients and 36 patients with unilateral hydronephrosis. An additional 17 patients were studied before and 2 weeks after renal surgery. Renal parenchymal volume was determined by summing up the parenchymal area in each scan, taken at 10 mm intervals. Renal parenchymal volume measured by CT correlated well with renal area on excretory urography in normal kidneys. Renal parenchymal volume in hydronephrosis, however, was totally unrelated to renal area on excretory urography because of the grossly dilated calyceal system. Reproducibility of this study was ascertained in 17 patients using the contralateral nonoperated kidneys before and after the surgery (r = 0.939; p less than 0.01).

Computerized tomography of the kidney: tissue-plasma ratio of contrast enhancement with bolus injection and renal function.

Computerized tomography can be used not only for morphological studies but for physiological ones as well. Using computerized tomography, we were able to observe changes in renal parenchymal flow rates, with the aorta and renal parenchyma as regions of interest. There were 62 studies performed on 48 patients with and without known renal disease. The change in the tissue-plasma ratio with the use of contrast medium in 124 renal units correlated well with the renal function observed on excretory urography. The 14 patients subjected to renal ischemia during surgery underwent computerized tomography before and after the operation. The change in the tissue-plasma ratio of those kidneys operated upon was decreased significantly postoperatively compared to values found for the nonischemic contralateral kidneys. The results were reproducible and suggest that computerized tomography can be used as a method of evaluating the renal function per unit of parenchymal volume.