Long-term prognosis of chronic hepatitis C after treatment with interferon alpha 2b and characterization of incomplete responders

OBJECTIVES

During the long-term follow-up of chronic hepatitis C patients treated with interferon alpha-2b, we have identified some patients who had continuous normalization, or transient elevation of the serum alanine aminotransferase levels within the first 6 months of follow-up and subsequent normalization, but HCV RNA was still found to be positive during the follow-up period (incomplete responder; ICR). We wished to clarify the characteristics of these patients, and to investigate the factors predictive of the response to interferon.

METHODS

Seventy patients were treated with 6 MU of rIFN alpha-2b, three times weekly for 24 wk. Sixty-six patients (94%) completed the entire therapy and 2-yr follow-up protocol.

RESULTS

Twenty-four months after cessation of IFN treatment, 24 patients (36%) were defined as complete responders (CR; continuously normal alanine aminotransferase levels, and HCV RNA negative). Nine patients (14%) were defined as ICR. Thirty-three patients (50%) were defined as nonresponders (NR). Compared with the CR or NR groups, the patients in the ICR group tended to have the mildest histological severity and lowest histological activity index scores, but there were no significant differences in any of the other histological features. The complete response rate was significantly higher in patients with low concentration of HCV RNA, and genotypes other than type II.

CONCLUSIONS

After long-term follow-up of the 66 patients, 24 patients (36%) were CR, nine (14%) were ICR, and 33 (50%) were NR. The histological stage and indices of chronic hepatitis may help to predict a patient's response to IFN therapy.

[Development of a respiratory monitoring device for truncal stereotactic radiotherapy using an abdominal pressure-detecting system with Stereotactic Body Frame]

The Stereotactic Body Frame, which was devised as a fastening unit for the irradiation of various truncal lesions, has obtained a good reputation for its high-precision reproductivity. This device is accessorized with 'Diaphragm Control', which can reduce the respiratory movement of intra-thoracic organs. In this study, to investigate the possibility of a respiratory monitor using our device, we try to clarify the relationship between the pressure against the abdominal board of 'Diaphragm Control' and each constrained tidal respiratory movement. Our original software was programmed to detect and analyze these data with our personal computer from some ready-made highly sensitive pressure detectors. In any fundamental performance of this system, response time is less than 1 msec at 115,200 bps, minimum detectable weight is 420 g, linearity correlation between loading weight and pressure index value is seen from 1000 g to 6000 g loading, and reproducibility of measurement is evaluated by coefficient of variation (CV=0.95% at 3000 g loading). It has sufficient capability to be used as a respiratory monitoring device during radiation therapy. In an experiment with three volunteers, the results revealed a positive correlation between pressure index value and ventilation air volume by spirometer. The decision coefficients (R(2)) were 0.7717, 0.7995, and, 0.8684, respectively. Our original respiratory monitoring device can be used for quantitative respiratory suppression and unexpected breathing detection without loading additional stress on the patient.

[Three-dimensional MR angiography of the celiac artery with single breath holding]

We performed a three-dimensional MR angiography of the celiac artery with single breath holding. The measuring time was just twenty-three seconds. In four healthy volunteers, celiac arteries were visualized clearly, moved cephalad with expiration and caudad with inspiration. In two patients with the median arcuate ligament compression of the celiac artery, the degree of stenosis increased with deep expiration and decreased with deep inspiration. Using this technique, we obtained different vascular images with each respiratory phase. This technique is considered to be a useful three-dimensional MR angiography in the abdominal region without respiratory artifacts.

[Significance of antitumor effects and immunological response on endogenously induced LAK therapy for primary or metastatic liver tumor]

Nineteen patients with metastatic liver tumor (9 of gastric cancer, 5 of colon cancer, 2 of pancreatic cancer, one each of mammary cancer, cholecystic cancer, carcinoid of biliary tract) and one patient with primary liver cancer were treated by endogenously induced LAK therapy consisting of transhepatic arterial infusion with ADM or MMC for induction therapy and OK-432 and rIL-2 (TGP-3) for immunotherapy. The following results were obtained. 1) Clinical response for liver tumor showed no CR but 8 cases of PR, for an overall response rate of 42.1%. 2) Reduced tumor marker value was noted in 76.5% cases, and 50% survival term became 349 days after the therapy. 3) Many CD4 and CD8 positive mononuclear cells had infiltrated around liver tumor after therapy by immuno-histochemical staining of surface marker. 4) NK activity of peripheral blood lymphocytes was markedly reduced soon after the therapy and continued for about 4-7 days, while in cases of combined subcutaneous administration with OK-432, NK activity showed only a slight decrease.

[Colon cancer with macroscopic invasion into surrounding organs]

Of 195 cases of colon cancer operated on between January 1972 and April 1985, 56 (30.3%) were with macroscopic invasion into surrounding organs. Among them, 45 patients underwent combined resection of the colon and one or more adjacent organs, and in 60% of them, the tumor invasion was verified microscopically. The organ invaded most frequently was the abdominal wall (26 cases), followed by the bladder (7) and stomach (6). The operative mortality was 8.9%, and the five-year survival rate in the curative resection group was 70.9%. Even the noncurative resection group showed a significantly longer mean survival time than the nonresectable group. Combined resection should be undertaken unless the patient is seriously ill.