Search

Background: Mucinous rectal carcinoma has been reported to have a lower survival rate and a poorer histologic response to chemoradiotherapy(CRT). Magnetic resonance imaging (MRI) can accurately evaluate the amount of mucin pools (MP) in primary cancer tissue. We compared the degree of MP on MRI before and after CRT with the histologic findings of resected specimens to investigate the predictors of response to CRT., Methods: The study group comprised 205 patients with rectal adenocarcinoma who received preoperative CRT. MPs were measured on MRI before and after CRT and in resected specimens. The degree of MP was classified into five classes according to the MP area ratio: 0%, class I; 1 to 19%, class II; 20 to 49%, class III; and 50% or higher, class IV., Results: The degree of MP on MRI was largely unchanged after CRT; however, the MP on MRI after CRT was underestimated in 26.3% of patients as compared with that in resected specimens. A pathological complete response was obtained in patients who initially had no MP or had an MP ratio of less than 20%. The tumor volume was significantly greater, and the rates of tumor shrinkage and T downstaging were significantly lower in patients who had an MP area ratio of 20% or higher before CRT than in those who had an MP area ratio of less than 20%., Conclusions: The MP area ratio measured on MRI before treatment was closely associated with the response to CRT and is a potentially useful predictor of treatment response.

Objective: A single-arm phase II clinical trial was conducted to evaluate the safety and efficacy of preoperative chemoradiotherapy (CRT) with concurrent S-1, bevacizumab, and radiation in patients with locally advanced rectal cancer (LARC)., Methods: Fifty-two patients with LARC were enrolled. A total dose of 45 Gy was delivered in 25 fractions over 5 weeks, S-1 was administered orally twice a day on days 1-14 and 22-35, and bevacizumab was administered on days 1, 15, and 29. Surgical resection was scheduled 8 weeks (6-10 weeks) after completing the CRT., Results: All 52 patients underwent R0 radical surgery. Sphincter preservation was possible in 38 (73.1%) patients. A pathologic complete response was obtained in 10 (19.2%) patients, a pathologic downstaging was achieved in 37 (71.2%) patients, and the tumor shrinkage rate was 77.1%. The only grade 3 adverse events were leukopenia and rash in 1 (1.9%) patient. The rate of postoperative complications was 28.8%. Anastomotic leakage occurred in 9 (23.7%) of the 38 patients who underwent sphincter-preserving surgery. Perineal wound dehiscence developed in 2 (14.3%) of the 14 patients who received an abdominoperineal resection., Conclusions: Adding bevacizumab to S-1 clearly increased the incidence of wound-related complications, with no distinct enhancement of tumor response., (© 2014 S. Karger AG, Basel.)

Background: Preoperative chemoradiotherapy (CRT) decreases the number of retrieved lymph nodes (LNs) in rectal cancer. LNs inside the irradiation field are affected by CRT, whereas those outside the irradiation field are affected only by concurrent chemotherapy., Patients and Methods: The study cohort comprised of 210 patients with clinical stage II/III rectal adenocarcinoma. One hundred and eight received surgery alone (S group), and 102 received preoperative CRT (40 or 45 Gy) with concurrent oral UFT or S-1 uracil/tegafur or S-1 (CRT group)., Results: The number of LNs inside the irradiation field was significantly smaller in the CRT group (4 ± 4) than in the S group (6 ± 6, p<0.01), but the number of LNs outside the irradiation field did not differ (5 ± 4 in both groups). The longest diameters of LNs in the S group were significantly smaller than those of the CRT group both inside and outside the irradiation fields (p<0.01)., Conclusion: The effects of CRT on LNs in patients with rectal adenocarcinoma differed inside and outside the radiation field., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Lung surgeries in patients with bronchial variations have rarely been reported. Here, we describe the case of a patient along with lung cancer with variant anatomy of the right upper lobe bronchus. This variation was evaluated by three-dimensional multi-detector computed tomography angiography with bronchography and a three-dimensional printing model using rapid prototyping. The variant anterior segment bronchus (S3) of the right upper lobe arising from the middle lobe bronchus was confirmed before surgery using the printing model, which helped to determine the extent of resection required and facilitated the understanding of the patient's anatomy during surgery. A thoracoscopic anterior segmentectomy and middle lobectomy were performed. The printing model was useful for detecting and evaluating the variant bronchi.

Lung segmentectomy with bronchial variation has rarely been reported. We report the case of a lung cancer patient with variant anatomy of the right upper lobe bronchus.Thoracoscopic posterior segmentectomy of the right upper lobe was performed. Variant bronchus and related blood vessels were confirmed preoperatively by three-dimensional multidetector computed tomography (3D-MDCT), which facilitated visualization of the patient's anatomy during surgery.

