1. Combined Therapy Using Arterial Infusion for Unresectable Pancreatic Cancer
Department of Radiology and Surgery1), Nara Medical University
Toshihiro Tanaka, Hideyuki Nishiofuku, Hiroshi Anai, Satoru Sueyoshi, Takeshi Sato
Aya Hashimoto, Masayuki Sho1), Yoshiyuki Nakajima1), Kimihiko Kichikawa
Department of Radiology, Nara Prefectural Mimuro Hospital
Department of Radiology, Saiseikai Chuwa Hospital
Department of Radiology, Saiseikai Gose Hospital
Department of Radiology, Nara Prefectural Nara Hospital
In recent years, gemcitabine has been widely used as a standard systemic chemotherapy for unresectable pancreatic cancer. However, the response rate has been around 10％ and the median survival time around 6 months. Thus, the efficacy of systemic gemcitabine is limited and the patient prognosis remains poor. To improve patient survival, it is required to develop novel therapeutic strategies.
Recently, there have been reports on arterial infusion chemotherapy for unresectable pancreatic cancer, and hopes have been raised regarding the efficacy of this modality. Here, we report our experience including the results of clinical trial in which an arterial infusion of 5-FU combined with radiotherapy and systemic gemcitabine, our technique to unify the pancreatic blood supply, and the results pharmacological evaluation of experimental study.
- Pancreatic cancer
- Arterial infusion chemotherapy
2. Concurrent Chemoradiotherapy with Bronchial Arterial Infusion of CDDP for the Treatment of Locally-advanced Non-small Cell Lung Cancer
Division of Radiation Oncology, Diagnostic Radiology1)
Department of Radiology Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital
Katsuyuki Karasawa, Noriko Kamata1)
The standard treatment for locally advanced (stage III) non-small cell lung cancer (NSCLC) is concurrent use of chemoradiotherapy containing cisplatinum (CDDP). To enhance the local control and reduce the systemic adverse effects, we have been performing intraarterial infusion of CDDP from the bronchial arteries (BAI of CDDP) instead of intravenous administration. In principle, we administered 80㎎/㎡ of CDDP intra- arterially twice during the conventionally fractionated radiation therapy of 60 to 70Gy. The dose of CDDP was changed according to the patient’s renal function. Between 1996 and 2001 40 cases with stage III NSCLC were treated definitively. Median age was 75 years. There were 28 Sqcca and 9 adenoca. There were 7 stage III A and 33 stage III B cases. Average total RT dose was 63.4Gy and median total CDDP dose was 220㎎. Median follow-up period was 63 months. Median survival time was 27 months. Five-year overall, relapse-free and cause-specific survival rates were 41％, 33％ and 56％, respectively. Five-year local relapse-free rate was 57％. As for acute complications, we had only six (15％) grade 3 hematological and 2 (5％) grade 3 pulmonary complications, and we had no severe esophageal complications, which is often a dose-limiting factor. Our survival results of concurrent radiotherapy and BAI of CDDP for the treatment of stage III NSCLC have been promising with a low rate of severe adverse effects. Judging from the high rate of long-term disease-free survivors, disease clearance by chemoradiotherapy might be quite essential to improve the treatment results.
