A case of chest wall recurrence of breast cancer treated with paclitaxel weekly, 5'-deoxy-5-fluorouridine, arterial embolization and chest wall resection.

Chest wall resection and reconstruction has proved to be a safe surgical procedure for local recurrence of breast cancer. Recently, as second- or third-line chemotherapy for the patients with recurrent breast cancer or ovarian cancer, weekly paclitaxel has provided a significant response rate in those patients, and generated much clinical interest. We report here a case of chest wall recurrence of breast cancer successfully treated by a combination of weekly paclitaxel, 5'-deoxy-5-fluorouridine, arterial embolization, and chest wall resection. A 56-year-old woman presented with a large mass in the left anterior chest. A recurrent tumor developed and enlarged one-and-half years after undergoing modified radical mastectomy for advanced breast cancer (T4N2M0, stage III B) at another hospital. The mass had enlarged while the patient underwent chemotherapy with cyclophosphamide, doxorubicin, 5-fluorouracil, and anastozole, followed by low-dose cisplatin, 5-fluorouracil, and goserelin. To reduce the mass and inflammatory changes of the skin, weekly paclitaxel and 5'-deoxy-5-fluorouridine was given. Furthermore, to obtain hemostasis and promote the mass reduction, arterial embolization of the supply arteries was performed. Chest wall resection, reconstruction of the bony chest wall with polypropylene mesh folded 8 times, and soft tissue reconstruction with a contralateral myocutaneous flap were carried out successfully. The patient was discharged from the hospital ten weeks after the operation without any major morbidity, and remained well for ten months. A multimodal approach with chemotherapy and arterial embolization was effective in this case in treating chest wall recurrence of breast cancer. Reconstruction of the chest wall bone with polypropylene mesh folded 8 times and soft tissue reconstruction with a contralateral myocutaneous flap was a useful procedure after chest wall resection, even after chemotherapy and arterial embolization.

Prognostic effects of dihydropyrimidine dehydrogenase in advanced colorectal cancer after surgery: immunohistochemistry using a new monoclonal antibody.

BACKGROUND: The response rate of 5-FU and its clearance are due to the activity of dihydropyrimidine dehydrogenase (DPD), which is the first and rate-limiting enzyme for the catabolism of 5-FU. Although several studies have evaluated the relationship between DPD expression and chemosensitivity to 5-FU in patients with colorectal cancer (CRC), only a few studies on DPD expression and clinicopathological features have been conducted using immunohistochemical staining since a monoclonal antibody for DPD has not been established. Now, a new monoclonal antibody (2H9-1b) for human DPD is available. PATIENTS AND METHODS: This study included 100 patients whose CRCs were classified into stage II to IV and completely resected surgically in our institute. DPD expression in CRC was evaluated by using immunohistochemical staining with 2H9-1b. The relationship between DPD expression and clinicopathological variables that might have affected the patients' prognosis were evaluated. Survival curves were calculated with the Kaplan-Meier method and differences were evaluated with the log-rank test. The Cox proportional hazards model was used in the univariate and multivariate survival analyses. RESULTS: DPD expression showed a positive correlation with advances in lymphatic invasion (p = 0.066), venous invasion (p = 0.033) and cancer stage (p = 0.033). The patients' survival rates after surgery were significantly (p = 0.018) higher in those DPD-negative than in those DPD-positive. The overall estimated hazard ratio for death in patients with DPD expression was 4.79 according to univariate analysis (p = 0.033). Multivariate analysis showed that DPD expression tended to be a prognostic factor less potent than other variables such as lymph node metastasis and venous invasion. CONCLUSION: With a new sensitive monoclonal antibody to human DPD, the present results indicated that DPD expression is associated with CRC progression and invasion, and closely correlated with poor prognosis in postoperative CRC patients. Moreover, DPD expression is a prognostic factor in CRC patients.

A case of ampullary carcinoma successfully managed with endoscopic snare resection.

Pancreaticoduodenectomy and transduodenal ampullectomy have been the procedures of choice for ampullary cancer in most patients. However, for patients with small ampullary neoplasms or who are unfit for laparotomy or refuse open surgical operations, endoscopic snare ampullectomy may be appropriate. We report here a case of ampullary carcinoma in which endoscopic snare ampullectomy was performed successfully, with long-term survival. The patient was a 77-year-old man with a 30-year history of ulcerative colitis, who presented with epigastric pain and fever. He had a history of four laparotomies. Laboratory studies showed a mild elevation in alkaline phosphatase, serum aspartate aminotransferase, gamma glutamyltransferase, and C-reactive protein values. At endoscopic retrograde cholangiopancreatography, the ampulla was prominent, with granulomatous proliferation. The common bile duct was dilated to approximately 25 mm in diameter. Biopsy specimens of the ampulla showed a well-differentiated adenocarcinoma. Because of extensive adhesions of the peritoneal cavity due to the prior four laparotomies and the patient's refusal of surgery, endoscopic snare ampullectomy was performed. Ten days after the ampullectomy, the patient was discharged from the hospital without any complication. The patient has been well for the 4 years since then, without recurrence of the tumor or jaundice. Endoscopic snare ampullectomy may be considered as a viable alternative to surgery in patients with small ampullary tumors who are unfit for surgery or who prefer a nonsurgical approach.

Prognostic value of thymidine phosphorylase/platelet-derived endothelial cell growth factor in advanced colorectal cancer after surgery: evaluation with a new monoclonal antibody.

BACKGROUND: Thymidine phosphorylase (TP) is an essential enzyme for activation of 5-fluorouracil and its derivatives and identical to platelet-derived endothelial cell growth factor. In colorectal cancer (CRC), previous studies evaluating the relationship between TP expression and clinicopathologic features have yielded inconsistent results. These studies used monoclonal antibody 654-1, which stained CRC cells weakly. Now, a new monoclonal antibody, 1C6-203, more sensitive than 654-1, is available. METHODS: This study included 80 patients whose CRCs were classified into stages II to IV and completely resected surgically in our institute. TP expression in CRC was evaluated by using immunohistochemical staining with 1C6-203. Relationships between TP expression and clinicopathologic variables that might have affected the patients' prognosis were evaluated. Survival curves were calculated with the Kaplan-Meier method, and differences were evaluated with log-rank test. Cox proportional hazards model was used in the univariate and multivariate survival analyses. RESULTS: TP expression showed a positive correlation with advances in histologic differentiation (P =.025), lymph node metastasis (P =.083), lymphatic invasion (P =.049), venous invasion (P =.042), and cancer stage (P =.002). The patients' survival rates after surgery were higher (P =.0041) in those with negative TP than in those with positive TP. The overall estimated hazard ratio for death in patients with TP expression was 6.24 according to univariate analysis (P =.013). Multivariate analysis showed that TP was a significant prognostic factor adjusted for other clinicopathologic variables. CONCLUSIONS: With a new highly sensitive monoclonal antibody to TP, the present results indicated that TP expression is associated with CRC progression and invasion and closely correlated with poor prognosis in postoperative CRC patients. Moreover, TP expression is an independent prognostic factor in CRC patients.