Survival outcomes including salvage therapy of adult head and neck para-meningeal rhabdomyosarcoma: a multicenter retrospective study from Japan

BACKGROUND

Rhabdomyosarcoma is the most common soft tissue sarcoma in children, but rare in adults. Para-meningeal rhabdomyosarcoma in head and neck (PM-HNRMS) is less applicable for surgery due to the anatomic reason. PM-HNRMS has a poor prognosis in children. However, its clinical outcomes remain unclear in adults due to the rarity. Further, there is almost no detailed data about salvage therapy.

METHODS

We retrospectively examined the adult patients with PM-HNRMS treated at institutions belonging to the Kyushu Medical Oncology Group from 2009 to 2022. We evaluated the overall survival (OS) and progression-free survival (PFS) of the patients who received a first-line therapy. We also reviewed the clinical outcomes of patients who progressed against a first-line therapy and received salvage therapy.

RESULTS

Total 11 patients of PM-HNRMS received a first-line therapy. The characteristics were as follows: median age: 38 years (range 25 - 63 years), histology (alveolar/spindle): 10/1, and risk group (intermediate/high): 7/4. As a first-line therapy, VAC and ARST0431-based regimen was performed in 10 and 1 patients, respectively. During a first-line therapy, definitive radiation for all lesions were performed in seven patients. The median PFS was 14.2 months (95%CI: 6.0 - 25.8 months): 17.1 months (95%CI: 6.0 - not reached (NR)) for patients with stage I-III and 8.5 months (95%CI: 5.2 - 25.8 months) for patients with stage IV. The 1-year and 3-year PFS rates were 54.5% and 11.3% for all patients. Median OS in all patients was 40.8 months (95%CI: 12.1 months-NR): 40.8 months (95%CI: 12.1 - NR) for patients with stage I-III and NR for patients with stage IV. The 5-year OS rate was 48.5% for all patients. Among seven patients who received salvage therapy, three are still alive, two of whom remain disease-free for over 4 years after completion of the last therapy. Those two patients received multi-modal therapy including local therapy for all detected lesions.

CONCLUSION

The cure rate of adult PM-HNRMS is low in spite of a first-line therapy in this study. Salvage therapy might prolong the survival in patients who received the multi-modal therapy including local therapy for all detected lesions.

Activation of memory/effector T cells and association between prognosis and OX40-positive T cells in advanced head and neck cancer patients treated with anti-programmed death-1 antibody

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Background: Anti-programmed death-1 (PD-1) monoclonal antibody, nivolumab, enhances anti-tumor activity by inhibiting the interaction of PD-1 and programmed death-1 ligand 1 and has shown efficacy for platinum-refractory recurrent or advanced head and neck cancer (HNC). However, subsets of immune cells predominantly activated during the period of anti-PD-1 therapy for HNC and specifically associated with the prognosis have not been clarified. Methods: Peripheral blood mononuclear cells of 15 HNC patients treated with nivolumab were prospectively obtained before the initial and second administrations of nivolumab, and at the time of progressive disease (PD). We performed comprehensive analysis of the proportion of immune cell subsets by flow cytometry, including the expression of coinhibitory and costimulatory molecules such as T-cell immunoglobulin and mucin domain 3 (TIM-3), lymphocyte-activation gene 3 (LAG-3), T-cell immunoreceptor with Ig and ITIM domains (TIGIT), B and T lymphocyte attenuator (BTLA), CD28, OX40, inducible T cell costimulator (ICOS). Association between changes in the proportion of the subsets and therapeutic effect were also analyzed. Results: Median progression free survival (PFS) of the whole patients was 96 days (95% CI 70–308). After a single course of nivolumab, patients showed a significant increase in activated central memory and effector subsets of CD4+/CD8+ T cells and activated helper T1 cells (p = 0.0039, 0.0078, 0.0273, 0.0391, 0.0391). A trend of increase of activated effector memory CD4+/CD8+ T cell was observed (p = 0.4961, 0.3594). At the time of PD, effector regulatory T cells, LAG3 positive CD4+/CD8+ T cells, TIM-3 positive CD4+/CD8 T cells and BTLA positive CD4+/CD8+ T cells significantly increased. Significant positive correlations were found between PFS and the proportion of OX40 positive CD4+/CD8+ T cells before nivolumab therapy (p = 0.0239, 0.0134). Conclusions: Nivolumab therapy enhances activation of central memory and effector subsets of CD4+/CD8+ T cells. The expression level of OX40 on T cells was correlated with efficacy of nivolumab therapy in HNC patients.

