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Primary small cell carcinoma of the renal pelvis is a rare and aggressive disease; reportedly, a mean survival is only 8 months. A 78 year-old woman with chronic kidney disease was referred to our hospital complaining of asymptomatic gross hematoturia. On imaging studies and voided urine cytology, diagnosis of right renal pelvic cancer (cT2N0M0) was made. She underwent total nephroureterectomy. Pathological diagnosis was small cell carcinoma, infiltrating into the renal parenchyma, with lymphovascular invasion. Post-operatively, hemodialysis was introduced. Five months after the operation, new lesions developed in the right adrenal gland, aortocaval lymph nodes and subcutaneous layer of the right back. The subcutaneous mass was surgically removed and low-dose chemoradiotherapy (sigma 45 Gy/25 Fr/32 d + cisplatin 10 mg/d for 2 d x 2) was given to the other lesions. Although the lesions regressed to CR, new small masses emerged in the muscle layers of the right flank 14 months after total nephroureterectomy. Low-dose chemoradiotherapy (sigma 40 Gy/20 Fr/29 d + cisplatin 10 mg/d for 2 d x 2) to these lesions successfully brought CR. She is alive without any evidence of disease at 3 years after total nephroureterectomy.

We present 2 cases with pulmonary undifferentiated carcinoma accompanying severe inflammatory responses. Both patients initially complained high-grade fever. Laboratory data on admission showed leukocytosis and elevation of serum CRP level. In both cases, the tumors were characterized by a low-density mass with the enhanced wall on chest computed tomography (CT). The presence of tumor cells could not be identified by bronchoscopical examination. One patient was suffered from left adrenal metastasis at the diagnosis. Both patients underwent pulmonary resection for the primary tumor. The tumors consisted of marked necrotic tissue and were histologically diagnosed as pulmonary undifferentiated carcinoma cells with sarcomatous elements, which was compatible with pleomorphic carcinoma by new World Health Organization (WHO) classification (1999). After operation, systemic inflammatory response such as high-grade fever, leukocytosis, high level of serum CRP continued and progressed. Furthermore, extrathoracic metastatic lesions newly appeared. Both patients died within 100 days after operation.

The effect of the combination treatment consisted of 5'-deoxy-5-fluorouridine (5'-DFUR) and medroxyprogesterone acetate (MPA) was investigated in 20 recurrent breast cancer patients. Out of 20 patients, 8(40.0%) responded to the treatment. The average duration of response was 10.3 months. Response rates stratified by recurrence site were soft tissues 36.4%, bone 44.4%, liver 60.0% and lung 20.0%, respectively. No serious side effect except body weight gain, which was caused by MPA, was seen. In a 76-year-old woman with liver metastases, a marked response was obtained and has continued for more than 24 months. It was suggested that the combination of 5'-DFUR and MPA may be effective for recurrent breast cancer patients.

Four cases of recurrent breast cancer effectively treated by CPT-11 were reported. These cases had undergone previous chemotherapy including adriamycin. Nevertheless, they developed no tolerance to such therapies and displayed good responsitivity to CPT-11. Effects on metastatic lesions: One was bone and three were soft tissues, was observed after the end of one course therapy. The response periods were over 210 days, 431 days, 175 days and 73 days. Thus, it was suggested that early response to drug was important clinically and was significant for enhancing the quality of life of patients. Major adverse reactions were leukopenia and gastrointestinal symptoms such as nausea, vomiting and diarrhea (Grade 2-3). However, these could be well managed by symptomatic treatment and dose modification. The results suggested that CPT-11 was an effective agent against advanced or recurrent breast cancer, and especially useful for patients who had developed a tolerance to previous therapies.

A rare case of malignant melanoma metastatic to the cavernous sinus and skull, with an unknown primary origin, is reported. A 46-year-old man noticed diplopia, lt. ptosis and swelling in the parietal and maxillary regions. The parietal skull tumor and the maxillary lymph node were excised and histological examination revealed malignant melanoma. Because of its roentogenological characteristics, the lesion of the cavernous sinus was also thought to be the site of metastasis of malignant melanoma. This case is rare because the initial symptom was cavernous sinus syndrome, and no involvement of brain parenchyma was observed.

