[A study of the efficacy of high-dose toremifene in advanced and recurrent breast cancer].

Recently, many patients have been treated with aromatase inhibitors(AI), either in an adjuvant setting or as a treatment for recurrence. The efficacy and safety of high-dose toremifene(HD-TOR)were evaluated in 18 patients with advanced/recurrent breast cancer. Twelve of the 18 patients had received AI just prior to the study treatment. The clinical benefit rate was 56%(PR: 28%, long SD: 28%). Progression-free median survival was 5. 5 months. Adverse events were mild and toremifene was well-tolerated. The results suggest that HD-TOR should be considered early on as a second-line treatment, or as a later treatment option for AI-resistant breast cancer.

[Surgical treatment for small bowel metastasis of pleomorphic carcinoma 6 months after pulmonary resection].

The prognosis of patients with distant metastases of pulmonary pleomorphic carcinoma is poor. We report a case of pulmonary pleomorphic carcinoma patient who underwent surgical resection of small bowel metastasis. A 69-year-old man developed anemia secondary to melena 6 months after right upper lobectomy for pulmonary pleomorphic carcinoma and small bowel metastasis was detected endoscopically. He underwent laparoscopic ileocecal resection and has survived for 2 years after lung cancer resection without any other recurrence or metastasis.

A case of advanced rectal adenocarcinoid tumor with long-term survival.

Adenocarcinoid tumor most commonly occurs in the appendix and a tumor arising in the rectum is extremely rare. A 58-year-old man underwent total pelvic exenteration with extended lateral lymph node dissection for rectal adenocarcinoid tumor invading the urethra with lateral lymph node metastasis. Microscopically and immunohistochemically, the tumor consisted of carcinoid-like components and signet-ring-cell-carcinoma-like components, and an adenocarcinoid tumor was diagnosed. Postoperatively, the patient received combination chemotherapy of fluorouracil and leucovorin as an adjuvant therapy. Three years and 5 years after the initial surgery, the patient developed left groin and left external iliac lymph node recurrences, and lymphadenectomy was performed each time. As a result, the patient is alive more than 5 years after the initial surgery. There is no consensus on the indication of surgical treatment for adenocarcinoid tumor. However, in advanced cases, an aggressive surgical procedure might result in long-term survival when resectable.

New method for colorectal cancer diagnosis based on SSCP analysis of DNA from exfoliated colonocytes in naturally evacuated feces.

BACKGROUND: Establishment of a sensitive, reliable and non-invasive method for the diagnosis of early-stage colorectal cancer is necessary, because colorectal cancer can be cured surgically if diagnosed early. The aim of the present study was to evaluate the feasibility of using PCR-SSCP (polymerase chain reaction-single strand conformation polymorphism) analysis of the DNA extracted from the colonocytes isolated from naturally evacuated feces, in order to detect colorectal cancer. MATERIALS AND METHODS: Colonocytes exfoliated into feces, retrieved from 33 patients with colorectal cancer and 63 healthy volunteers, were analyzed for the presence of mutations in their DNA. The DNA extracted from the colonocytes was examined for mutations of the APC, K-ras and p53 genes using direct sequence analysis, and also subjected to PCR-SSCP analysis. RESULTS: Genetic alterations were detected in the colonocytes isolated from the feces of 12 out of 33 patients with colorectal cancer (36.4%) by direct sequence analysis. PCR-SSCP analysis using the same DNA samples revealed abnormal signals in 18 of the 33 patients (54.5%). However, 3 and 7 among the 63 healthy volunteers were also found to have abnormal genetic alterations by direct sequence and PCR-SSCP analysis, respectively. CONCLUSION: The present study indicated the feasibility of using PCR-SSCP analysis for the detection of mutations in the DNA extracted from colonocytes isolated from naturally evacuated fecal samples.

PCR-based assessment of the recovery rate of exfoliated colonocytes or cancer cells from fecal samples depends on the storage conditions after defecation.

BACKGROUND AND AIMS: We recently developed a new methodology for isolating colonocytes from fecal samples. We then applied a DNA-based analysis to the isolated colonocytes to detect colorectal cancer cells originating from any part of the colorectum. The purpose of the present study was to determine how long after defecation and at what temperature the fecal samples should be stored to isolate the colonocytes successfully. METHODS: Fecal samples were collected from 6 patients with colorectal cancer and 6 healthy volunteers soon after defecation at the National Cancer Center Hospital. The fecal samples were stored at 4 degrees C, room temperature or 40 degrees C for 0, 24 or 48 hours. Colonocytes were then isolated from the fecal samples, and the DNA was purified. Finally, PCR for p53, K-ras and APC was conducted to determine whether the corresponding PCR products could be obtained. RESULTS: The colonocyte recovery rate was not reduced, when compared with the data for successful PCR amplification, if the fecal samples were kept at 4 degrees C after defecation and if the colonocytes were isolated within 48 hours after defecation. CONCLUSIONS: The present data provided important clinical knowledge regarding the storage of fecal samples for future mass screening tests.

A new method for isolating colonocytes from naturally evacuated feces and its clinical application to colorectal cancer diagnosis.

BACKGROUND & AIMS: The early detection of colorectal cancer is desired because this cancer can be cured surgically if diagnosed early. The purpose of the present study was to determine the feasibility of a new methodology for isolating colonocytes from naturally evacuated feces, followed by cytology or molecular biology of the colonocytes to detect colorectal cancer originating from any part of the colorectum. METHODS: Several simulation studies were conducted to establish the optimal methods for retrieving colonocytes from any portion of feces. Colonocytes exfoliated into feces, which had been retrieved from 116 patients with colorectal cancer and 83 healthy volunteers, were analyzed. Part of the exfoliated colonocytes was examined cytologically, whereas the remainder was subjected to DNA analysis. The extracted DNA was examined for mutations of the APC, K-ras, and p53 genes using direct sequence analysis and was also subjected to microsatellite instability (MSI) analysis. RESULTS: In the DNA analysis, the overall sensitivity and specificity were 71% (82 of 116) of patients with colorectal cancer and 88% (73 of 83) of healthy volunteers. The sensitivity for Dukes A and B was 72% (44 of 61). Furthermore, the sensitivity for cancers on the right side of the colon was 57% (20 of 35). The detection rate for genetic alterations using our methodology was 86% (80 of 93) when the analysis was limited to cases in which genetic alterations were present in the cancer tissue. CONCLUSIONS: We have developed a new methodology for isolating colonocytes from feces. The present study describes a promising procedure for future clinical evaluations and the early detection of colorectal cancers, including right-side colon cancer.