Purpose: Preoperative chemoradiation therapy (CRT) significantly decreases local recurrence in locally advanced rectal cancer. Various biomarkers in biopsy specimens obtained before CRT have been proposed as predictors of response. However, reliable biomarkers remain to be established., Methods and Materials: The study group comprised 101 consecutive patients with locally advanced rectal cancer who received preoperative CRT with oral uracil/tegafur (UFT) or S-1. We evaluated histologic findings on hematoxylin and eosin (H&E) staining and immunohistochemical expressions of Ki67, p53, p21, and apoptosis in biopsy specimens obtained before CRT and 7 days after starting CRT. These findings were contrasted with the histologic response and the degree of tumor shrinkage., Results: In biopsy specimens obtained before CRT, histologic marked regression according to the Japanese Classification of Colorectal Carcinoma (JCCC) criteria and the degree of tumor shrinkage on barium enema examination (BE) were significantly greater in patients with p21-positive tumors than in those with p21-negative tumors (P=.04 and P<.01, respectively). In biopsy specimens obtained 7 days after starting CRT, pathologic complete response, histologic marked regression according to both the tumor regression criteria and JCCC criteria, and T downstaging were significantly greater in patients with apoptosis-positive and p21-positive tumors than in those with apoptosis-negative (P<.01, P=.02, P=.01, and P<.01, respectively) or p21-negative tumors (P=.03, P<.01, P<.01, and P=.02, respectively). The degree of tumor shrinkage on both BE as well as MRI was significantly greater in patients with apoptosis-positive and with p21-positive tumors than in those with apoptosis-negative or p21-negative tumors, respectively. Histologic changes in H&E-stained biopsy specimens 7 days after starting CRT significantly correlated with pathologic complete response and marked regression on both JCCC and tumor regression criteria, as well as with tumor shrinkage on BE and MRI (P<.01, P<.01, P<.01, P<.01, and P=.03, respectively)., Conclusions: Immunohistochemical expressions of p21 and apoptosis together with histologic changes on H&E-stained biopsy specimens obtained 7 days after starting CRT are strong predictors of the response to CRT., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Although fewer lymph nodes are dissected with video-assisted thoracic surgery than with open lobectomy, thoracoscopic lobectomy is increasingly becoming the preferred surgical approach for early-stage lung cancers. The endoscopic surgical spacer SECUREA™ is a medical device that has been effectively employed in laparoscopic surgery, but no study has evaluated its efficacy in thoracoscopic surgery. In this report, we demonstrate the utility of SECUREA for complete thoracoscopic mediastinal lymph node dissection in patients with non-small cell lung cancer.

Some variations in pulmonary vein anatomy can have serious consequences in patients undergoing lung surgery, but clinicians rarely encounter patients with these variations. We report here a thoracoscopic lobectomy for right lung cancer in a patient with three right vein ostia. Preoperative review of three-dimensional 64-row multidetector computed tomography (3D-MDCT) of the patient showed a variation that was not confirmed in transverse plane computed tomography films. However, the variant anomaly was confirmed during thoracoscopic right lower lobectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Preoperative 3D-MDCT of the pulmonary vein produced a precise preoperative simulation for the surgeon and clearly showed the orientation of the patient's vascular variant during surgery. This imaging technology contributes to safer thoracic surgery, especially thoracoscopic surgery.

Purpose: To assess the maximum tolerability of a combination of S-1 and preoperative radiotherapy and to evaluate the feasibility and activity in patients with locally advanced rectal cancer., Methods: Patients (n = 30) with adenocarcinoma of the middle or lower rectum were enrolled in a phase I (n = 9) and/or phase II (n = 21) trial. A total dose of 45 Gy was delivered in 25 fractions over 5 weeks, and S-1 was orally administered twice a day on days 1-14 and 22-35. Surgical resection was scheduled 4-8 weeks after the completion of chemoradiation., Results: In phase I, the recommended dose (RD) of S-1 was 80 mg/m(2)/day, and the maximum-tolerated dose was never reached. A total of 27 cases, including the 6 RD cases in phase I, were enrolled in phase II. In phase II, a pathological complete response (pCR) was observed in 6/27 patients (22%), pathological downstaging was observed in 21/27 patients (78%), and a tumor volume reduction of 69 ± 22% was obtained. These results were similar to the previously reported pCR rates of 16-18%, pathological downstaging rates of 49-59%, and tumor volume reduction of 68% after chemoradiotherapy with capecitabine. Grade 3 adverse events consisted of one case of leukopenia (4%), 2 cases of anemia (7%) and 3 cases of diarrhea (11%). Overall, the adverse events were very mild. Hand-foot syndrome was not observed., Conclusion: The efficacy of chemoradiotherapy with S-1 seems to be equivalent to the efficacy reported for chemoradiotherapy with capecitabine, but the adverse events were much milder, although further study is warranted., (Copyright © 2011 S. Karger AG, Basel.)