Outpatients with advanced and recurrent breast cancer were treated by a combination therapy of the following drugs: doxifluridine (5'-DFUR) orally administered at a dose of 1200 mg/day; cyclophosphamide (CPA) orally given at dose of 100 mg/day; and tamoxifen (TAM) orally given at dose of 20 mg daily. 5'-DFUR and CPA were administered on consecutive days 1-14, then discontinued for 14 days. The response rate was 44.8% including five CR and eight PR out of 29 complete cases. As for response cases in terms of the subject lesions, corresponding cases were chiefly found in soft tissue and the lung. As for the response rate with or without pretreatment, cases previously treated showed a higher response rate such as 42.9% indicating that the present therapy was effective in pretreatment cases. The main side effect was leukopenia, but not so severe. Few cases with diarrhea were found. Based on the above findings, the present treatment is conceivably a highly useful therapy, on an outpatient basis, for advanced and recurrent breast cancer, especially metastatic lesions of soft tissue and the lung.

A 54 year-old female patient with disseminated breast cancer refractory to various kinds of previous therapies was treated with a combination therapy of 5'-DFUR, MPA and CPA. Partial response (PR) was obtained both against pleural and liver metastases with complete disappearance (CR) of soft tissue lesions and was still being continued for the following 7 months. No serious side effects were observed except for a mild degree of diarrhea and moon face. The patient was enjoying a favorable quality of life. We confirmed that this combination regimen was effective as the second line treatment for disseminated breast cancer.

Transcatheter arterial embolization therapy was performed in fifteen patients with hypervascular metastatic bone and soft-tissue tumors (7 from renal carcinoma, 5 from hepatocellular carcinoma, and one each from breast, thyroid, and cholangiocarcinoma). Sites of metastasis were spine (7), pelvis (5), skull (2), paraspine (2), chest wall (1), and thigh (1). Five patients had not responded to previous radiation therapy and hyperthermia. Embolization of feeding arteries was performed superselectively with long tapered catheters or coaxial microcatheters. Emulsion of Lipiodol and anticancer agent, polyvinyl alcohol sponge, gelatin sponge, and microcoils were used as embolic materials in various combinations. Relief of pain was experienced in 14 of 15 patients. Two patients were operated following embolization with minimal blood loss. Change in tumor size was evaluated by CT or MRI in ten patients. Reduction of tumor size were more than 50% in five patients, from 25% to 50% in two, and no change in three patients. Especially, patients embolized with microcatheter and microcoils showed excellent long-term results. No serious complications were seen. In conclusion, superselective arterial embolization therapy with coaxial microcatheter and microcoils was proved to be an useful treatment for hypervascular metastatic bone and soft-tissue tumors.

An 11-year-old girl noted a small mass on the left upper eyelid. The tumor was excised and diagnosed as round cell-type liposarcoma. In spite of intensive multimodal therapy, the tumor tended to recur, metastasizing to the central nervous system and soft tissues. The patient died of progressive disease three years after diagnosis. Features unique to this case include the ophthalmological primary site, the age at onset, the histological subtype and the mode of metastasis.

Effect of chemotherapy for relapse of prostatic cancer was evaluated with new response criteria, in which four objective parameters including the prostate, bone metastasis, soft tissue metastasis and the serum acid phosphatase level estimated by radioimmunoassay or enzyme immunoassay were judged separately and then summarized to evaluate the response as complete response (CR), partial response (PR), stable and progressive disease (PD). Eighty-two patients were included in the study. Rate of PR and stable were 19% and 27%, respectively, and these two groups showed longer survival than those with PD. Evaluation of prostate and bone showed tendency to be discrepant with total judgement. Evaluation of soft tissues and prostatic acid phosphatase reflected the effect of chemotherapy. Chemotherapy often improved subjective symptoms but the effect did not parallel the total judgement in many cases. Factors influencing response of chemotherapy were mode of pretreatment, performance status, age, number of affected areas and clinical stage, but the grade at initial treatment was not correlated to response. The new criteria used in this study was valid for evaluation of response in prostatic cancer.

The formation of heterotopic bone tissue in carcinomas of the gastrointestinal tract and/or their metastases is extremely rare. In a 74-year-old female with gastric adenocarcinoma, we observed extensive bone formation within metastases in the skeletal muscles. There are only 7 other cases of heterotopic bone formation in gastric cancer reported in the world literature. We suggest that heterotopic ossification in primary cancers and/or their metastases is probably the result of metaplasia of stromal fibroblasts into osteoblasts.