Analysis of Response Evaluation Criteria in Solid Tumors reduction ratio of primary chemotherapy in unresectable advanced or recurrent colorectal cancer

Response Evaluation Criteria in Solid Tumors (RECIST) is used to assess the objective response of solid tumors to treatment. However, it remains unclear to what extent the response rate assessed by RECIST reflects a reduction of tumor size in multiple organs in patients with unresectable advanced or recurrent colorectal cancer (CRC) with multiple organ metastases. It is also unclear whether the management of liver metastases with systemic chemotherapy in CRC patients with multiple organ metastases improves their prognosis, although surgical resection has been shown to be the most effective treatment approach to CRC cases with liver metastases. A total of 38 CRC patients who underwent systemic chemotherapy in Kyushu Medical Center Hospital between January 2013 and April 2016 were examined. The patients had measurable lesions in multiple organs, including the liver, and did not undergo curative surgery for metastatic lesions after initiation of chemotherapy. The association between the total reduction ratio (TRR) of all lesions and liver lesion reduction ratio (LRR) was retrospectively analyzed. A total of 18 patients (47%) had H3 liver metastases, and the median liver lesion occupancy rate in the sum of the measured lesions with RECIST was 76%. TRR and LRR were strongly correlated, regardless of the volume of the liver metastases. Although a TRR of >30% was significantly associated with improved overall survival (OS), this improvement was not observed in patients with H3 liver metastases. TRR was correlated with LRR and was associated with a better OS. CRC patients with both multiple organ and H3 liver metastases exhibited poor survival, even with a high reduction ratio by chemotherapy.

Anti-Epidermal Growth Factor Receptor Antibody Readministration in Chemorefractory Metastatic Colorectal Cancer

BACKGROUND/AIM

Readministration of anti-epidermal growth factor receptor (EGFR) antibody for metastatic colorectal cancer (mCRC) after disease progression remains to be determined.

PATIENTS AND METHODS

Readministration of anti-EGFR antibody in mCRC patients previously refractory to anti-EGFR antibody was prospectively observed.

RESULTS

A total of thirteen patients with a median age of 60-years old and an Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, were enrolled. The median number of previous chemotherapies was 3 (range 2-5). Prior anti-EGFR antibody in combination with cytotoxic drugs was administered in 12 patients. Anti-EGFR antibody readministration regimens were cetuximab/panitumumab plus capecitabine/S-1 (seven patients), panitumumab plus FOLFOX (three patients), cetuximab plus irinotecan (two patients), and panitumumab monotherapy (one patient). Seven patients showed stable disease following readministration and six patients showed progressive disease. The median overall survival (OS) following readministration was 228 days and the median PFS was 102 days. Patients with intervals longer than 90 days between anti-EGFR therapies exhibited more favorable survival than those with intervals shorter than 90 days. Switching of anti-EGFR antibody between treatments was observed to contribute survival.

CONCLUSION

Anti-EGFR antibody readministration could show a modest survival benefit in mCRC patients, with the length of therapy interval and switching of antibody being important contributory factors.

Predictive value of the modified Glasgow Prognostic Score for the therapeutic effects of molecular-targeted drugs on advanced renal cell carcinoma

Inflammation is considered to be a prognostic factor for renal cell carcinoma (RCC). An inflammation-based prognostic score (modified Glasgow Prognostic Score; mGPS) is widely used for preoperative patients; however, little information is available regarding its prognostic value in patients with RCC treated with molecular-targeted drugs. A total of 32 advanced and recurrent RCC patients initially treated with molecular-targeted drugs from October, 2009 to August, 2015 were retrospectively investigated. Information on patient characteristics prior to treatment initiation and the clinical course were retrieved from clinical records. The correlation between survival and patient variables was analyzed. Survival was compared among patient groups according to the mGPS score. The median patient age was 66 years. The percentage of patients with an Eastern Cooperative Oncology Group performance status of 0 or 1 was 87.5, and 65.6% of the RCCs were clear cell carcinomas. A Memorial Sloan-Kettering Cancer Center index of good or intermediate was determined for 75% of the patients. Sunitinib, pazopanib or sorafenib was administered to 56, 22 and 13% of the cases, respectively. An mGPS score of 0, 1 and 2 was calculated for 66, 9 and 25% of the cases, respectively. Patients in the mGPS low group (score 0) exhibited significantly better progression-free survival (PFS) and overall survival (OS) compared with patients in the mGPS high group (score 1 or 2) (median PFS, 307 vs. 70 days and median OS, 1,081 vs. 140 days, respectively). In conclusion, inflammatory status as assessed by the mGPS score was closely associated with the prognosis of RCC patients treated with molecular-targeted therapy.