We describe herein a case of a 68-year-old woman with primary lung cancer who had undergone induction chemoradiotherapy and then a right pneumonectomy for non-small cell cancer (adenocarcinoma). Twenty-one months later, the cancer had metastasized to the brain, which was treated with 2-knife radiosurgery. She had been well for up to 32 months; however, the chest radiography and chest computed tomography (CT) demonstrated a nodule in the left upper lobe of the lung that was gradually growing. We preformed a partial resection of the left upper lobe by video-assisted thoracic surgery (VATS) under percutaneous cardiopulmonary support (PCPS), considering the oxygenation requirement of the patient. PCPS was applied via venoarterial (V-A) bypass, and the hemodynamic status of the patient was mostly stable. The postoperative course was uneventful, and the patient has no evidence of metastatic lung cancer, 10 months postoperatively, indicating that the minimally invasive VATS under PCPS was successful and safe. Although few reports have been described and some key questions remain unanswered, the method appears to be promising.

Various anatomical variants in pulmonary veins can have a serious effect on patients undergoing lung surgery. We present a case of a patient with an unusual pulmonary vein variation. Preoperative review of the patient's three-dimensional 64-row multidetector computed tomography imaging allowed us precise simulation and good orientation of the patient's vascular variant anatomy during surgery. Upper lobectomy through thoracoscopic approach was performed successfully in the case where the middle lobe vein might have been divided without preoperative anatomical evaluation by 3D CT images.

Variations in pulmonary veins can have a serious effect on patients undergoing lung surgery. But few clinicians are familiar with patients who have these variations, and few have been reported in the left pulmonary vein. We report the case of a lung cancer patient with a variant anatomy in the inferior segment of the lingular vein (V5) that drained into the left inferior pulmonary vein. A preoperative review of the patient's three-dimensional 64-row multidetector computed tomography (3D MDCT) imaging showed that the variant vein (V5) was draining from the inferior lingular segment into the upper side of the inferior pulmonary vein, which was also observed on conventional CT films. This variant anatomy was confirmed during a thoracoscopic left upper lobectomy. Furthermore, the superior segment (V6) of the inferior pulmonary vein drained into the basal part of the inferior pulmonary vein, but not into the superior side where V5 in this patient was drained. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Preoperative 3D MDCT imaging of the pulmonary vein allowed good visualization of the patient's vascular variant during surgery, and it contributed to safe thoracic surgery, especially in a thoracoscopic operation.

Background: We previously reported that preoperative chemoradiotherapy (CRT) combined with intraoperative electron irradiation for cT3/T4 adenocarcinoma of the rectum reduced the local recurrence, with significant improvement of survival. Radiotherapy has been reported to reduce immune function. We examined the effects of PSK, a protein-bound polysaccharide, concomitant with preoperative CRT on immune responses., Patients and Methods: Thirty patients with cT3/T4 adenocarcinoma of the rectum were randomly assigned to 2 weeks' irradiation and 4 weeks' S-1 administration before surgery (control group), or the same CRT with simultaneous 4 weeks' PSK administration (PSK group). Both systemic and local immune responses were evaluated., Results: Significant increase of natural killer cell count in the peripheral blood and cytotoxic T-cell counts in the peri-tumoral and normal mucosa, and a significant decrease of serum immunosuppressive acidic protein level were observed in the PSK group., Conclusion: Combined use of PSK with preoperative CRT may improve immune function.

Few clinicians are familiar with the anatomy of anomalous pulmonary veins, and studies reporting patients who required right lower lobectomy for lung cancer and who had anomalies of the middle and lower pulmonary veins are even rarer. This report describes the case of a lung cancer patient who had an anomalous lateral part of the middle lobe vein (V4) draining into the right inferior pulmonary vein, which was confirmed by three-dimensional 64-row multidetector computed axial tomography (3D-MDCT) angiography. She was then successfully treated with video-assisted thoracic surgery. The preoperative 3D imaging of the pulmonary vein and artery allowed us to comprehend fully the patient's vascular anatomy before the operation. Thus, we recommend preoperative 3D-MDCT angiography for patients with lung cancer undergoing thoracic surgery, especially video-assisted thoracic surgery.