An analysis was made on localized extranodal non-Hodgkin's lymphoma in the maxillo-facial region treated with radiation. Histopathological evaluation was reviewed by Rappaport classification and Working Formulation (WF). High grade histology of WF was rather frequent (32%) compared to Waldeyer's (NHL) (7%). Prognosis of the disease was highly influenced by histopathologic grade in WF; five-year survival rate was 100% with low grade, 65.6% with intermediate grade and 33.3% with high grade. Marginal relapse was rare after radiation dose of 30-50 Gy, however, there was a high incidence of bone and/or soft tissue relapses. Bone marrow biopsy and bone scintigram were useful examinations in the staging procedure of extranodal NHL.

Unlabelled: A comparative study was performed to evaluate the efficacy and safety of 5'-DFUR and tegafur in recurrent breast cancer. The oral daily dosage of 5'-DFUR was 1,200 mg and that of tegafur was 800 mg, both drugs being administered every day for more than 4 weeks., Results: Cases evaluable for anti-tumor effect were 50 with 5'-DFUR and 38 with tegafur. The response rate was 28.0% (14/50) with 5'-DFUR while that with tegafur was 15.8% (6/38). In the cases with no prior fluorinated pyrimidine therapy, 5'-DFUR was significantly superior to tegafur in the response rate. Effective cases determined within 8 weeks numbered 9 out of 50 cases with 5'-DFUR, showing a tendency to be more than those of tegafur, 1 out of 38 cases. This indicates that the appearance of response for 5'-DFUR seems to be faster. The duration of PR tended to be longer with 5'-DFUR than with tegafur. As for the safety, there was no difference between the two groups except for a high incidence of diarrhea in 5'-DFUR. 5'-DFUR tended to be superior to tegafur in its usefulness judged from the angles of efficacy and safety. From the above results, 5'-DFUR can be regarded as having a better efficacy than tegafur for the treatment of recurrent breast cancer, with a fast-appearing anti-tumor effect and a long durability for continuous treatment.

A 73-year-old male was admitted because of a localized tumor in the nasal cavity, which was suspected to be malignant lymphoma by biopsy specimens. Laboratory findings were within normal limits except for small amounts of M protein (IgG-lambda) in the serum. The patient was successfully treated by radiotherapy, with the disappearance of both the tumor and M protein. Two years after the onset, however, a solid tumor was observed in the soft tissue, followed by rapid systemic dissemination. An increase in M protein was obvious, and the biopsy specimens disclosed plasmacytoma. The patient died three months after admission, and post-mortem examinations revealed a diffuse infiltration of plasmacytes predominantly in the soft tissues.

Effects of tamoxifen (TAM)-medroxyprogesterone (MPA) sequential therapy were evaluated in 22 patients with recurrent breast cancer. TAM-MPA therapy was given in the form of TAM 20 mg b.i.d. for 14 days followed by MPA 1200 mg t.i.d. for the subsequent 14 days, in alternating sequence. The response rate was 27% (6/22). Weight gain (greater than 5 kg) was observed in 18% (4/22) and this incidence was lower than that reported for MPA therapy. These results demonstrate that TAM-MPA therapy offers fewer side effects than MPA therapy, but response rate is unlikely to be improved.

Extranodal non-Hodgkin's lymphoma (NHL) in the head and neck except Waldeyer's ring treated with radiation were analyzed. No definite difference was observed both in actuarial and relapse-free five-year survival rate between stage I and II. There was a high survival rate with orbital NHL in which most of the patients occupied with favorable histology. Prognosis of the disease was highly influenced by the histologic subtype; five-year survival was 91.4% in DWDL, 77.2% in the DM, 52.0% in DPDL and 51.7% in DH. Application of histologic classification with the Working Formulation was also recommended. There was a high incidence of extranodal relapses to bone and/or soft tissue from the lesions with nasal cavity, paranasal sinus and oral cavity.

Intratumoral administration of 5 K.E. OK-423 was given every other day for a patient with an abdominal wall recurrence of gastric cancer. After a total dose of 465 K.E. the abdominal tumor turned necrotic and its demarcation was monitored. Finally, the tumor separated and fell from the abdominal wall. Histologically, marked infiltration of neutrophils, lymphocytes, and macrophages were observed in the cancerous tissue. Clinically, local pain lessened and the serum CEA level decreased. PPD and PHA skin tests were markedly stimulated. A long term small-dose intratumoral administration of OK-432 seemed to be effective for a local recurrence of gastric cancer.