[Effect of vasodilators on femoral-to-radial arterial pressure gradient after cardiopulmonary bypass].

In 57 adult patients undergoing valve replacement surgery or valve plastic surgery, pressure gradient between the femoral and radial artery was evaluated after cardiopulmonary bypass (CPB). During CPB, the rectal temperature was kept at mild or moderate hypothermia. Nitrates and prostaglandin E1 were administered in all patients during operation. Patients were divided into two groups; Group A of 31 patients who had history of hypertension and received some vasodilators up to the operation, and Group B of 27 patients who had no history of such medication. There was no difference in patient's characteristics, anesthetic time, CPB time and aortic cross clamping time between the two groups. There was a significant difference between the pre-CPB and post-CPB in hematocrit data. Systemic vascular resistance (SVR) decreased significantly from the pre-CPB level to the post-CPB level. There was no significant difference between Group A and Group B in SVR, but a higher femoral-to-radial artery pressure gradient was observed in Group A until the end of operation. Hypertension and the use of vasodilator change the tone of peripheral blood vessels and intensify femoral-to-radial artery pressure gradient after CPB.

Radiotherapy for locoregional recurrent tumors after resection of non-small cell lung cancer.

Thirty-two patients with locoregional recurrence without documented distant metastasis after resection of non-small cell lung cancer were treated with radiotherapy. There were 29 male patients and three female patients. The age range was 49-79 years (median 66 years). Twenty patients had squamous cell carcinoma, 11 patients adenocarcinoma and one patient large cell carcinoma. Ten patients had bronchial stump recurrence alone, 14 patients bronchial stump recurrence with mediastinal and/or supraclavicular fossa lymph nodes recurrence, and eight patients mediastinal and/or supraclavicular fossa lymph nodes recurrence without bronchial stump recurrence. The total dose delivered ranged from 47.5 to 65 Gy. We achieved good results on improving on subjective complaints. Eighty-nine percent (17/19) of patients indicated subjective improvement. Eight of 32 (25%) patients showed a complete response, and 13 of 32 (40.6%) patients showed a partial response. Only one of seven patients (14.3%) with less than 60 Gy showed a complete response, but seven of 25 patients (28%) with 60 Gy and more showed a complete response. The survival rate was 56.2% at 1 year and 12.5% at 5 years. Four patients have survived more than 5 years. The survival rate of the patients with complete response was 50% at 3 and 5 years, that of the patients with non-complete was 12.5% at 3 years and 0% at 5 years (Cox-Mantel test, P < 0.05). In conclusion, high-dose radiotherapy for locoregional recurrent tumors after resection was effective for palliation and improved survival.

Treatment of squamous cell carcinoma of the esophagus with alternating radiotherapy and chemotherapy (cisplatin, methotrexate, and peplomycin).

Between 1985 and 1990, 20 patients with stage 2 and 3 esophageal cancer without esophagopulmonary fistulas were treated with alternating radiotherapy and chemotherapy (cisplatin, methotrexate, and peplomycin). Patients given the combined therapy received courses of chemotherapy during weeks 1 and 6 and radiotherapy during weeks 2-5 and 7-9. Chemotherapy consisted of i.v. cisplatin (80 mg/ m2 of body surface area) on day 1, i.v. methotrexate (40 mg/ m2) on day 2, and s.c. peplomycin (10 mg/day) continuously from day 2 to day 5. Radiotherapy was external irradiation with or without intracavitary irradiation. In seven cases, external irradiation alone was administered at 65-70 Gy, and in 13 cases, external irradiation (50-55 Gy) was combined with intracavitary irradiation (14-20 Gy). At the end of treatment, the rate of complete response was 60% with an overall response rate of 95%. Five-year total survival was 25%; cause-specific survival was 36.8%. The most common acute toxicities were bone marrow suppression, hepatic and renal damage, pneumonitis, and esophagitis. There was no life-threatening toxicity.

Results of cesium needle interstitial implantation for carcinoma of the oral tongue.

