Endoscopic radiofrequency ablation in elderly patients with hepatocellular carcinoma.

BACKGROUND: The number of elderly patients with hepatocellular carcinoma (HCC) has increased in Japan. PATIENTS AND METHODS: A total of 280 patients with HCC treated with endoscopic radiofrequency ablation (ERFA) were enrolled in the present study. The patients were divided into two groups, an elderly group (≥ 70 years) and a non-elderly group (<70 years) and their clinical and survival data were compared. RESULTS: The cumulative overall survival rates in the elderly and non-elderly groups were equivalent: 73% and 70% at three years and 57% and 52% at five years, respectively (p=0.900). The disease-free survival rates were 21% and 23% at three years and 17% and 14% at five years, respectively (p=0.628). No significant effects were observed between the two groups due to any of the covariates in the survival analysis (all p-values for interaction ≥ 0.19). The complication rates were also comparable: 5.1% in the elderly group and 8.6% in the non-elderly group. CONCLUSION: ERFA is safe and provides excellent therapeutic effects in elderly as well as non-elderly patients with HCC.

[The assessment of chemoradiation therapy with CDDP/S-1 for advanced gastric cancer that was actively bleeding].

In the management of inoperable patients with advanced gastric cancer, it is important to control a tumor bleeding actively and to make sure that the patient can take meals through the stenotic cardia for the purpose of keeping the patients' quality of life well. We treated five gastric cancer patients with chemoradiation therapy consisting of CDDP (6 mg/m2) and S-1 (100 mg/body). In the treatment results, we have never seen an active tumor bleeding and anemic state, which required a blood transfusion after the treatment. In all of the 5 cases, a total quantity of taking meals increased due to a cardia stenosis improvement by tumor. We thought this treatment was useful for patients with cardia stenosis and actively bleeding in advanced gastric cancer.

[Assessment of chemoradiation therapy for advanced rectal cancer invaded the pelvic organ].

We assess the effect of chemoradiation therapy for four cases of advanced rectal cancer. The radiation therapy consisted of 40-50 Gy delivered in fraction of 2 Gy/day. A treatment of 5-fluorouracil (500 mg/body) with l-leucovorin (100 mg/body) intravenously once a week, or oral S-1 (100 mg/day/body) for four weeks, was given during radiation therapy. Efficacy for primary carcinoma was evaluated as partial response in all four cases. We performed a curative operation in two cases. Histological efficacy for primary tumors was diagnosed as Grade 2 and Grade 3. Grade 3 adverse effect for neutropenia occurred in one patient, and Grade 3 adverse effect for appetite loss occurred in 2 patients. All cases survived without a recurrence for a period of 4 months-5 years and 3 months. Chemoradiation therapy was safe and an effective treatment prior to curative operation for advanced rectal cancer which invaded the pelvic organ.

[Successful treatment of embolization and chemoradiationtherapy with S-1 for the advanced gastric cancer which was actively bleeding].

In the management of inoperable patients who have advanced gastric cancer, it is important to control an active tumor bleeding for the purpose of keeping the patient's quality of life well. We treated two patients: embolization with coil to aneurysm in the gastric tumor in one case, and embolization and chemoradiationtherapy with S-1 in the other. In results, we have never seen an active tumor bleeding and anemic state requiring a blood transfusion after the treatment. Both patients died from other diseases. We think these treatments are useful for patients with active bleeding in advanced gastric cancer.

[A case of advanced accessory breast cancer effectively treated with trastuzumab and paclitaxel].

A 53-year-old woman was admitted for left axillary mass. The computed tomography showed an invasive mass in the left axilla and left supraclavicular lymph node swelling. Histological findings of axillary mass revealed infiltrating ductal carcinoma of scirrhous type. We diagnosed advanced accessory breast cancer, and the patient was treated by combination chemotherapy with paclitaxel and trastuzumab. The lesions disappeared after 4 courses of chemotherapy and was clinically diagnosed as complete response (CR).

[Long survival of a colon cancer case with multiple liver metastases cured by multidisciplinary therapy].

The patient was a 79-year-old a man who had a sigmoid colon resection for sigmoid colon carcinoma in another hospital 11 years ago. Four years later,he was noted to have multiple unresectable hepatic metastases on CT. Therefore,intrahepatic arterial and portal infusion with CDDP 10 mg + 5-FU 250 mg, respectively,were started. His CEA level decreased to the normal range,and a partial response (PR) was achieved. But two years later, the CEA level increased again,so radiofrequency ablation (RFA) therapy was given during abdominal surgery. Then, IFL, CPT-11+S-1, and FOLFOX were administered. Currently, the patient is being treated as an outpatient with CPT-11+S-1. The patient's multiple hepatic metastases were treated with multidisciplinary therapy, and the man has lived for 6 years 11 months since his first hepatic metastases were noted. The multidisciplinary therapy that was used lengthened this patient's life.

[Second-or third-line chemotherapy with CPT-11+TS-1 for 5 cases of metastatic and recurrent colorectal cancer].

The 3-drug regimen of CPT-11+5-FU+l-LV is generally used for metastatic and/or recurrent colorectal cancer. We have applied this treatment as the first-line intervention in our hospital. However,when the efficacy is reduced we try chemotherapy using CPT-11+TS-1 for 5 outpatients as second- or third-line chemotherapy. Decreased CEA levels were subsequently observed in 4 of 5 cases. In addition, 2 cases exhibited grade 1 or 2 adverse effects, but no case developed neutropenia. We could expect such effects even for patients after only 5-FU, and this treatment may be performed safely on ambulatory patients.

[Utility of arterial infusion chemotherapy and radiation therapy for the pelvic local recurrence of rectal cancer].

We treated 3 cases of local pelvic recurrence due to a rectal cancer post operation by arterial infusion chemotherapy with 5-FU and levofolinate calcium and also by radiation therapy. The result of imaging analysis showed that a recurrent tumor was decreased effectively in 2 cases by chemo-radiation therapy. We confirmed the cancer pain and tumor bleeding were gone for all of the 3 cases. As for side effects of arterial infusion chemotherapy and radiation therapy, we confirmed a paralysis of the pelvic nerve in 1 case and dermatopathy in 1 case. This therapy seemed to be an effective treatment for elderly patients with inoperable cases.