LJM716 in Japanese patients with head and neck squamous cell carcinoma or HER2-overexpressing breast or gastric cancer

Purpose

Human epidermal growth factor receptor 3 (HER3) has been identified as an important component of many receptor tyrosine kinase-driven cancers. LJM716 is a human IgG monoclonal antibody that binds HER3, trapping it in an inactive conformation. In this study, a phase I dose escalation was performed with a primary objective to establish the maximum tolerated dose and/or the recommended dose of LJM716 in Japanese patients with selected advanced solid tumors. Secondary objectives included the evaluation of the safety and tolerability, preliminary antitumor activity, and pharmacokinetics of LJM716 in Japanese patients.

Methods

LJM716 was administered intravenously at doses of 10, 20, or 40 mg/kg once weekly, in 28-day cycles, to 12 patients with HER2-amplified breast cancer or gastric cancer, or with esophageal squamous cell carcinoma or squamous cell carcinoma of the head and neck, regardless of HER2 status.

Results

The maximum tolerated dose was not reached, and the recommended dose was established at 40 mg/kg. No dose-limiting toxicities were observed in the first cycle. The most frequently reported adverse events were diarrhea, fatigue, stomatitis, pyrexia, and paronychia. One unconfirmed partial response was observed in a patient with breast cancer, and 50% of the patients achieved stable disease as the best overall response. Exposure increased with ascending dose, and half-life was estimated to be 11–14 days. No anti-LJM716 antibodies were detected.

Conclusions

LJM716 was well tolerated in Japanese patients, and a degree of tumor shrinkage was observed.

Clinical trial information

ClinicalTrials.gov NCT01911936.

Electronic supplementary material

The online version of this article (doi:10.1007/s00280-016-3214-4) contains supplementary material, which is available to authorized users.

Survival analysis of treatment with S-1, alone or in combination with CDDP (SP), in elderly patients with advanced gastric cancer: A 10-year retrospective cohort study

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Background: In Japan, the elderly population is increasing, and steadily increase the number of deaths in the elderly gastric cancer patients. However, the standard treatment of elderly gastric cancer has not been established, either treatment of S-1 or SP is carried out in the clinical practice, while SP is considered as standard therapy in the young people. Now, we investigated the impact of S-1 and SP on survival time in clinical practice. Methods: Between 2003 and 2012, advanced gastric cancer patients over 70 years of age received S-1 or SP as first line therapy were retrospectively reviewed to investigate clinical outcomes. Patient characteristics analyzed included age, gender, performance status (PS), tumor histology, renal function and metastatic site. In addition, we have analyzed prognostic factors in multivariate analysis. Results: Among 93 patients (pts), 67 pts (72%) received S-1 and 26 pts (28%) received SP. Patient characteristics between the two groups showed no significant differences in gender, histology, metastatic site, or creatinine clearance level, but did show an imbalance in PS (tended with better at SP group) and age (tended with younger at SP group), significantly. Even though the background factors were favorable results in SP group, there were no significant differences in median progression-free survival (median 139 vs. 102 days; p = 0.96) and overall survival (median 330 vs. 263 days; p = 0.55) between S-1 and SP group, respectively. Grade 3-4 neutropenia (10 vs. 27%, p < 0.05) , fatigue (3 vs. 15%, p < 0.05) and Grade 1-2 creatinine increased (9 vs. 31%, p < 0.01) were more frequent in the SP group than in the S-1 group, respectively. According to the multivariate analysis, exposure to CDDP was not independently associated with a better prognosis. Conclusions: Despite the obvious limitations of this analysis, there does not appear to be a benefit for the addition of CDDP in the elderly gastric cancer patients due to the increase of toxicity. A randomized controlled trial in this age group is warranted. We will also report the results of clinically meaningful prognostic factors associated with the primary treatment at annual meeting.

Transport properties of the layered Rh oxide K0.49RhO2

We report measurements and analyses of resistivity, thermopower and the Hall coefficient of single-crystalline samples of the layered Rh oxide K(0.49)RhO(2). The resistivity is proportional to the square of the temperature up to 300 K, and the thermopower is proportional to the temperature up to 140 K. The Hall coefficient increases linearly with the temperature above 100 K, which is ascribed to the triangular network of Rh in this compound. The different transport properties between Na(x)CoO(2) and K(0.49)RhO(2) are discussed on the basis of the different bandwidth between Co and Rh evaluated from the magnetotransport.