One hundred thirty previously untreated patients with invasive squamous cell carcinoma of the oral tongue received interstitial radiotherapy with curative intent using cesium needles. Ninety-nine patients were treated with interstitial radiotherapy alone and 31 patients received interstitial radiotherapy combined with external beam irradiation. The recurrence-free rates in the primary lesions were 94.4% (17/18) in T1, 91.2% (52/57) in T2, and 70.9% (22/31) in T3 lesions. The local recurrence-free rates with single-plane and two-plane implantation were good: 89.7% (70/78) and 85.7% (12/14), respectively. The rate of 64.2% (9/14) for volume implantation was significantly poorer (p < 0.05). It is evident that tumor volume is an important factor in the control of cancer following interstitial therapy. The overall incidence of ulceration of the tongue and mandibular complication was 20% (26/130) and 13% (17/130), respectively. Using both interstitial and external radiotherapy, the incidence was 22.5%, compared with 10.1% using interstitial radiotherapy alone. The mandibular complication incidence of 8.9% with single-plane implants was much lower than 20.8% for two-plane and 23.5% for volume implants. Interstitial radiotherapy is most suitable in T1 and T2 cases in which single-plane implantation is possible; for these patients interstitial radiotherapy, which has the advantage of preserving the structure and function of the tongue, should continue to be used in the future in spite of the progress in reconstructive surgery.

[Prospective randomized trials comparing hyperfractionated radiotherapy with conventional radiotherapy in stage III non-small cell lung cancer].

From September 1987 to August 1990, 36 patients with stage III non-small cell lung cancer were randomly assigned to 65 Gy in 26 fractions of 2.5 Gy each (conventional radiotherapy) or 71.5 Gy in 52 fractions of 1.375 Gy given twice a day (hyperfractionated radiotherapy). The overall time for both groups was 6.5 weeks. The groups were similar in terms of age, performance status, previous chemotherapy, stage IIIA and IIIB, and histopathology. The rate of complete response was 44.4% for hyperfractionation, and 16.7% for conventional fractionation. Overall survival rates at 24 months and 36 months were 50.0% and 21.8% for hyperfractionation, and 31.3% and 0% for conventional fractionation. Fever due to radiation pneumonitis occurred in seven of 18 patients with hyperfractionation (38.9%) and four patients with conventional fractionation (22.2%). No severe late toxicity has been observed in either group. We conclude that hyperfractionated radiotherapy in non-small cell lung cancer may improve survival without increasing severe toxicity.

Intracavitary brachytherapy combined with external-beam irradiation for squamous cell carcinoma of the thoracic esophagus.

During the 15 year period from 1974 to 1988, 277 patients with previously untreated, histologically confirmed, squamous cell carcinoma of the thoracic esophagus were treated with the Time Dose and Fractionation (TDF) factor of more than 99. Of these, 161 patients were treated with external beam irradiation combined with intracavitary brachytherapy. Intracavitary brachytherapy was done for all patients for whom insertion of an outer applicator 1 cm in diameter was possible and for whom a relatively good performance status was seen at completion of external beam irradiation. Except for mild radiation-induced esophagitis, no acute radiation injuries were noted. The early clinical effect of radiation upon the esophageal lesion was determined by esophagography and esophagoscopy, approximately 1 month after the combined radiotherapy; a complete response was observed in 86 (53.4%) of the 161 patients. Furthermore, after a 5 year follow-up, local control of esophageal cancer was found to have been successful in 51 (31.7%) of the 161 patients. The highest rate of local control was associated with the following criteria: Stage I, T1, tumor length less than 5 cm, and superficial or tumorous type of tumor. The 5-year actuarial survival rates were 43.3% for Stage I, 21.1% for Stage II, and 0% for both Stages III and IV. Benign radiation-induced esophageal ulcerations or strictures did develop in five of the long-term survivors, suggesting that the dosage is close to the maximal tolerance of the esophagus. We recommend that 1500-2000 cGy in two or three fractions is the optimal dosage for intracavitary radiation of the esophageal mucosa after external irradiation of 5500 cGy in 22 fractions for 5.5 weeks or 6000 cGy in 30 fractions for 6 weeks. We believe that intracavitary treatment of esophageal carcinoma is a highly effective and a safe therapeutic modality, not only as a palliative therapy, but also as a radical treatment for patients in Stages I and II.

[Radiotherapy and chemotherapy of esophageal cancer].

