Biomedical subjects

Motohiro Hirao

Publications and source records attributed to Motohiro Hirao.

At least 19 recordsLinked to original sources

PubMed2006

An icteric type hepatocellular carcinoma with no detectable tumor in the liver: report of a case.

A 70-year-old man was admitted to our hospital with obstructive jaundice. Computed tomography revealed a tumor in the left intrahepatic bile duct extending to the common bile duct without any significant lesions in the liver. Cholangiography showed a filling defect due to an intraductal tumor. Cytology of the bile juice was negative and tumor markers were carcinoembryonic antigen 5.7 ng/ml, carbohydrate antigen 19-9 49 U/ml, alpha-fetoprotein 9 ng/dl, and PIVKA-II 19 200 AU/ml. With a preoperative diagnosis of hilar bile duct carcinoma, a laparotomy was performed. The common bile duct was filled with a tumor and it extended into the bilateral intrahepatic bile ducts. The intraductal tumor was removed together with the extrahepatic bile ducts. An intraoperative histological examination of the tumor showed a well-differentiated hepatocellular carcinoma. No lesions were detected in the liver by ultrasonography, palpation during the operation, or a computed tomography scan after the operation. At 1 year postoperatively, no recurrence has been seen in this patient.

Aged↗

PubMed2006

[FOLFOX].

In metastatic colorectal cancer, a combination of Leucovorin (LV) and fluorouraci (l FU) with oxaliplatin (FOLFOX) is a standard first-line regimen. The two limiting toxicities of FOLFOX are neutropenia and the specific reversible sensory neuropathy of oxaliplatin. The cumulative neurotoxicity often requires therapy to be stopped. Immediate hypersensitive reactions (anaphylaxis) have been noted as often as to 0.6 percent. We should pay sufficient attention to side effects of FOLFOX.

Anaphylaxis↗

PubMed2005

Phase I and pharmacokinetic study of S-1 combined with weekly paclitaxel in patients with advanced gastric cancer.

OBJECTIVE: A dose-escalation study of weekly paclitaxel combined with S-1, a novel oral fluoropyrimidine, was performed to determine the maximum tolerated dose (MTD), the recommended dose (RD) and the dose-limiting toxicities (DLTs) in advanced gastric cancer. PATIENTS AND METHODS: Twelve patients were enrolled. S-1 was given orally at a fixed dosage of 40 mg/m(2) b.i.d. for 14 consecutive days, followed by a 1-week rest. Paclitaxel was scheduled to be given intravenously on days 1 and 8 at a dose of 50, 60, 70 or 80 mg/m(2), depending on the DLTs. Treatment was repeated every 3 weeks. A pharmacokinetic study was conducted in an additional 5 patients on days 7 and 8 during the first course given at the RD. RESULTS: The MTD of paclitaxel was presumed to be 60 mg/m(2), because 50.0% of patients (2/4) developed DLTs (mainly grade 3 anorexia). DLT was observed in 1 out of 8 patients at a dose of 50 mg/m(2). Therefore, the RD of paclitaxel was estimated to be 50 mg/m(2). The preliminary response rate was 62.5% (5/8) at the RD. There were no significant pharmacokinetic interactions between S-1 and paclitaxel. An adequate plasma paclitaxel concentration for an antineoplastic effect was achieved with weekly doses of 50 mg/m(2). CONCLUSION: Weekly paclitaxel combined with S-1 was demonstrated to exhibit a tolerable toxicity profile with therapeutic plasma concentration at the dose of 50 mg/m(2). This regimen could represent a novel and low toxic combination for advanced gastric cancer.

Administration, Oral↗

PubMed2005

Patient-controlled dietary schedule improves clinical outcome after gastrectomy for gastric cancer.

