MRI findings of radiation-induced myocardial damage in patients with oesophageal cancer.

AIM: To evaluate radiation-induced myocardial damage after mediastinal radiotherapy using MRI. MATERIALS AND METHODS: Between May 2010 and April 2011, delayed contrast-enhanced MRI was performed for patients who had maintained a complete response to curative radiotherapy for oesophageal cancer for more than 6 months. The patients received radiotherapy with a median total dose of 66 Gy (60-70 Gy) for the primary tumour and metastatic lymph nodes. Images of MRI were analysed by a 17-segment method recommended by the American Heart Association. A segment included mainly in the 40 Gy dose line was defined as Segment 40 Gy, a segment included mainly in the 60 Gy dose line as Segment 60 Gy, and a segment out of the radiation fields as Segment OUT. The percentage of late gadolinium enhancement (LGE) was examined in those categories. The layer in which LGE was predominantly distributed was evaluated for each patient. RESULTS: Four hundred and eight segments in 24 patients were analysed. The median interval from completion of radiotherapy to MRI was 23.5 months (range 6-88 months). LGE was detected in 12 of the 24 patients. LGE was detected in 15.38% of Segment 40 Gy cases, 21.21% of Segment 60 Gy cases, and 0% of Segment OUT cases. LGE in mid-myocardial and subendocardial layers was detected in 11 patients and one patient, respectively. CONCLUSION: LGE suggesting radiation induced myocardial fibrosis was observed by performing delayed contrast-enhanced MRI. Care should be taken when planning radiotherapy to avoid late cardiac damage.

Results of chemoradiotherapy for stage I esophageal cancer in medically inoperable patients compared with results in operable patients.

The purpose of the present study was to evaluate long-term results of chemoradiotherapy for clinical T1b-2N0M0 esophageal cancer and to compare outcomes for operable and inoperable patients. Patients with stage I esophageal cancer (Union for International Cancer Control [UICC] 2009), excluding patients with cT1a esophageal cancer, were studied. All patients had histologically proven squamous cell carcinoma. Operable patients received cisplatin and 5-fluorouracil with concurrent radiotherapy of 60 Gy including a 2-week break. Inoperable patients received nedaplatin and 5-fluorouracil with concurrent radiotherapy of 60-70 Gy without a pause. End-points were overall survival rate (OS), cause-specific survival rate (CSS), progression-free survival rate (PFS), and locoregional control rate (LC). Thirty-seven operable patients and 30 medically inoperable patients were enrolled. There was a significant difference in only age between the operable group and inoperable group (P = 0.04). The median observation period was 67.9 months. In all patients, 5-year OS, CSS, PFS, and LC were 77.9%, 91.5%, 66.9%, and 80.8%, respectively. Comparison of the operable group and inoperable group showed that there was a significant difference in OS (5-year, 85.5% vs. 68.7%, P = 0.04), but there was no difference in CSS, PFS, or LC. Grade 3 or more late toxicity according to Common Terminology Criteria for Adverse Events v 3.0 was found in seven patients. Even in medically inoperable patients with stage I esophageal cancer, LC of more than 80% can be achieved with chemoradiotherapy. However, OS in medically inoperable patients is significantly worse than that in operable patients.

[Reirradiation with brachytherapy for recurrent tongue cancer after initial brachytherapy].

The purpose of this study was to assess the efficacy of reirradiation with brachytherapy in the treatment of patients with tongue cancer that had recurred after initial brachytherapy. A retrospective analysis was performed in 12 patients with tongue cancer treated by reirradiation with brachytherapy using rigid linear sources such as the 226Ra-needle or 192Ir-hairpin at Kyushu University Hospital from 1978 to 1998. The patients included 8 men and 4 women, who ranged in age from 30 to 69 years (mean, 52 years). At the time of reirradiation, 7 patients had stage I cancer, and 5 had stage II cancer, according to the UICC (1997) classification. The median follow-up time of the surviving patients was 92 months. The 5-year relapse-free and cause-specific survival rates were 31% and 64%, respectively. The 5-year cause-specific survival rate varied according to the interval between the first and second course of brachytherapy and was 25% for intervals of less than 12 months and 83% for intervals of more than 12 months. Only 4 patients with local recurrence were recognized after their second course of brachytherapy. Among the 6 patients who survived more than 2 years after reirradiation without local recurrence, symptomatic complications such as soft tissue necrosis and minimal bone necrosis were found in 3 patients, but these side effects were not serious enough to require surgery. Reirradiation with a second course of brachytherapy may be useful in the treatment of patients with tongue cancer that recurs more than 12 months after initial brachytherapy.

Comparison of survival rates of patients with nasopharyngeal carcinoma treated with radiotherapy, 5-fluorouracil and vitamin A ("FAR" therapy) vs FAR therapy plus adjunctive cisplatin and peplomycin chemotherapy.

The overall survival rate (OSR) of 36 patients with nasopharyngeal carcinomas (NPC) treated at Kyushu University hospital between 1983 to 1992 was analyzed. As primary treatment, 16 patients received a combination therapy of 5-fluorouracil, vitamin A, and radiation (FAR therapy); two patients received radiotherapy only; 18 patients received FAR therapy plus adjunctive systemic chemotherapy consisting of cisplatin and peplomycin. The radiation dose to the nasopharynx was 6000 to 7050 cGy while that to the neck was 4000-6000 cGy. The 5-year OSR of all the patients was 49%. Histological type (moderately differentiated squamous cell carcinoma) and patient age (> or = 55) were found to be significant prognostic factors for a worse OSR. Although survival decreased with increasing T stage, no significant difference was observed. The 5-year OSR of the patients treated with FAR therapy was 53% and was 51% with FAR therapy plus chemotherapy. Compared to FAR therapy alone, adjunctive chemotherapy did not increase OSR of the patients with NPC.