Radiotherapy for esophageal cancer is an available modality as well as surgery. Since radiotherapy for esophageal cancer is generally used for those patients with inoperable extensive disease, radiotherapy alone is unsatisfactory. New methods of radiotherapy are intracavitary treatment, hyperfractionation etc. Combination chemotherapy, especially including CDDP, seems to be more effective than single agents. Radiotherapy combined with chemotherapy is used by many investigators in an attempt to improve both local control and the cure rate of esophageal cancer.

[Treatment of squamous cell carcinoma of the head and neck with multi-drug chemotherapy and radiotherapy].

Multi-drug chemotherapy containing cisplatin has been reported to be one of the most active chemotherapy regimens in advanced or recurrent head and neck squamous cell carcinoma. In this study, the current status of clinical investigation of combination chemotherapies is reviewed. And our data are presented in head and neck cancer with multi-drug chemotherapy containing cisplatin. Thirty-five patients of stage 3-4 and 70 patients with recurrent and/or metastatic head and neck squamous cell carcinoma were treated by multi-drug chemotherapy containing cisplatin, and radiotherapy and/or operation. The overall response rate was 71.4%, with 17.1% complete remission in previously untreated, locally advanced patients and 31.4% in recurrent or metastatic patients. Problems of chemotherapy combined with radiotherapy and future direction of clinical study in locally advanced or recurrent head and neck cancer are discussed.

Interstitial irradiation for carcinoma of tongue complicated by chronic renal failure undergoing hemodialysis--a case report.

There has been some controversy concerning dose-time correction in continuous irradiation at low dose rates. We present the results of carcinoma of the tongue in a patient complicated by chronic renal failure, for which he was undergoing hemodialysis three times a week. This patient was treated with a single implant but with a doubling of 137Cs needles for double strength. The actual dose was given in a shorter treatment time than recommended, with the dose-time adjustment following the Paterson-Parker system. The patient has been alive and well for eight years.

[Antiemetic efficacy of betamethasone versus betamethasone combined with metoclopramide in cisplatin-treated cancer patients].

This study was designed to compare the antiemetic effect of betamethasone alone with that of betamethasone combined with metoclopramide. Forty-seven patients on chemotherapeutic regimens including cisplatin were entered into this study. Betamethasone was given in 4 doses of 20 mg/body at 30 minutes before and at 2.5 and 8 hours after cisplatin. Metoclopramide was given in 4 doses of 1mg/kg on the same schedule. Within 24 hours after the administration of cisplatin, no vomiting was observed in 42.9% of the patients treated with betamethasone alone and in 76.9% with betamethasone and metoclopramide. Betamethasone combined with metoclopramide was superior to betamethasone alone for the antiemetic effect in cisplatin-treated patients.

[The usefulness of intracavitary brachytherapy in esophageal cancer].

Two different irradiation methods for the treatment of esophageal cancer have been compared and analyzed. One group of 146 patients were treated by external irradiation alone at the Aichi Cancer Center Hospital, while another group, consisting of 76 patients, were treated by external irradiation combined with booster intracavitary brachytherapy utilizing Radium-226 tubes at the National Sapporo Hospital. The patients that were treated by the addition of booster intracavitary brachytherapy showed a better response than the patients treated by external irradiation alone, with respect to the local control rate and survival. Booster intracavitary brachytherapy was found to be a more effective method for patients with esophageal smaller lesions and/or patients manifesting the serrated spiral, or funnel type lesions in their X-rays.

[UFT in esophageal cancer: a report of two cases].

We report two patients with esophageal cancer who responded to UFT. The patients were a 71-year-old female and a 61-year-old male, both of whom had recurrent disease in the esophagus or abdominal lymph nodes. They had received previous treatment consisting of radiotherapy and chemotherapy containing cisplatin, methotrexate and peplomycin. Each patient was administered UFT 400 mg/day p.o. No toxic effect was seen.

[Osteonecrosis following radiotherapy in carcinoma of the uterus and pediatric tumors].

Osteonecrosis following radiation therapy in 611 Patients with uterine cancer and 41 patients with pediatric tumor were studied. The 5- and 10-year cumulative bone injury rate after radiation therapy in uterine cancer was 4% and 15.6%, respectedly. Patients who are older than 60 years of age showed high occurrence of radiation bone injury. Otherwise, severe aletrations in shape and complete arrest of growth in irradiated growing bone were observed of even with small doses of 1600 cGy in the lower age level (0-3 age of years) at the time of treatment.