Expression of epiregulin and amphiregulin in the rat ovary

We have previously reported that the epidermal growth factor (EGF) family growth factor, epiregulin, is expressed in rat ovarian granulosa cells by induction with pregnant mare serum gonadotropin (PMSG). In this study, we report that amphiregulin, another member of the EGF family, was also induced in the rat ovary by gonadotropin treatment. Northern blot analysis revealed that PMSG treatment induced the expression of both epiregulin and amphiregulin mRNA after 24 h, but the expression then decreased 48 h after treatment. Further treatment with human chorionic gonadotropin (hCG) rapidly induced the expression of both epiregulin and amphiregulin genes and maximal levels were reached 4 h after hCG treatment. A marginal increase in amphiregulin mRNA levels was also observed 6 h after PMSG treatment. In situ hybridization revealed that epiregulin and amphiregulin mRNAs were localized in the granulosa cells of large antral follicles. These spatio-temporal expression patterns were similar to those of cyclo-oxygenase-2 (COX-2) and progesterone receptor (PR). In adult cycling rats, epiregulin and amphiregulin were strongly induced at 1800 and 2000 h on proestrus coinciding with the preovulatory LH surge. An in situ hybridization study also showed that epiregulin and amphiregulin mRNAs were detectable in the granulosa cells of preovulatory ovarian follicles at 2000 h on proestrus, where transcripts of COX-2 and PR were co-localized with those of epiregulin and amphiregulin. These observations suggested that the EGF family members, epiregulin and amphiregulin, may play a role in the ovulatory process of cycling rats as well as in the induction of ovulation in immature rats.

[Comparative clinical study of adjuvant postoperative chemotherapy (5-FU, Tegafur, 5-FU + MMC) in curatively resected cases of gastric cancer. Study Group on 5-FU Oral Adjuvant Chemotherapy in Gastric Cancer]

A multi-center collaborative study was conducted in curatively resected gastric cancer patients at Stages II and III to compare oral 5-FU (Group A), oral Tegafur (Group B) and i.v. MMC + oral 5-FU (Group C). From May 1982 to April 1985, 1,012 cases were enrolled at 55 institutions. Some 138 (13.8%) were excluded, and 874 were analyzable. In the analysis of background factors, Group B had more cases with tumor of large diameter and advanced Stage. Adverse effects were relatively mild in all groups, and there was no problem in drug tolerance. Five-year survival rate was 67.6%, 62.4% and 68.6% in Groups A, B and C, respectively, reflecting no significant difference among them. It was 85.0%, 83.0% and 81.1% in Stage II and 52.5%, 51.0% and 59.0% in Stage III of Groups A, B and C, respectively. No significant difference was found, but Stage III of Group C showed a slightly higher survival rate. Supportive clinical study will be required to assess the usefulness of MMC as an introduction therapy. We found no difference in efficacy between 5-FU and Tegafur as maintenance therapy. The life-prolongation effect of fluoropyrimidines in comparison with surgery alone should be studied separately.

Physical map of the linear chromosome of Streptomyces griseus

The chromosomal DNA of Streptomyces griseus 2247 (a derivative of strain IFO3237) was digested with several restriction endonucleases and analyzed by pulsed-field gel electrophoresis (PFGE). Digestion with AseI and DraI gave 15 and 9 fragments, respectively, the total sizes of which were 7.8 Mb. All the AseI and DraI fragments were aligned on a linear chromosome map by using linking plasmids and cosmids. PFGE analysis of the intact chromosome also showed a linear DNA band of about 8 Mb. Detailed physical maps of both terminal regions were constructed; they revealed the presence of a 24-kb terminal inverted repeat on each end. PFGE analysis with and without proteinase K treatment suggested that each end of the chromosome carries a protein molecule.

[Relationship between proliferative activity, and tissue differentiation and invasive mode in human oral squamous cell and colorectal carcinomas analysed by PCNA immunostaining]

The proliferative activity of carcinoma cells is generally considered to relate to the degree of the malignancy of carcinoma tissues. In this study, the proliferative activity at the tumor-stromal border was studied in 17 cases of oral squamous cell carcinoma (OSCC) and in 30 cases of colorectal adenocarcinoma (CAC) by means of proliferating cell nuclear antigen (PCNA) immunostaining, to evaluate the correlation between proliferative activity and tissue differentiation or invasive mode at the tumor-stromal border. No statistical difference was detected between the PCNA labelling index (PI) and the tissue differentiation of both OSCC and CAC. A significant difference was demonstrated between PI and invasive mode in OSCC, suggesting that the invasive mode at the tumor-stromal border relate to the degree of the malignancy of carcinoma tissues. However, no significance was found between PI and invasive mode of CAC. In addition, no difference of PI was demonstrated between tissue differentiation or invasive mode, and vascular invasion or lymph node metastasis. Therefore, it seems likely that the invasive mode at the tumor-stromal border in CAC also has no significance in deciding the degree of the malignancy of carcinoma tissues.