- Non-small cell lung cancer
- Concurrent chemoradiotherapy
- Bronchial arterial infusion
3. Intra-arterial Infusion Chemoradiotherapy for Advanced Carcinoma of the Uterine Cervix
Department of Radiation Oncology, Radiology1), Obstetrics and Gynecology2), Hiroshima University
Yuko Kaneyasu, Yasushi Nagata, Naoyuki Toyota1), Hideaki Kakizawa1), Ikuno Nishibuchi
Tomoki Kimura, Yuji Murakami, Masahiro Kenjo, Hisaya Fujiwara2), Yoshiki Kudo2)
Department of Obstetrics and Gynecology, Asa Citizen Hospital
Prognosis for patients with advanced uterine cervical cancer is still poor. In order to improve the prognosis for such patients, further effort is required. Intra-arterial infusion chemotherapy (IAIC) is considered to be useful for improvement of local control and survival. Many investigations have shown encouraging results for local control, but many reports have shown no definite effect on survival time. We analyzed 29 cases of Stage III squamous cell carcinoma of the uterine cervix treated with radiotherapy and IAIC of CDDP from 1991 to 2006. Five-year overall survival (OAS) rate for StageIII patients was 62％, cause specific survival (CSS) rate was 70％ and local relapse-free survival rate was 89％. Severe late complication rates (Grade 3≦) of the bladder, rectum and intestine were 3％, 3％ and 10％, respectively. Our study showed good local control, although numerous extra-pelvic distant metastases, especially PAN metastases were noted. Therefore, in order to decrease distant metastases, it is thought that some whole body chemotherapies are necessary. We should evaluate the position of the catheter and the drug distribution from the effectiveness and safety points of view. We confirmed excellent drug distribution directly by using angio-CT. To improve the survival rate for advanced cervical cancer, it is advocated that to improve local control IAIC be considered, and to reduce potential systemic disease, systemic chemotherapy be considered. In order to improve the prognosis of these patients, we should furthermore consider a combination of IAIC and systemic chemotherapy.
- Cervical carcinoma
- Intra-arterial infusion chemotherapy
- High-dose rate brachytherapy
4. Radiofrequency Ablation Therapy after Primary Systemic Therapy for Breast Cancer
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
In the past three decades, local management of breast cancer has dramatically changed from mastectomy and axillary dissection to breast-conserving therapy and sentinel node biopsy. In addition, breast-conserving therapy has become to be often applied to breast cancers responding to primary systemic therapy (PST). Radiofrequency ablation therapy (RFA) has attracted attention in the treatment of localized early breast cancer, and is expected to be a useful approach in the PST setting, too. In our department, 63 breast cancer patients were treated with primary systemic therapy followed by RFA, the mean follow-up period of which was 41 months (11～69 months). Three of the 63 patients developed in-breast recurrence. Of the three patients, one was alive without further recurrence after salvage surgery, and another was successfully treated with surgery and trastuzumab-containing chemotherapy. Cosmesis of the patients treated with PST followed by RFA was equally excellent to those with primary RFA. In conclusion, PST followed by RFA may be a feasible therapeutic option for breast cancer.
- Breast cancer
- Primary systemic therapy
- Radiofrequency ablation
5. Percutaneous Radiofrequency Ablation Plus Systemic Chemotherapy of Lung Tumors
Department of Radiology, Chemotherapy Center and Respiratory Medicine1),
Osaka City University Graduate School of Medicine
Toshiyuki Matsuoka, Shinzo Kudo1)
Recently, percutaneous radiofrequency ablation (RF ablation) has been increasingly attracting attention as a new modality of local treatment of malignant tumors in various organs. Especially for liver tumors, good results of the procedure are reported, and RF ablation is widely performed. Since the first clinical cases of RF ablation of lung tumors were reported in 2000, many reports have been published. The puncture is carried out under CT guidance. The heat generated by radiofrequency coagulates the tissues surrounding the electrode. However, at present this procedure is still limited to only a few institutions. In the first part of this report, we describe the flow of enforcement, indications, and the details of the technical procedure conducted in our institution. Local control rate was about 80％, and the most frequent complication was pneumothorax, which was observed in about 30％. Good results can be expected for tumors with a diameter of 3cm or less. The initial results were promising, and further development is expected in combination with other therapies. In the latter part of this report, general ideas about the systematic chemotherapy of primary and secondary lung tumors is described by an expert. Although the interventional radiologist is not familiar with chemotherapy, it could be useful in the expansion of indications and improvement of prognosis to be familiar with the latest knowledge of chemotherapy.
- Radiofrequency ablation
- Lung cancer