[Reduction of angialgia during peripheral administration of oxaliplatin mixed with dexamethasone].

Seven patients who had been receiving capecitabine+oxaliplatin±bevacizumab(CapeOX±BV)therapy at our hospital between February 2010 and March 2011, had complained of angialgia during oxaliplatin(L-OHP)administration. Therefore, 3. 3 mg of dexamethasone(DEX)was added to their infusion solution. The patients were then asked to rate their angialgia severity using a numerical rating scale(NRS), when L-OHP in a 5% dextrose solution was administered with or without DEX. By changing the L-OHP in 5% dextrose solution without DEX to the solution containing 3. 3 mg of DEX, the mean NRS was improved to 2. 4 from 7. 1. These findings indicate that L-OHP in 5% dextrose solution mixed with 3. 3 mg of DEX seems to be useful in reducing angialgia during peripheral administration of L-OHP.

A proposal of a practical and optimal prophylactic strategy for peritoneal recurrence.

Peritoneal metastasis, which often arises in patients with advanced gastric cancer, is well known as a miserable and ill-fated disease. Once peritoneal metastasis is formed, it is extremely difficult to defeat. We advocated EIPL (extensive intraoperative peritoneal lavage) as a useful and practical adjuvant surgical technique for those gastric cancer patients who are likely to suffer from peritoneal recurrence. In this paper, we review the effect of EIPL therapy on prevention of peritoneal recurrence on patients with peritoneal free cancer cells without overt peritoneal metastasis (CY+/P-) through the prospective randomized study, and we verified its potential as an optimal and standard prophylactic therapeutic strategy for peritoneal recurrence.

Prognostic factors of curatively resected esophageal carcinoma associated with multiple metastatic lymph nodes.

BACKGROUND/AIMS: Prognosis of esophageal carcinoma with multiple metastatic lymph nodes is dismal despite radical operation and adjuvant therapy. We investigated prognostic factors for curatively resected esophageal carcinoma with multiple positive nodes. METHODOLOGY: From January 1983 to December 2002, 343 patients with thoracic esophageal carcinoma underwent an esophagectomy with curative intent. Of these patients, 82 patients were associated with 4 or more histopathologically positive nodes. Of these patients, 59 patients underwent a curative resection. Of these 59 patients, 7 patients who died of postoperative complications during the hospital stay were excluded. Therefore, 52 patients were enrolled in this study. Survival curves were compared after stratifications according to 14 clinicopathologic variables. Independent prognostic factors were detected using a multivariate Cox proportional hazard model. RESULTS: The cumulative 5-year survival rate for the subjects was 10.6%. The factors affecting cumulative survival rate by a univariate analysis were intramural metastasis (absence vs. presence) (p=0.03), and postoperative therapy (performed vs. not performed) (p=0.02). A multivariate analysis detected the performance of postoperative therapy (Hazard Ratio= 0.390, p= 0.002) and the absence of intramural metastasis (Hazard ratio=0.429, p=0.01) as positive prognostic factors. CONCLUSIONS: The positive prognostic factors for esophageal carcinoma with multiple lymph node metastases were the absence of intramural metastasis and the performance of adjuvant therapy.

[A case of recurrent breast cancer with bone metastasis causing pancytopenia--efficacy of low-dose CPT-11+ MPA].

A 46-year-old woman underwent breast-conserving surgery. The patient was treated with six cycles of CMF and, subsequently, combination therapy with UFT and CPA. However, multiple metastases were detected in the thoracic vertebrae after two years and two months of surgery. Weekly administration of paclitaxel was initiated, but the drug could not be continued due to pancytopenia. CPT-11 (40 mg/body) once a week and medroxyprogesterone acetate (MPA) 600 mg a day was substituted for paclitaxel. During the treatment with CPT-11, no severe adverse reactions, such as myelosuppression and diarrhea, were observed, and the patient's condition was stable without discontinuing the chemotherapy. The results suggest that the low-dose CPT-11 and MPA therapy should improve the prognosis of advanced and recurrent breast cancers with only slight adverse effects.

[A case of hepatocellular carcinoma with multiple lung metastases responding to intermittent intrahepatic arterial chemotherapy of CDDP+5-FU].

A 72-year-old man who had multiple hepatocellular carcinoma underwent eight times intrahepatic arterial chemotherapies of SMANCS and two times percutaneous ethanol injection (PEIT) therapies over three years, but new diffuse lesions appeared in the liver. He was treated by intermittent intrahepatic arterial chemotherapy with CDDP 10 mg/body/w and 5-FU 500 mg/body/w. Three months after the start of this therapy, the liver tumor was enlarged and multiple lung metastases appeared. But ten months later, the size of the hepatic lesion was reduced and the lung lesion disappeared. Fifteen months later, a solitary metastatic lesion in the left lung was resected. After two years, peritonitis carcinomatosa was observed, and the patient died.

Three-field dissection or two-field dissection?--A proposal of new algorithm for lymphadenectomy.

BACKGROUND/AIMS: There are no systematic criteria for cervical lymphadenectomy in esophageal carcinoma. We provide a new algorithm for deciding whether to use three-field dissection or two-field dissection. METHODOLOGY: Ninety-eight patients underwent curative esophagectomies with three-field lymph node dissections for squamous cell carcinoma of the thoracic esophagus. We examined the outcomes and predictors for survival of these patients. Therefore, we devised a new decision tree for deciding whether to use three-field dissection or two-field dissection. RESULTS: The overall 5-year survival rate for the 98 patients was 41.3%. The number of positive nodes was the only significant predictor for survival in the multivariate Cox proportional hazard model. The outcomes of patients with positive supraclavicular/internal jugular nodes were poor. On the other hand, positive cervical paraesophageal nodes do not worsen prognosis. We provided a new algorithm for selecting procedure of lymphadenectomy based on the presence of lymph node metastases. This algorithm is decided by the number of positive nodes, the presence of cervical node metastasis and recurrent nerve node metastasis. According to this decision tree, there were a few patients who needed absolutely three-field dissections. CONCLUSIONS: The new algorithm may be helpful for deciding three-field dissection or two-field dissection for thoracic esophageal carcinoma.

The width of a gastric tube has no impact on outcome after esophagectomy.

BACKGROUND: We evaluated the impact of the size of gastric tubes on tissue blood flow of the anastomotic site, the frequency of leakage and the postoperative nutritional status. METHODS: Forty-four patients were randomly allocated to either reconstruction using subtotal stomach (n = 22) or to reconstruction using slender gastric tube (n = 22) after esophagectomy. The tissue blood flow at the anastomotic site was measured. The postoperative nutritional status of 17 patients without recurrence was examined. Possible correlations between the type of esophageal substitute and the tendency to leakage as well as postoperative nutritional status were examined. RESULTS: There was no significant difference in the tissue blood and the frequency of leakage between the types of gastric tubes. There was no significant difference noted between the two in the postoperative nutritional status at 6 and 12 months after operation. CONCLUSIONS: The width of gastric tube has no impact on tissue blood flow, the frequency of leakage, and the postoperative nutritional status after esophagectomy.