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This case involved an 82-year-old man with a history of diabetes mellitus and myocardial infarction. He was undergoing treatment with 2 oral antiplatelet agents. The patient presented to our hospital for carcinomatous pyloric stenosis caused by type 4 advanced gastric cancer. Although distal gastrectomy was planned, preoperative coronary angiography revealed triple- vessel coronary artery disease. Therefore, surgery was performed under management of intra-aortic balloon pumping (IABP)therapy. The patient's hemodynamics at the time of the operation were stable, and no perioperative cardiovascular complications occurred. However, the patient was not able to start an oral diet because of impaired swallowing function. Although he underwent daily swallowing rehabilitation, he died of aspiration pneumonia 40 days postoperatively. There are many reports of cancer resection under IABP management for patients with severe heart disease. Because the perioperative hemodynamics were stable in all 21 reported cases of digestive malignant tumor resections in Japan, an IABP is suggested to be very effective for patients with severe heart disease. However, early death has also occurred, as in the present case. Close attention to the indications for IABP therapy is needed, especially in elderly patients, in consideration of not only cancer and heart disease but also preoperative activities of daily living.

This study investigated the relationship between quality of life (QOL) and efficacy or occurrence of adverse events in patients who were administered lenalidomide and dexamethasone (Len+Dex) therapy for relapsed or refractory multiple myeloma (MM) in the hematology department at Obihiro Kosei Hospital from September 2010 to September 2012. QOL was evaluated using a quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD). The average QOL score of 7 patients receiving 4 cycles of Len+Dex treatment decreased 5 points from baseline Len+Dex treatment. The change in QOL score was significantly correlated with changes in serum M-protein (correlation coefficient: R=0.777). However, there was no significant correlation between adverse events and the change in QOL score. Our results indicate that QOL may be improved by the effects of Len+Dex treatment.

In 35 patients who underwent balloon-occluded transarterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) since January 2013, 5 patients (14%) had postoperative cholangitis, 1 of whom required drainage of a liver abscess. Four of these patients(80%)were treated with cisplatin (CDDP)-epirubicin (EPI)-Lipiodol (Lp) emulsion, and 1 was treated with EPI-Lp emulsion.The balloon was located and inflated at the lobar level (C: conventional)in 3 patients (60%) and at the subsegmental or more distal level (SS: superselective) in 2 patients (40%). Chemical vascular damage was considered to cause the cholangitis.We conclude that it is necessary to determine the optimal drug for B-TACE to reduce vascular damage. Miriplatin may be useful because of its lower vascular damage compared with CDDP-Lp and EPI-Lp.

Nausea and vomiting are major adverse reactions in cancer chemotherapy, and affect quality of life (QOL). We performed a retrospective study that examined the efficacy of aprepitant and palonosetron for chemotherapy-induced nausea and vomiting (CINV) on patients taking cisplatin doublets for lung cancer. The study subjects were 73 patients. A 5-HT(3) group received old-generation 5-HT(3) receptor antagonists and dexamethasone for preventive treatment (32 patients). An A group received old-generation 5-HT(3) receptor antagonists, aprepitant and dexamethasone (22 patients). An A+P group received palonosetron, aprepitant and dexamethasone (19 patients). On acute emesis (occurring within 24 hours after chemotherapy), there was no significant difference in the complete suppression rate of nausea and vomiting among the three groups. However, on delayed onset emesis (occurring between 24 to 120 hours), the complete suppression rate of nausea was significantly higher in the A+P group (57. 9%) than in the 5- HT(3) group (16. 7%) and A group (23. 8%). Significantly better efficacy was seen in the 5-HT(3) group and A group in the complete suppression rate of vomiting, and in the need of rescue medication rates on delayed-onset emesis. The cost of antiemesis was 19, 735 yen for the 5-HT(3) group, 32, 252 yen for the A group and 15, 557 yen for the A+P group. In conclusion, it was suggested that concurrent administration of palonosetron, aprepitant and dexamethasone for CINV on cisplatin doublet in lung cancer is a clinically useful treatment that might reduce the economic burden on patients.

Background and Aim: Partial splenic embolization (PSE) is often performed to improve thrombocytopenia in liver cirrhotic patients. The aim of this study was to evaluate the efficacy and safety of PSE in combination with trans-catheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC)., Patients and Methods: From January 2004 to December 2007, 8 HCC patients associated with hypersplenism caused by cirrhosis were synchronously treated with TACE and PSE. Fifteen patients with TACE alone at the same period were enrolled as a control. Follow-up examinations included a calculation of peripheral blood cells (leukocytes and platelets), liver damage, duration until recovery, and treatment-associated complications., Results: Initially, there were no significant differences in sex, age, Child-Pugh grade and peripheral blood cell counts between two groups. After treatment, leukocyte and platelet counts were significantly higher in PSE combined with TACE group during the follow-up period than TACE group (p<0.01). Severe complications never occurred in both groups., Conclusion: PSE combined with TACE is more effective than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.

We report a long-term survival case of hepatocellular carcinoma with lymph node metastases treated with surgery and radiotherapy. A 71-year-old man was admitted to our department at Kumamoto University Hospital in May 2003 for a treatment of local recurrent HCC after transarterial chemoembolization. CT showed an infiltrative type tumor, 2.5 cm in diameter, in the segment 8 of the liver. We treated the liver tumor with a right paramedian sectionectomy in May 2003. Postoperatively, lymph node metastases and recurrent HCC were diagnosed. Three times of local ablation therapies for recurrent HCC, twice lymph node dissections, and twice radiotherapies for lymph node metastases were successfully achieved. The patient survived without recurrence for 60 months after the initial hepatectomy.