[Quantitative evaluation of liver function with 99mTc-GSA scintigraphy using extraction index]

Extraction index (EI5) was introduced to evaluate liver function quantitatively with 99mTc-GSA (GSA) scintigraphy, and it was compared with conventional indices; receptor index (LHL15) and clearance index (HH15). EI5 is expressed as following equation: EI5 = (L5 - L3)/(H3 + H5) * PH/PL where L3, L5: counts at 3 or 5 minutes after the injection in the liver ROI, respectively, H3, H5: counts at 3 or 5 minutes in the heart ROI, respectively; PL, PH: numbers of pixels in the liver- and heart-ROI, respectively. We performed GSA scintigraphy in 40 patients with liver dysfunction and calculated values of the indices. Good correlations were observed between EI5 and liver function tests. Correlation coefficients were almost equal to or higher than those between conventional parameters and liver functional tests. EI5 was thought to be a practical index, and it could be calculated in a short time without aid of computer. Evaluation of local liver function may be possible, because EI5 was corrected with numbers of pixels in the liver- and heart-ROI; which was not considered in the conventional parameters.

[Study of pre- and post-operative chemotherapy with oral 5-FU in patients with gastric cancer. Study Group of Pre- and Post-Operative Oral 5-FU in Gastric Cancer]

A cooperative study group consisted of 37 medical institutions evaluated the utility of pre- and post-operative chemotherapy with oral 5-FU by comparing with the historical controls of the patients treated with operation alone who were registered in Japanese Gastric Cancer List. Of 634 patients entered in this trial, 366 patients received curative operation at macroscopical stages II and III were studied as eligible cases. The relative 5-year survival at macroscopical stage II and III was 68.6% with 5-FU, significantly higher than 62.6% with operation alone (p < 0.05). Particularly, 5-year survival at macroscopical stage III was markedly different between 57.1% with 5-FU and 42.7% with operation alone. In order to make more effective comparison with the historical controls in this 1-arm trial, the background factors in 5-FU and control groups were matched in the ratio of 1:2 or 1:3 with respect to the following 4 factors: tumor site, S, N and macroscopical tumor type (by Kajitani's classification). As a result, the 5-year survival at macroscopical stages II and III was significantly higher with 5-FU (67.5%, 69.1%) than with operation alone (59.9%, 59.8%), and in particular this tendency was more marked at macroscopical stage III. These results suggest the usefulness of adjuvant chemotherapy in macroscopical stage III gastric cancer.

Relationship between benign epilepsy of children with centro-temporal EEG foci and febrile convulsions

In order to clarify the relationship between benign epilepsy of children with centro-temporal EEG foci (BECCT) and febrile convulsions (FC), we compared the previous and family histories of FC of one hundred children with BECCT, aged 3 years to 13 years, with those of 100 non-epileptic controls matched for age and sex. The incidences of FC in children with BECCT and non-epileptic controls were 18% and 8%, respectively (P less than 0.05). Forty-eight children (48%) with BECCT and 21 (21%) non-epileptic controls had positive family histories of FC within third-degree relatives (P less than 0.001). Of the fourteen pairs of siblings, one of each having BECCT and the other FC, we conducted an EEG examination in 7 siblings. All of these 7 siblings exhibited rolandic discharges (RD) on EEG. These observations strongly suggested a genetic link between BECCT and FC.

Improvement in treatment results of gastric cancer with surgery and chemotherapy: experience of 9,700 cases in the Cancer Institute Hospital, Tokyo

Treatment results of 9,741 cases of gastric cancer treated at the Cancer Institute Hospital, Tokyo during the past 42 years were retrospectively analyzed. Resectability was 89.6% (94.1% for 1960-1988) and operative mortality was 1.9% (1.5% for 1960-1988). Five-year survival rate was 48.5% (54.9% for 1960-1988) for all cases, 68.8% (73.1% for 1960-1988) for patients with curative surgery, and 4.7% (4.9% for 1960-1988) for those with noncurative surgery. Curative rate was improved twofold among patients with curative gastrectomy. Postoperative adjuvant chemotherapy had a marginal benefit for stage II and III disease. Improvement could be attributed mainly to the relative increase in early gastric cancer, and partly to the extended surgeries for stage III and IV cases, such as systemic lymphadenectomy and combined resection of involved adjacent organs. Multimodality therapy is expected to control the relapse of peritoneal dissemination (14.2%) and hematogenous metastasis (8.9%).