Surgical treatment of a solitary pancreatic metastasis from renal cell carcinoma: report of a case.

The pancreas is a rare site of metastasis from renal cell carcinoma (RCC). We present herein the case of a 47-year-old male in whom a solitary pancreatic metastasis was treated by a pylorus-preserving pancreatoduodenectomy (PpPD), 3 years after a radical nephrectomy for a RCC. The few reported cases of surgically treated pancreatic metastases from RCC are reviewed following the presentation of this case.

Primary non-Hodgkin lymphoma of the sinonasal cavities: correlation of CT evaluation with clinical outcome.

PURPOSE: To determine retrospectively the primary site of origin of sinonasal lymphomas with computed tomography (CT) and correlate the CT findings with histologic phenotype and clinical outcome. MATERIALS AND METHODS: In 24 patients with stage I and II non-Hodgkin lymphomas of the sinonasal cavities, the CT appearances and clinical data were reviewed retrospectively. RESULTS: The sites of primary tumor determined at CT were the nasal cavity in 13 patients, the ethmoidal sinus in three patients, and the maxillary sinus in eight patients. B-cell lymphomas were found mainly in the maxillary sinus, while T-cell lymphomas were found in the nasal cavity and ethmoidal sinus (P < .005). The 5-year survival rates in relation to the primary site of the tumor were 64% for the nasal cavity, 50% for the ethmoidal sinus, and 100% for the maxillary sinus (P = .26). CONCLUSION: Patients with B-cell primary lymphoma of the maxillary sinus tended to have a good prognosis in contrast to those with T-cell lymphomas that originated from midline structures. The primary site determined at CT appears to be correlated with the histologic phenotype and clinical outcome.

Primary non-Hodgkin's lymphoma of the maxillary sinus.

Primary non-Hodgkin's lymphoma of the maxillary sinus is a rare lesion. We studied nine patients with malignant lymphoma involving the maxillary sinus, treated between 1980 and 1994 in the Kyushu University Hospital. All lymphomas had a diffuse pattern; five were the large-cell type, two the mixed type, and one the small lymphatic and small cleaved type. Immunohistologically, all tumors were B-cell type. Using the Ann Arbor staging system, six patients were classified as stage I, two stage II, and one stage IV. Two patients received only radiotherapy because of advanced age; the remaining seven received a combination of radiotherapy and chemotherapy (CHOP or VEPA). The tumor doses ranged from 30 to 51 Gy (mean, 46.7). The mean follow-up was 51 months. Only one patient (stage IV) died of disease, and eight stage I-II patients were rendered disease-free. The 5-year survival rate was 80%, suggesting that primary lymphoma of the maxillary sinus has a relatively good prognosis.

[Successful treatment of hypereosinophilic syndrome with cyclosporin and steroids].

A 41-year-old man with severe hypereosinophilic syndrome was first given a high dose of steroids. His condition improved, and the dose of steroids was tapered. His condition then worsened, and administration of cyclosporin was begun. Disease activity decreased and eosinophil counts decreased to the normal range. Cyclosporin and steroids inhibit the interleukin-2 gene transcription factors NF-AT and AP-1. They also inhibit the interleukin-5 production by peripheral lymphocytes stimulated by interleukin-2. AP-1 is the primary target for steroid-mediated repression of IL-2 gene transcription, but NF-AT appears to be the main target of cyclosporin. In patients with the hypereosinophilic syndrome, cyclosporin can be effective and can minimize the adverse effects of long-lasting therapy with high doses of steroids.

Resection of liver metastasis from alpha-fetoprotein-producing early gastric cancer: report of a case.

We herein present a case of resected synchronous solitary liver metastasis from alpha-fetoprotein (AFP)-producing early gastric cancer. A 61-year-old woman, who was diagnosed at a routine medical checkup as having early gastric cancer with a liver tumor, came to our hospital for surgery. Her serum AFP level was high at 910 ng/ml. An examination was performed to determine whether the liver tumor was primary hepatocellular carcinoma or metastasis from early gastric cancer. She had no evidence of either a hepatitis B or C virus infection, and her liver function was normal. A biopsy specimen from the gastric cancer predominantly revealed moderately differentiated adenocarcinoma, but a focally trabecular pattern compatible with AFP-producing gastric cancer was also observed. Preoperatively, it was concluded that the liver tumor was metastasis from an AFP-producing early gastric cancer. We thus performed distal gastrectomy and a posterior segmentectomy of the liver. Her serum AFP level decreased to the normal range within 2 weeks after the operation. An immunohistological examination revealed that AFP-positive cells were present in both the gastric cancer and liver tumor. One year after the operation, there was no sign of recurrence.

[A case of hepatocellular carcinoma with reduction of primary tumor and disappearance of multiple lung metastasis].

A 62-year-old male patient was admitted for spontaneous rupture of hepatocellular carcinoma. He also had multiple lung metastases and liver dysfunction. So neither operation nor trans-arterial embolization could be performed. He had been administered UFT (400 mg/day) orally every day. After 5 months of daily administration, there was complete disappearance of multiple lung metastasis and reduction of the primary tumor. This case suggests that UFT is effective for some advanced hepatocellular carcinoma with extrahepatic metastasis.