Transcatheter arterial embolizations of severe arterioportal shunt (A-P shunt) were performed with steel coils in 3 patients with hepatocellurlar carcinoma (HCC) as shown below. Case 1: A 56-year-old man with HCC associated with portal hypertension (esophageal varices and ascites abnominal pain), portal vein tumor thrombus and severe A-P shunt was performed in critical conditions. Case 2: A 51-year-old man with HCC, lung and adrenal gland metastases was accompanied with severe portal hypertention caused by A-P shunt and was in a harmful condition similar to case 1. Case 3: A 68-year-old woman with HCC associated with autoimmune hepatitis was performed a hepatic resection. Then multiple intrahepatic recurrences appeared 6 months later. A-P shunt made impossible to detect the feeding artery of tumor. After embolization of A-P shunt, esophageal varices and ascites resolved, and abdominal pain improved in cases 1 and 2. In addition, embolization enabled to perform transcatheter arterial chemoembolization in case 3. This procedure is a useful tool to improve various symptoms due to A-P shunt and to continue treatments for HCCs.

The patients with hepatocellular carcinoma (HCC) with adrenal metastases are often accompanied with the metastasis from other sites, and their prognosis is poor. After 1999, we examined the prognosis and efficacy of the seven patients with drenal metastases from HCC. Four patients were surgically treated, and three of them received radiation therapy (RT). All of the 7 patients were men and the mean age was 72 years old (range: 53-77 years old). The mean interval from the initial treatment of hepatocellular carcinoma to the adrenal metastases was 46 months (1-95 months). If there was a good control observed in the intrahepatic lesion with no metastases besides adrenal glands, we selected a surgical resection of the metastatic adrenal glands. The mean overall survival time after the surgical treatment of the adrenal metastases was 23 months (7-54 months), and we considered it as a good prognosis. The mean progression free survival of the adrenal metastases was 15 months (5-30 months). Besides on such a good clinical outcome, we conclude that aggressive multimodal therapy including surgical resection of metastatic foci may be recommended if the patients with hepatocellular carcinoma have no other metastatic sites other than the adrenal gland and liver lesions are well-controlled.

Introduction: Treatments of hepatocellular carcinoma (HCC) located in the caudate lobe have been difficult because of the unique anatomical location. Our objective was to evaluate the surgical outcomes of hepatic resection for a single HCC located in the caudate lobe., Methods: Between January 1999 and December 2005, 97 patients with a single HCC underwent hepatic resection at our department. Seven (7.2%) of the 97 patients had a single HCC located in the caudate lobe. The caudate lobe HCC was located in the spiegel lobe in 2 patients, the paracaval portion in 2, caudate process in 2 and a total caudate lobe in 1. The influence of the tumor location (caudate lobe origin) on the surgical outcomes was analyzed in comparison with the other site tumors., Results: The morbidity rate after hepatic resection for a single HCC in caudate lobe and the other lobes were 57% and 20%, respectively. The morbidity rate was significantly higher in the caudate lobe group (p < 0.05). The 3- and 5-year cumulative survival rates of the patients with a single caudate lobe HCC and the other lobes were 83.3%, 83.3%, 89% and 85.4%, respectively. Similarly, the 3- and 5-year cumulative disease free survival rates were 51.4%, 51.4%, 59.4% and 45.5%, respectively. There was no significant difference in both the cumulative survival rate and cumulative disease free survival rate., Conclusions: Hepatic resection for a single HCC located in the caudate lobe was an effective treatment, being equal clinical outcomes to a single HCC in the other sites of the liver.

In patients with multiple hepatocellular carcinomas (HCCs), a liver resection for the main tumor may be performed in combination with local ablation therapy for satellite lesions. Of 63 multiple HCC patients without radiological vascular invasions, 27 were treated with liver resection alone and the other 36 treated with the combination of liver resection and local ablation therapy. No significant differences were found in both groups with regard to age, gender, BMI, etiology of hepatitis, liver damage grade, tumor number, size of the main tumor and size of satellite lesion. In the liver resection group, 11 hemihepatectomies, 12 sectionectomies and 4 partial hepatectomies were performed. In the combination therapy group, 8 hemihepatecomies, 17 sectionectomies and 11 partial hepatectomies were performed. No significant differences were found in both groups with respect to bleeding, transfusion, disease-free survival rate, and survival rate. In the combination therapy group, a resected liver volume was significantly lower (p = 0.003) and an operation time was shorter (p = 0.009). It appears to indicate that the combination of liver resection and local ablation therapy can be useful for multiple HCCs.

The patients with hepatitis B or C based liver cirrhosis are at high risk for developing Hepatocellular carcinoma (HCC), and HCC patients treated surgically or by other therapies are also at high risk for recurrence. As a result, the prognosis of HCC remains poor, and new therapies for the prevention of cancer development and recurrence are urgently needed. We previously reported that glypican 3 (GPC3) was over expressed specifically in HCC. In this report, we found the HLA-A2 or HLA-A24 restricted GPC3 epitope peptide, and investigated whether these peptides could induce GPC3 reactive CTLs from the peripheral blood mononuclear cells (PBMCs) of HLA-A2+ or HLA-A24+ HCC patients. We used HLA-A2.1 (HHD) transgenic mice (Tgm) to identify the HLA-A2-restricted GPC3 epitopes. We found that these epitope peptides could induce peptide-reactive CTLs in about 50% of HLA A2+ or HLA-A24+, and GPC3+ HCC patients. Our study raises the possibility that these GPC3 peptides may therefore be applicable to cancer immunotherapy for prevention of cancer development and recurrence of HCC.