[Possible radiation induced cancer of the thoracic esophagus after postoperative irradiation in breast cancer]

We report 11 cases with cancer of the thoracic esophagus developing after postoperative irradiation therapy for the breast cancer. Irradiation was done immediately after mastectomy in these cases and the irradiation field included the unilateral or bilateral parasternal region. They received a total dose ranging from 35 Gy to 60 Gy and the dose received to the thoracic esophagus was estimated from 10 Gy to 48 Gy. All cancer sites were involved in the irradiation filed. The latent intervals of 10 cases from radiation to the manifest of cancer ranged between 10 to 19 years. Among 4777 women undergone mastectomy for breast cancer between 1946 and 1980 in our hospital, 8 women (0.17%) developed cancer of the thoracic esophagus, whereas 5 (0.335%) out of 1534 women treated with mastectomy and radiotherapy with Linac between 1964 and 1980 developed cancer of the thoracic esophagus. Higher incidence of esophageal cancer in patients treated with surgery and radiation suggests that these cancers might be induced by radiation. Eight patients had esophagectomy and 4 patients of them received postoperative irradiation. They have survived from 9 months to 13 years. Two patients were controlled well by the irradiation alone. It is interesting that radiation therapy is sensitive to the possible radiation induced cancer of the thoracic esophagus. Follow up study should be directed to the possible development of second malignancy in patients who survive for a long time after radiation therapy.

[Indications for total gastrectomy combined with pancreaticosplenectomy in the treatment of middle gastric cancer]

Of 1725 patients with middle gastric cancer (M, MA, MC) on whom radical surgery was performed (except for absolute non-curative resection) from 1960 to 1984 at the Cancer Institute Hospital, 238 patients in whom total gastrectomy or proximal partial gastrectomy combined with pancreaticosplenectomy was carried out, were submitted for both clinico-pathological and prognostic examination. The following results were obtained: 1. There are few indications for total gastrectomy plus pancreaticosplenectomy in patients with middle gastric cancer in which the lesions are superficial or semi-superficial. 2. For patients in whom the cancer occupies portions of the greater curvature, on posterior wall of the stomach, the whole stomach, or is of a non-localized type, the metastatic rate of lymph nodes No (10) or lymph nodes No (11) is high, then total gastrectomy plus pancreaticosplenectomy should be considered. 3. Lymph nodes No (2), (4d), (4sb) (7) and (9) can be good indices indicating presence or absence of metastasis of lymph nodes No (10) and lymph nodes No (11). 4. Radical surgery as well as effective adjuvant therapy are required for gastric cancer with invasion of the serosa.

Diffuse papillomatosis of the gallbladder complicated with tuberculosis

A rare case of diffuse papillomatosis of the gallbladder complicated with tuberculosis is reported. The mucosa of the gallbladder displayed a diffuse papillary pattern composed of excrescences that varied in size and height. The proliferative glands contained many Paneth cells, and the diffuse papillomatosis appeared to be derived from metaplastic-type epithelium. Tuberculous granulomas were observed in the serous layer of the gallbladder. The relationship between diffuse papillomatosis and tuberculosis of the gallbladder is discussed.

[Distribution of recurrent lesions after radical resection of cancer of the thoracic esophagus]

In 150 patients who got cancer recurrence after curative resection for cancer of the thoracic esophagus, the sites where recurrent lesions were clinically detected for the first time were examined. The distribution of recurrent lesions in patients who did not undergo neck dissection at the operation (group A) differed from the distribution in those who underwent neck dissection (group B). Cervical and/or upper mediastinal recurrence occurred in 49% of cases in group A and in 11% of group B. On the contrary, middle or lower mediastinal recurrence was more often in group B. The distribution of recurrent lesions varied depending on the state of lymph node metastasis detected at surgery. Cervical and upper mediastinal recurrence was much more frequent than hematogenic recurrence in cases without lymph node involvement in group A, while hematogenic recurrence was more frequent in cases with both mediastinal and abdominal lymph node metastasis. In the upper mediastinum, recurrence along the recurrent laryngeal nerves was most frequent and it was supposed to have developed from residual lymphatic metastases. In the middle and lower mediastinum, recurrent lesions were located around the left main bronchus and descending aorta, and cancer infiltration of the neighboring organs was frequent. Recurrence at the abdominal paraaortic nodes was observed mainly in cases with perigastric lymph node involvement.

Early gastric carcinoma with special reference to macroscopic classification

During a period beginning in 1946 and ending in October of 1978, 1000 cases of solitary early gastric carcinoma were operated on at the Cancer Institute Hospital, Tokyo, Japan. The clinical characteristics and the macroscopic and chronological changes were studied in these cases. Early gastric carcinoma comprised one third of all resected gastric carcinoma. If early gastric carcinoma was divided into two groups, the depressed and the elevated, the former was more common. By location, the depressed type lesions were more frequently seen in the middle third of the stomach and the elevated type lesions in the lower third. By age, distribution of the elevated type lesions showed a peak with a mode at the age of 60 to 69 years and of the depressed type, a plateau with a mode at the age of 50 to 59 years. The relative incidence of the elevated type of gastric carcinoma to the depressed type was one to four. In depth of invasion, the mucosa and the submucosa were equally involved. Lymph node metastases were encountered in 12.7% of early gastric carcinoma cases. The incidence of positive nodes in mucosal carcinoma was 3.4% and that of submucosal lesions was 21.7%. Of the elevated type carcinoma, 20.9% of the cases had positive nodes. The 5-year survival rate of the patients with surgery for cure was 93.8% in contrast to 56.5% of those with palliative resection.

