[Microwave coagulation therapy for liver metastases from colorectal cancer].

Hepatic resection has gained acceptance as the most effective therapy for liver metastases from colorectal cancer. Microwave coagulation therapy (MCT) and radiofrequency ablation as well as resection are also reported as effective therapies. We analyzed the prognosis of 52 patients with liver metastases from colorectal cancer treated with MCT as the first radical therapy. A total of 4 percutaneous MCT's (3 cases with interruption of hepatic blood flow), 23 MCT's with laparotomy, and 25 with hepatic resection + MCT with laparotomy were performed. Thirty-three MCT's performed as a second therapy for recurrence in the liver were also analyzed. Clinical risk scoring as reported by Fong, et al was used in our cases. The indication for percutaneous MCT with interruption of hepatic blood flow is solitary tumor less than 20 mm in diameter. The 5-year survival rate for the 4 percutaneous MCT's, 23 MCT's with laparotomy, and 25 hepatic resection + MCT's with laparotomy and 68 hepatic resections were 20, 24 and 24%, respectively. No significant difference was found among them. The 5-year survival rate for the 17 MCT's and 12 hepatic resections with recurrence in the liver were 20% and 24%, respectively. There was no significant difference found between them. The 5-year survival rate for the 28 CRS3 was 17%, almost equal to the rate, 20%, reported by Fong, et al for hepatic resections only. MCT is effective therapy for liver metastases from colorectal cancer, recurrence in the liver, and hepatic resections.

Acute tumor lysis syndrome caused by palliative radiotherapy in patients with diffuse large B-cell lymphoma.

Acute tumor lysis syndrome (TLS) is a condition that results from the rapid destruction of tumor cells accompanied with a massive release of cellular breakdown products. Acute renal failure resulting from TLS has been reported in cases of hematologic malignancies, spontaneous or treatment induced, the latter especially by chemotherapy. We present the case of a patient with diffuse large B-cell lymphoma who developed radiotherapy-induced TLS and subsequently acute renal failure. He presented with a large mediastinal tumor compressing the airway, thus causing dyspnea. After 6 Gy/3 fractions/3 days of palliative radiotherapy for the tumor, a decrease in urine volume was noted as well as rapid tumor shrinking. Because this patient died despite previous prophylaxic anti-uric acid treatment and hemodialysis, his case illustrates the need to anticipate the development of acute renal failure, even though there may be no remarkable serum uric acid elevation after the initiation of radiotherapy.

[Outcomes of patients undergoing microwave coagulation therapy for liver metastases from colorectal cancer].

To evaluate the efficacy of microwave coagulation therapy (MCT) for liver metastases from colorectal cancer, we analyzed the survival and the disease-free survival rate. From 1990 to 2001, 18 patients with liver metastases measuring < or = 3 cm in diameter and number of metastases < or = 3 were treated with MCT. The 3- and 5-year survival rates were 62% and 18%, respectively. These results are almost equal to those for liver resection. The disease-free survival rate was 86% and 52%, respectively. Local recurrence has not been observed, which puts the disease-free interval over 24 months. MCT can be considered an effective therapy for liver metastases from colorectal cancer.

Four cases of central nervous system involvement of breast malignant lymphoma.

Although malignant lymphoma of the breast is a rare disease, we recently experienced a high incidence of central nervous system (CNS) involvement. Thus, we retrospectively reviewed clinical records of 921 patients with breast tumors, treated from 1990 to 2002, to examine CNS involvement. Eight patients were found to have malignant lymphomas during this period. Of these, four patients ranging from 46 to 80 years of age had CNS involvement, one with Burkitt type and three with diffuse large B-cell lymphoma. The patients received surgery and/or chemotherapy and/or radiotherapy. The four other patients without CNS involvement are alive without tumor, whereas three of four patients with CNS involvement died of the disease. It should be noted that CNS involvement in breast lymphoma is not so rare. It is difficult, but important, to determine whether malignant lymphoma of the breast originates in the breast or is of systemic origin. Although brain metastasis could be treated effectively by radiotherapy and/or chemotherapy, the prognosis was poor. Further intensive treatment is required for breast malignant lymphoma with CNS involvement.

[Clinicopathological analysis of two patients with local recurrence after microwave coagulation therapy for liver metastases from colorectal cancer].

UNLABELLED: We analyzed the clinicopathological factors in two cases of local recurrence after a disease-free interval (DFI) of more than 12 months following microwave coagulation therapy (MCT) for liver metastases from colorectal cancer. Case 1: A local recurrence was diagnosed at 14 months after MCT for a liver metastasis of 20 mm in diameter from rectal cancer. Following liver resection, the patient remains alive without recurrence at 9 months. Case 2: A local recurrence was diagnosed at 19 months after MCT for a liver metastasis of 20 mm in diameter from rectal cancer. After MCT, the patient remains alive without recurrence at 36 months. CONCLUSION: We treated two patients with local recurrence who have more than 12 months' DFI after MCT for liver metastases from colorectal cancer. MCT or liver resection was performed as a curative therapy in these cases. Caution is recommended for local recurrence at more than 12 months after MCT for liver metastases from colorectal cancer.

Changes in natural killer cell activity by external radiotherapy and/or brachytherapy.

Our purpose in this study was to determine the influence of radiotherapy, especially brachytherapy, on the activity of natural killer cells (NK). We examined changes in NK activity before and after radiotherapy in 27 patients who underwent radiotherapy with or without brachytherapy, comprising of 16 cases of cervical cancer (three recurrences), 5 of prostate cancer, 4 of esophageal cancer and 2 of tongue cancer. Fourteen intracavitary procedures (for 13 cervical cancers and 1 esophageal cancer) and 10 interstitial brachytherapy (for 3 cases of recurrent cervical cancer, 5 of prostate cancer and 2 of tongue cancer) were performed with Ir-192 microSelectron HDR and Selectron Cs-137. External radiotherapy consisted of 10 MV X-ray administration for 13 cases of cervical cancer and 4 of esophageal cancer. The number of white blood cell was reduced by radiotherapy from 5065 +/- 2002 count/ml to 4281 +/- 1392 count/ml (p=0.02), that of lymphocytes from 1518 +/- 817 to 762 +/- 409 /ml (p<0.0001), and that of CD 16+ cells from 274 +/- 197 to 14 +/- 96 (p=0.03). No significant change was observed in the number of CD 56+ cells (274 +/- 166 to 211 +/- 153 /ml). Overall NK activity was reduced by radiotherapy from 37 +/- 19% to 30 +/- 19% (p=0.001). External radiotherapy with or without brachytherapy reduced NK activity from 33 +/- 18% to 23 +/- 16% (p=0.004). However interstitial brachytherapy produced little change in NK activity from 42 +/- 18 to 39 +/- 19%). Radiotherapy reduced the number of white blood cell, lymphocyte and CD 16+ cells. Although external radiotherapy suppressed NK activity, only brachytherapy showed little influence on NK activity alteration.