Intraarterial injection therapy of newly developed cisplatin-phosphatidyl choline-lipiodol suspension for hepatocellular carcinoma.

Twenty-seven patients with hepatocellular carcinoma were treated by intraarterial injection of a suspension of cisplatin powder and iodized oil using phosphatidyl choline as a dispersing stabilizer. A reduction in tumor size of over 25% was obtained in 23 patients (85%) and a reduction of more than 50% was obtained in 17 patients (63%). In all of 14 patients with a high serum alpha-fetoprotein level (more than 200 ng/ml), 27% to 99% reduction in the level was obtained. The one-, two-, and three-year survival rates were 74%, 50%, and 35%, respectively. As for side effects, digestive symptoms were rather frequently observed. Liver abscess and cholangitis were observed in one patient each in patients combined with embolization using gelatin sponge particles. Injection of the suspension with embolization was superior to injection only in therapeutic effect, but was associated with a higher frequency of side effects. The therapeutic effect was better in cases of higher Lipiodol retention in the tumor on follow-up CT.

[Bile lake: a complication of transcatheter hepatic arterial infusion and embolization therapy (TAI, TAE)].

A 74-year-old man with hepatocellular carcinoma developed cholangitis and bile lake in the liver after repeated TAI (anticancer drug-lipiodol suspension) and gelfoam TAE. Despite percutaneous transhepatic drainage, he died of hepatic failure 34 months after the first TAI and TAE. We speculate that cholangitis and bile lake were caused by chemical toxicity of highly concentrated anticancer drug to the bile duct and compression of the proximal bile duct by the tumor.

[Sclerotic changes in bone tumors following radiation therapy].

54 cases of osteolytic bone tumors were investigated concerning sclerotic change after radiotherapy. Particular attention was paid to the frequency and the appearance time of sclerotic change, and also to the effects of sclerotic change on pathological fracture and prognosis. There was no correlation between the sclerotic change and the frequency of pathological fracture. However, the interval between radiotherapy and pathological fracture tended to be longer in the group with sclerotic change. Sclerotic change after radiotherapy is considered as a sign of good therapeutic local effect and better prognosis.

[Radiotherapy of bone metastases from cervical cancer].

The authors have investigated 6 cases of bone metastases from cervical cancer out of a total of 90 cases of metastatic bone tumors that were irradiated for relief of associated pain at the Department of Radiology, Nagasaki University Hospital from April 1977 to March 1987. In 2 of the 6 cases, a rare, delayed recurrence with paraaortic lymph node metastases was seen. An invasion to the psoas major muscle, ilio major muscle was demonstrated by Computed Tomography after the initiation of therapy, so that the size of the field was modified. Computed Tomography was found useful to determine the exact field size for radiotherapy of metastatic bone tumor.

[Effective radiation therapy of two cases of primary Ewing's sarcoma of the rib].

Two cases of primary Ewing's sarcoma of the rib are reported, in which radiation therapy was quite effective. Case 1 was an 18-year-old female who had had an operation and radiation therapy for Ewing's sarcoma of the left 7th rib. She was referred to our hospital after a recurrent tumor was found. Radiation therapy (tumor dose 46.2 Gy) and chemotherapy were given. The tumor disappeared and there has been no relapse for 1 year and 3 months after the treatment. Case 2 was a 2-year-old-infant. Radiation therapy (tumor dose 74 Gy) was given for primary Ewing's sarcoma of the left 6th rib. The tumor became small and was successfully removed at operation. There has been no relapse or distant metastasis for 8 months following the operation. We emphasize the importance of multidisciplinary treatment in case 1 and the usefulness of preoperative radiotherapy in case 2.