Early gastric carcinoma with special reference to macroscopic classification

During a period beginning in 1946 and ending in October of 1978, 1000 cases of solitary early gastric carcinoma were operated on at the Cancer Institute Hospital, Tokyo, Japan. The clinical characteristics and the macroscopic and chronological changes were studied in these cases. Early gastric carcinoma comprised one third of all resected gastric carcinoma. If early gastric carcinoma was divided into two groups, the depressed and the elevated, the former was more common. By location, the depressed type lesions were more frequently seen in the middle third of the stomach and the elevated type lesions in the lower third. By age, distribution of the elevated type lesions showed a peak with a mode at the age of 60 to 69 years and of the depressed type, a plateau with a mode at the age of 50 to 59 years. The relative incidence of the elevated type of gastric carcinoma to the depressed type was one to four. In depth of invasion, the mucosa and the submucosa were equally involved. Lymph node metastases were encountered in 12.7% of early gastric carcinoma cases. The incidence of positive nodes in mucosal carcinoma was 3.4% and that of submucosal lesions was 21.7%. Of the elevated type carcinoma, 20.9% of the cases had positive nodes. The 5-year survival rate of the patients with surgery for cure was 93.8% in contrast to 56.5% of those with palliative resection.

[Estimates of circulating breast cancer-associated antigen CA 15-3 as a monitoring marker in patients with breast cancer]

CA 15-3 is a newly developed tumor marker detected by breast tumor-associated antigen 115D8/DF3 and is being studied as a monitoring marker in breast cancer patients (pts), even though its sensitivity as a screening marker is not so high. The cut off value of CA 15-3 was set at 27 U/ml. We assayed the plasma CA 15-3 levels of breast cancer pts from June 1985 for the purpose of estimating it as a monitoring marker in comparison with CEA. In the monitoring of over 2,000 postoperative pts, 23 were discovered to have metastatic lesions. For prediction of recurrence, CA 15-3 was useful for 11 pts (48%), while CEA was useful for 8 pts (35%), and CA 15-3 or CEA were useful for 14 pts (61%). Although it was little useful for local recurrence, CA 15-3 was highly useful for the prediction of organ & bone recurrence in 7/11 pts (64%). With regard to monitoring of the clinical course of metastatic carcinoma of the breast, the levels of CA 15-3 were positive in 47/68 pts (69%), while in contrast CEA was positive in 42/68 pts (62%). The trend of CA 15-3 was also highly correlated with the clinical course. CA 15-3 thus appears to be a better marker, especially as a monitoring marker, than CEA for breast cancer. Additional research will be required on this marker, but it seems likely that CA 15-3 combined with CEA would provide better information for the monitoring of breast cancer patients.

Surgical treatment of gastric cancer today

The utilization of radical operation in gastric cancer cases has led to the development of various operation techniques. With the improvement in perioperative management it can be said that age no longer is a restriction. A study of gastric cancer prognosis indicates an upward trend in survival since 1960 along with the increased detection of early cancer. This suggests the most importance of early detection in increasing the therapeutic results obtained in cases of gastric cancer. In cases with advanced cancer, 5-year survival rate of 44.7 per cent was attained through such aggressive actions as extended dissection of lymph nodes and combined resection of surrounding organs with evaluation of the macroscopic classification of the cancer.

[Adjuvant chemotherapy of colorectal cancer--results of prospective randomized trials]

The group of research for colorectal cancer treatments-Kajitani-group (chief T. Kajitani) has carried out the co-operative study for the evaluation of adjuvant chemotherapy after curative resection of colorectal cancer. During the period 1975 and 1978, a series of 1,156 cases of cancer of colon and rectum were entered into the prospective randomized controlled study which consisted of three treatment programs. There included chemotherapy of 2 modes of regimen combining MMC with Tegaful and non adjuvant treatment as control. In colon cancer, adjuvant chemotherapy combining MMC with Tegaful was effective on the increasing of survival rates, especially significantly (p = 0.017) in the cases of Dukes B stage (85-88% vs 69.2% in survival rates of 8 year). In rectal cancer, systemic intravenous administration of MMC 4 mg, two times a week for immediately postoperative three weeks, combined with postoperatively prolonged oral administration of Tegaful 800 mg/day more than three months was also significantly effective, especially in the cases of Dukes C stage (52.3% vs 40% in survival rates of 8 year). However, the analysis of recurrence did not prove that the intra-operative local intra vessel administration of MMC 10 mg was useful for the prevention of liver metastasis in colon cancer or pelvic recurrence in rectal cancer respectively.