Although studies have shown that early oral feeding after abdominal surgery is feasible, the optimal dietary schedule has not been established. This study was conducted prospectively to compare the clinical outcome of patient-controlled dietary schedule with that of conventional dietary schedule after gastric resection for early cancer. Patients in the patient-controlled diet (PC) group (n = 53) received a solid diet on demand; patients in the conventional regimen (CR) group (n = 50) received a solid diet from postoperative day (POD) 10. All patients underwent distal gastrectomy for early gastric cancer. A liquid diet was tolerated by the PC group on POD 2, and a solid diet was taken on POD 6 after gastrectomy, earlier than in the CR group. The postoperative hospital stay was 18.5 +/- 5.9 days (10-40) in the PC group, versus 21.7 +/- 8.8 days (14-57) in the CR group (p = 0.02). Patients in the PC group had a higher daily oral intake of calories on POD 10 than those in the CR group (p = 0.02). Changes in body weight and serum albumin during the postoperative period and after discharge, and the incidence of complications and variances from clinical pathways did not show significant differences between the two groups. The PC schedule was feasible after distal gastrectomy for early gastric cancer. It improved the clinical outcome, with a shorter postoperative hospital stay and a higher oral energy intake on early phase, compared with the CR schedule. Moreover, the PC approach was useful for establishing the optimal dietary schedule and improving the clinical pathway.

Adult↗

PubMed2005

[Phase I study of the combination of nedaplatin (NED), adriamycin (ADM), and 5-fluorouracil (5-FU) (NAF) for treatment of unresectable advanced esophageal cancer].

BACKGROUND: Esophageal cancer has a poor prognosis. Several strategies including chemotherapy (CDDP+5-FU), either alone or with radiotherapy, have been used to improve the prognosis. However, since CDDP itself has substantial toxicities, including renal and gastrointestinal toxicities, newer platinum analogues, such as nedaplatin (NED) have been developed, and it is of interest to test this new platinum analogue in a combination chemotherapy. METHODS: We conducted a phase I-II study using a combination of NED (3 levels, 60-80 mg/m2 on day 1), ADM (30 mg/m2 on day 1), and 5 FU (700 mg/m2 on day 1-5) for treatment of previously untreated advanced esophageal squamous cell carcinoma. Cycles were repeated every 28 days. The objectives were to determine dose-limiting toxicity (DLT), maximum-tolerated dose (MTD), recommended dose (RD) for a phase II study, and to determine antitumor effects. RESULTS: Phase I: 12 patients (pts) (male/female=11/1) were evaluable. The median age was 65 (range 46-74), PS 0/1=7/5. At level 1, 1 pt developed DLT (grade 4, neutropenia). At level 2, 2 pts developed DLT (grade 4 neutropenia and grade 3 diarrhea). Level 2 (70 mg/m2) was determined as the MTD, and a level 1 dose (60 mg/m2) was recommended. Phase II: 7 pts (male/female=4/3) are at RD of level 1 at the present time. Median age 62 (range 46-75). The median number of cycles on phase II study at RD was 2 (range 1-3). 4 PRs were obtained. The response rate was 57.1%. Median survival time (MST) was not reached at the time. CONCLUSIONS: This combination therapy appears to be highly effective and generally well tolerated for advanced esophageal cancer.

Aged↗

PubMed2005

[A case of unknown primary squamous cell carcinoma in the neck showing a high response with combined chemotherapy including nedaplatin, adriamycin and 5-fluorouracil].

We report a case of a 54-year-old man with unknown primary squamous cell carcinoma in the bilateral neck. The patient was treated with chemotherapy and radiation therapy, because his right common carotid artery was invaded by the right neck tumor, and a complete curative operation was not considered possible. We chose instead combination chemotherapy with nedaplatin, adriamycin and 5-fluorouracil (NAF), because it was reported that NAF was available for advanced squamous cell carcinoma of the esophagus. After 3 cycles of NAF chemotherapy, the patient showed a partial response of approximately an 86% decrease in the right neck tumor for over three months. In addition to NAF, radiation therapy was performed. In the CT findings after chemotherapy and radiation therapy, the patient showed a complete response in the bilateral neck tumors. Unknown primary squamous cell carcinoma in the neck has been treated by combination therapy consisting of chemotherapy, radiation therapy and surgery. The regime of 5-fluorouracil and cisplatin is said to be an effective treatment for unknown primary squamous cell carcinoma in the neck. Based on our experience, NAF would be available as chemotherapy for unknown primary squamous cell carcinomas in the neck.