[Brachytherapy of cancer].

Brachytherapy is one of most effective methods of radiotherapy for cancer, and therefore, low-dose-rate brachytherapy is widely used for carcinoma of the uterus and carcinoma of the tongue. Between 1974 and 1983, 76 primary thoracic esophageal squamous cell carcinomas were treated with external irradiation combined with additional intracavitary radium therapy at the National Sapporo Hospital. The esophageal primary control rate was 34% and the 5-year survival rate was 24.1%. We believe that external irradiation therapy followed by additional intracavitary radium irradiation produces good results. Also, from 1982, 30 patients with small residual or unresectable tumors received interstitial irradiation using an after-loading technique and iridium-192 seeds. Eighteen of these 30 patients treated with iridium-192 were recurrent cases, and 20 had outer tubes intra-operatively inserted into the tumor following iridium-192 irradiation. Ten of these patients had brain tumor, nine had cancer of the head and neck, and each of the remaining fifteen had the following malignancies: lung cancer, breast cancer, pancreatic cancer, bile duct cancer, uterus cancer, skin cancer and soft tissue sarcoma. Overall 4-year survival was 17.1% in among the patients treated with Ir 192. Favorable preliminary results from these patients and those of various clinical trials on the extension of indications for brachytherapy were also reported.

[The dose of radiotherapy in esophageal cancer combined with external beams and intracavitary radium brachytherapy].

Between 1974 and 1982, 78 primary esophageal squamous cell carcinomas were treated by external irradiation combined with additional intracavitary radium therapy. 50 to 60 Gy were given by external irradiation, and 5 to 20 Gy were delivered on the surface of the esophageal mucosa. The combined dose ranged from TDF 110 to 140 on the esophageal mucosa and TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa. The 5-year survival rate was 19.3% by this combined radiotherapy alone. We conclude that the optimal dose of the combined therapy for esophageal cancer ranges from TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa.

[Cisplatin, methotrexate and peplomycin in the treatment of esophageal carcinoma].

Sixteen patients with advanced or recurrent squamous cell carcinoma of the esophagus were treated with cisplatin 80 mg/m2 i.v. on day 1, methotrexate 40 mg/m2 i.v. on day 2 and peplomycin 15 mg/day 24 hours continuous subcutaneous infusion from day 2 to day 5. Each course was repeated every 3 weeks. The overall response rate was 56% (9/16) with no complete response. Of 10 patients with no prior therapy, 7 (70%) showed partial response. Toxic effects were acceptable with no fatalities, but severe nausea and vomiting (56%), transient nephrotoxicity (44%), anemia (44%), thrombocytopenia (31%) and leukocytopenia (19%) occurred. No clinical evidence of pulmonary toxicity was seen. The dose-limiting toxic effect of this regimen was myelosuppression.

[Results of several combination modalities for maxillary cancer].

Two hundred forty-six patients with the histologically proved squamous cell carcinoma of the maxillary sinus were treated at the Department of Radiology, National Sapporo Hospital, with various combined modes of surgery, irradiation and chemotherapy. Four combination modalities were used from 1966 to 1983. One hundred sixty-three (66.3%) patients were men and 83 (33.7%) were women. Five-year survival was 41.0% in T2 (16 cases), 22.3% in T3 (176 cases) and 15% in T4 (53 cases). In 72 cases treated since 1978 with tumor reduction as completely as possible, five-year survival was 43.5%. We recommand tumor reduction as complete as is possible and 40-50 Gy irradiation.

[Results of brachytherapy of tongue cancer].

One hundred thirty-two patients with primary cases of squamous cell carcinoma of the tongue treated at National Sapporo Hospital from 1972 to 1982 were reviewed. Most primary sites were treated with interstitial needle implant with or without external beam irradiation. The local control rate by needle implant for the primary tongue lesions was 85.5%. That for the single plane implant was especially notable at 92.5%. The cumulative five-year survival rate was 92.8% in stage, I, 74% in stage II, 53.2% in stage III, 12.5% in stage IV and 64% overall.