The influence of family history of cancer, irradiation and anticancer medication (mitomycin C), on the occurrence of multiple primary neoplasms with breast cancer--statistical analysis by the person-year method

The influence of family history of cancer, radiation therapy and anticancer drug therapy (mitomycin C) on the occurrence of multiple primary neoplasms, following treatment of a first primary cancer of the breast, was analyzed by the person-year method in 1,359 patients, in Japan. During 14,371.8 person-years of observation, 111 multiple primary neoplasms including bilateral breast cancers were found in 109 patients. The incidence rate of multiple primary neoplasms were 0.00772 per person-year. The incidence in patients with a family history of cancer was 1.29 times greater than that in patients without such a family history, and the incidence in patients with a family history of breast cancer was about three times greater than that in those without it (p less than 0.01). Radiation therapy raised the occurrence of subsequent primary neoplasms 1.28-fold (or 1.62 fold after 5 years), and mitomycin C (a total dose of 0.8 mg/kg) therapy caused no increase in the occurrence of subsequent primary cancers, after an observation of 10 years or so.

Synergistic effect of radiation and N-nitrosoethylurea in the induction of lymphoma in mice: cellular kinetics and carcinogenesis

The effect of a combined treatment with radiation and N-nitrosoethylurea (NEU), or a split administration of NEU in inducing lymphoma was studied in female C57BL/6N mice. A single intragastric administration of 5 mg of NEU was only slightly lymphomagenic, inducing thymic lymphomas in 20% of mice, while the incidence was elevated to 92% if the NEU treatment was preceded (by 5 days) by 400 rad of total-body X-irradiation, which alone is seldom lymphomagenic. A high yield of lymphoma (84-93%) was also obtained if 5 mg of NEU was delivered in two split doses of 4 mg and 1 mg with a 4 day interval. Drastic injury to both the thymus and bone marrow caused by either 400 rad total-body X-irradiation or the first dose of NEU (4 mg) was followed by a vigorous regeneration within a few days. The maximum induction rate of lymphoma was obtained when the subsequent dose of NEU (1 mg) was given at the peak of DNA synthesis in the bone marrow and thymus following the first treatment. The data indicate that the principal effect of the irradiation or the first dose of NEU was to provide a susceptible cell population, and that a high yield of lymphoma was brought about through the action of the subsequent dose of NEU on a sufficient number of target cells engaged in heightened DNA synthesis.

Comparison of 5-fluorouracil with ftorafur in adjuvant chemotherapies with combined inductive and maintenance therapies for gastric cancer

A group of 243 patients with gastric cancer was subjected to a prospective randomized trial of adjuvant chemotherapy after curative gastrectomy. One of the three arms (regimen A) is induction therapy with a three-drug combination of mitomycin C (MMC), 5-fluorouracil (5-FU), and cytosine arabinoside (ara-C) followed by intermittent oral administration of 5-FU for two years (MFC + F). In regimen B, 5-FU in regimen A is replaced by ftorafur, administered on the same schedule as regimen A (MF'C + F'). Regimen C is the control, in which patients are treated by surgery alone. Regimen A was proven effective for the suppression of relapse in the limited groups of moderately locally advanced cancer; five-year survival rates of the subset of stages I, II, and III were 72.1% with regimen A and 53.1% with regimen C (P less than .05). Regimen B yielded a better survival than the control, although the difference did not reach statistical significance. The results seem to favor 5-FU as adjuvant chemotherapy for gastric cancer.

[Studies on carcinoma of the remnant stomach after distal gastrectomy]

Sixty-one patients with carcinoma of the remnant stomach after distal gastrectomy were admitted by the end of 1982. Twenty-six of them were gastrectomized for benign disease such as peptic ulcer and 35 for malignant disease such as gastric carcinoma. The age of the benign group was 58, and the average interval from the first operation was 19 years. The corresponding figures for the malignant group were 63 and 8 years, respectively. In the malignant group, the methods of anastomosis at the first operation were 18 cases of Billroth-I (B-I) and 17 of B-II. The lesion was located at the surgical stump in 7 patients and distant from the stump in 14 patients in this group. In the benign group, there were 10 cases of B-I and 16 of B-II, and no differences were seen in the location. Early carcinoma was noted in 11 patients, and 34 were advanced. Differentiated adenocarcinoma was observed in 25 cases and undifferentiated in 20 in the resected specimen. Although no metastases were seen in early cases, the rate of lymph node metastasis was 70%, and the five-year survival rate was 21% in advanced cases, and 80% in early cases.