[Evaluation of 99mTc-ECD SPECT for the detection of brain tumor: comparison with 201TI SPECT].

For the evaluation of brain tumor (n = 15), we performed both dynamic and static 99mTc-ECD (ECD) SPECT studies 201Tl SPECT was also used for comparison with the results of ECD SPECT. Dynamic ECD SPECT was obtained following the injection of 600 MBq of ECD. Five min after the injection of ECD, static ECD SPECT was performed. 201Tl SPECT was obtained 10 min after the injection of 74MBq. Abnormal uptake was recognized in 7 of 15 tumors with dynamic ECD: 5 of 7 meningiomas, 1 of 1 glioblastoma and 1 of 1 astrocytoma. However, no abnormal uptake was seen in 3 of 3 benign tumors (1 low grade astrocytoma, 1 hemangioma, 1 cranio-pharyngioma) and in 2 of 2 brain metastases. In contrast abnormal uptake was seen in 11 of 15 tumors with 201Tl:7 of 7 meningiomas; 2 of 2 brain metastases, 1 of 1 glioblastoma and 1 of 1 craniopharyngioma. No abnormal uptake was seen in 3 of 3 benign tumors (1 hemangioma and 2 low grade astrocytomas). Equivocal uptake was seen in 1 low grade astrocytoma with dynamic ECD and 201Tl. The mechanism of the accumulation of dynamic ECD to brain tumor is unclear. However, it may reflect not only blood flow, but also metabolism.

[Therapeutic efficacy of pre-operative radiotherapy on breast carcinoma: in special reference to its abscopal effect on metastatic lymph-nodes].

UNLABELLED: The abscopal effect is the radiation response in tissue at a distance from the irradiated site invoked by local irradiation. It is reported that the abscopal effect is observed occasionally in the cases of radiotherapy for malignant lymphoma, malignant melanoma and seminoma. However, pathophysiology and mechanism of the abscopal effect have not been well defined. An aim of this study was to investigate the pathophysiology and mechanism of the abscopal effect in patients with breast carcinoma. SUBJECTS AND METHODS: Sixty two patients entered this study. Age distribution was from 29 to 84 years old (mean 54.0 years old) and all cases were females. Their stages were as follows: stage II 12 cases, stage IIIa 16 cases, stage IIIb 22 cases and stage IV 12 cases. They were irradiated pre-operatively using less fractionated large dose irradiation. Then, they underwent mastectomy or tumor resection. RESULTS: The abscopal effect on metastatic lymph nodes was observed in 15 out of 42 cases (35.7%) by palpation. The histopathological abscopal effect was noted in 22 out of 42 cases (52.4%). Incidence of the abscopal effect was significantly higher in patients under 55 years old as compared with that in patients over 56 years old (p less than 0.05). The abscopal effect was highly observed in the cases who had the infiltrating lymphocytes around the degenerated cancer cells in the irradiated primary tumor nests (p less than 0.01). The subsets of the infiltrative lymphocytes were analyzed immunohistologically using monoclonal antibodies. It disclosed that the infiltrative lymphocytes were CD8 and CD4 positive lymphocytes. Those findings suggest that abscopal effect was caused by activated cellular immunity in hosts. The five and ten years survival rates of stage IIIa were 71.4% and 71.4% respectively. Stage IIIb showed 62.5% in 5 years survival rate and 54.7% in 10 years survival rate. The survival rate of the cases with the abscopal effect was higher than that of the cases without the abscopal effect, however it was not statistically significant. No complications such as pneumonia was observed.

[Therapeutic efficacy of postoperative irradiation on carcinoma of the breast].

From July 1973 to October 1983, 77 patients received mastectomy followed by postoperative irradiation at National Medical Center Hospital. The patients were classified as follows: 9 cases as stage I, 30 cases as stage II, 28 cases as stage IIIa, 7 cases as stage IIIb and 2 cases as stage IV. Irradiation fields were the parasternal and supraclavicular region. The axis of the irradiation fields to parasternal and supraclavicular regions were set up at 3.5 cm from the surface of the body and they were irradiated separately. The irradiation fields were about 0.5 cm apart from each other. Parasternal region contained bilateral parasternal lymphnodes. In some cases, the centersplit was used to prevent the radiation myelopathy. Prophylactic irradiation to axilla was performed by electron beam from October 1974 to September 1977. Prophylactic irradiation to chest wall has not been done since 1973. The five and ten years survival rates of stage II were 93.2% and 86.3%, stage IIIa were 61.9% and 55. 7%, Stage IIIb were 71.4% and 35.7%. The rate of the local recurrence at the supraclavicular region was 0% as stage I, 6.7% as stage II, 0% as stage IIIa and 14.3% as stage IIIb. Among the cases with regional lymphnode involvement at the time of mastectomy, the rate of local recurrence at the supraclavicular region was 6.7% in prophylactic irradiation group and it was significantly lower than in non-prophylactic irradiation group (11.5%) (p less than 0.05). The rate of local recurrence to chest wall was 0% as stage I, 6.7% as stage II, 8.0% as stage IIIa and 42.9% as stage IIIb.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of abscopal effect and cellular infiltration of tumor nests using less-fractionated, large-dose radiation].