Five patients of primary lung cancer with giant bullous disease underwent surgery from April 1985 to December 1995. All patients were male and heavy smokers, and the median age was 50 years. The location of the tumor was in the right upper lobe in four patients and in the left upper lobe in the other. Three patients were treated by lobectomy and two by sleeve lobectomy. Histological examination showed large cell carcinoma in four patients and poorly-differentiated adenocarcinoma in the other. The pathological stage was I in three. IIIA in one, and IV in the other. Two of three in stage I have survived for more than 6 years postopertively without recurrence, and the other died of brain metastasis. The stage IIIA case and the IV case died 3 years and one year postoperatively, respectively. The clinical features of lung cancer associated with giant bullous disease was discussed by reviewing 33 patients reported in Japan, including our patients. In 13 patients, lung cancer and bullous disease were diagnosed simultaneously (group A), and in 20 patients, bullous disease were diagnosed prior to the appearance of an abnormal shadow due to lung cancer (group B). The patients in group B had a tendency to be diagnosed at an earlier stage of lung cancer than the patients in group A. In the patients of stage I, the 5-year survival rate was 78.6%, however, in the patients of more than stage IIIA, 3-year survival rate was 26.5% and the 5-year survival rate was 0%. Significant differences in the survival curves were demonstrated between the cases with stage I and the cases with more than stage IIIA. In conclusion, in order to improve the prognosis of lung cancer with giant bullous disease, it is considered to be important to detect giant bulla prior to lung cancer, and when a case of bullous disease is found, periodical follow-up must be done to find early stage lung cancer.

A 56-year-old housewife was incidentally discovered to have an abnormal shadow in the right B6 area upon a chest X-ray film being taken. A transcutaneous lung biopsy of the mass revealed adenocarcinoma of the lung (WHO classification). A brain computed tomography (CT) scan demonstrated multiple brain metastasis. Following whole brain irradiation, carboplatin (CBDCA) (450 mg/m2) was administered by intravenous drip infusion on March 7, 1986. After three weeks of initial treatment with CBDCA, the size of the tumor in the primary site was found to have decreased on the chest X-ray film by more than 50%, following which, similar doses of CBDCA were administered twice, and reduced (330 mg/m2) doses three times every three to four weeks. She showed a partial response and, for seven months after the beginning of the CBDCA treatment, no progression was seen on the chest X-ray film. It is suggested that there is a need for further phase II studies of CBDCA against non-small cell lung cancer.

A 63-year-old man was admitted to the National Cancer Center Hospital on December 20, 1983 for a close examination of the abnormal shadows found in chest roentgenograms. Chest radiographs showed a massive right pleural effusion, a large tumor in the right hilar region and swelling of the left hilar nodes. Transcutaneous needle biopsy revealed the tumor's cytological type to be adenocarcinoma. The clinical stage was considered to be T3N2M1 (American joint committee (AJC) stage III M1), and his performance status was 4, so he was given etoposide (VP-16) alone as the initial chemotherapy treatment. He showed a partial response upon two courses of VP-16 therapy. Subsequently, one course of cisplatin (80 mg/m2) + vindesine (3.3 mg/m2), two courses of VP-16 (80 mg/m2 D1-4), five courses of cyclophosphamide (80 mg/m2) + adriamycin (50 mg/m2) + vincristine (1.4 mg/m2) and two courses of VP-16 (100 mg/m2 D1, 3, 5) were administered sequentially until May 31, 1985. No radiation therapy was given and, up to March 31, 1987, no sign of recurrence had been observed.

Nine cases of malignant mesothelioma of pure epithelial and biphasic types (five pleural, three peritoneal, and one pericardial mesotheliomas), seven cases of benign adenomatoid tumor of the uterus, and 21 cases of peripheral pulmonary adenocarcinoma of non-mucus-producing type were examined immunohistochemically for expression of keratin, vimentin, carcinoembryonic antigen (CEA), surfactant apoprotein, Lewis blood group antigens, and Tn antigen. The majority (78%) of the malignant mesotheliomas expressed keratin, but CEA and surfactant apoprotein were not detected in any mesotheliomas. On the other hand, pulmonary adenocarcinomas expressed not only keratin (100%), but also CEA (62%) and surfactant apoprotein (62%). The expression of Lewisa blood group antigen and Tn antigen was detected in 76% and 62% of the pulmonary adenocarcinomas, respectively, but only one mesothelioma was stained for Lewisa antigen. This study reveals that the majority of malignant mesotheliomas can be distinguished from pulmonary adenocarcinomas by immunohistochemcial staining for CEA, surfactant apoprotein, Lewisa antigen, and Tn antigen. Immunohistochemically, adenomatoid tumors behaved similarly to malignant mesotheliomas.