As reported by several authors, abscopal effect and favorable cellular infiltrations into the tumor nest caused by irradiation suggest the existence of cell immunity in the host. In our present study, as first step to elucidate the mechanism of the fact mentioned above, effects of radiation with a single dose irradiation was estimated in terms of the increase of survival rate and the inhibition of pulmonary metastasis, i.e. abscopal effect in the mice of irradiated tumor burden. Therefore, we examined the resected and pulmonary specimen after irradiation histopathologically. We also examined the effects of the administration of immune modulator PSK and OK-432. Results; 1) Increase of survival rate and inhibition of pulmonary metastasis were observed in groups of mice with inoculated tumor and with again inoculated tumor treated by a single dose irradiation, compared to either the control groups. 2) Also administration of immune potentiator with radiation enhanced the survival rate and inhibition of pulmonary metastasis in all experimental protocols. 3) Remarkable cellular infiltrations of tumor nest after irradiation were observed, and these cellular infiltrations suggest participation of immunoreaction. In the group of using immune modulator, the cellular infiltrations were observed more remarkable than the other groups. 4) Optimal radiation dose was proved to be 30 Gy in this study.

[Diagnosis and treatment of metastatic bone tumor in the field of radiology].

From 1973 December to 1986 September, we have experienced 2,500 cases of radiation treatment, of which 237 cases have been with bone metastasis. X-ray CT was examined on the 19 cases to detect the bone metastasis. The detective rate was 89.5% with bone scintigram alone improved to 94.7% with both bone scintigram and X-ray CT. Serum Alkali phosphatase (Al-p) were measured after and before radiation treatment on 147 cases. Values of Al-p increased on 64.6% cases measured and when values of Al-p were decreased after radiation treatment, good treatment effects were showed. Electron microscope disclosed that Al-p has existed around cell membrane of metastatic tumor cell. We considered there is a correlation between increment of Al-p in blood and contents of Al-p in bone metastatic tissues. Judgement of effects of radiation treatments were scored by three grades of pain relieving on 217 cases. Effective rate showed 87.5%. Effective rate increased by using high dose rates irradiation with small fraction. Effective cases in relieving pain had longer survival than less ones. 26 cases which could not walk due to spinal cord paresis were treated by irradiation only or irradiation with decompression surgery. Walk recovery rate was 33% by radiation treatment only, on the other hand, by treatment with decompression surgery, it was 20%. Regarding as side effect, radiation myelopathy hardly occurred about 50 Gy (conventional irradiation method). We think if longer survival time is hoped, about 50 Gy is needed.

[Diagnosis and treatment of bone metastasis].

Diagnosis and treatments of bone metastasis were reviewed with clinical experiments in National Medical center Hospital. As for diagnosis of bone metastasis, early detection of bone metastasis was significantly improved by using bone scintigrams recently progressed. But the results of reviews suggest the possible improvements in diagnosis of bone metastasis. X-CT (X-ray Computed Tomography) for diagnosis of bone metastasis is advantages in three dimensional delineation of the extend and spread of bone lesions in bone marrow over bone scintigram. MRI (magnetic resonance imaging) has clinically been developed since 1981, does not directly represent bone structures but soft tissues in bone marrow, giving useful information concerning changes and spread of metastatic bone tumor not only inside the bone but also around it. MRI is now in technical progress and expected some improvements, could be expected in early diagnosis of bone metastasis. Regarding as treatment, we have individually to choose from radiotherapy, hormonal therapy, chemotherapy, surgical therapy according to clinical circumstances and does themselves. Radiation treatment is widely approved not only much effective in relieving the pains from bone metastasis, but also it is considered at the first choice in treatment of the spinal cord paresis by vertebral metastasis, because of frequently bringing good therapeutic effects.