Antibiotics, Antineoplastic↗

PubMed2005

[Clinical outcome of the use of self-expandable metallic stents (SEMS) for palliation of patients with malignant upper GI obstruction caused by incurable gastric cancer].

Ten patients with malignant upper gastrointestinal obstruction caused by incurable gastric cancer underwent an endoscopic placement of self-expandable metallic stents for palliation. There were 6 male and 4 female patients aged 39-98 (median, 65.5). The site of obstruction was the cardia in 2, the pylorus in 4, the duodenum in 1, and surgical anastomosis in 3 patients. All the patients were unable to take food orally. Stent deployment was technically successful in all patients. After the stent insertion, 80% of patients resumed solid diet. The median survival time after the insertion was 129 days. The median length of home stay after the procedure was 54.5 days. Although chemotherapy was added in 5 patients after the insertion, there were no significant differences either in survival time or in home stay between the patients with and without chemotherapy. No procedure-related mortality was observed. Mediastinitis occurred in 1 patient, and the remaining 9 patients had no serious complications. Stent migration was observed in 2 patients, and stent occlusion due to tumor ingrowth occurred in 4 patients.

Adult↗

PubMed2005

[A case of successful resection for recurrent intraductal papillary mucinous adenocarcinoma].

Intraductal papillary-mucinous neoplasms (IPMN) of the pancreas have recently been defined and classified by the World Health Organization. In addition, many cases of IPMN continue to be recognized frequently. We report a case of a 65-year-old female who underwent surgical resection of the pancreas twice within a period of 6 months for primary and recurrent IPMN. We first performed distal pancreatectomy with splenectomy for IPMN in the pacreatic body. A histopathological study revealed invasive adenocarcinoma and the negative margin of the pancreatic duct. A cystic mass in the uncinate process of the gland was identified by CT scan 6 months after the initial surgery. Complete pancreaticoduodenectomy was performed. Recurrent IPMN consisted of adenosquamous cell carcinoma. She currently is alive without evidence of disease at 3 years from the second resection. Recurrent disease in the residual pancreas suggests that a long-term surveillance is critical.

Adenocarcinoma, Mucinous↗

PubMed2004

[Evaluation of prophylactic hepatic arterial infusion chemotherapy after curative hepatectomy for metastatic colorectal cancer].

We evaluated the effect of hepatic arterial infusion (HAI) chemotherapy after curative resection of liver metastases of colorectal cancer. A total of 161 patients underwent curative resection of liver metastases. Among them, 50 patients underwent HAI of 5-FU, and 111 patients had no HAI therapy. The 50% disease-free survival time (50% DFS) was 758 days and 342 days in the HAI group and the non-HAI group (logrank test, p<0.01), and the 50% overall survival time (50% OS) was 978 days versus 730 days (p<0.05), respectively. Among the 71 patients with multiple resectable metastases (H2 or H3), the HAI group had a significantly superior 50% DFS. HAI therapy seems to be an effective form of adjuvant chemotherapy after hepatic resection of metastatic colorectal cancer.

Antineoplastic Agents↗

PubMed2004

[Safety of intraperitoneal chemotherapy with paclitaxel in gastric cancer patients with peritoneal dissemination].

We evaluated the safety of paclitaxel (TXL) via intraperitoneal (i.p.) administration in 6 patients with peritoneal dissemination of gastric cancer. Four patients were treated with TXL via i.p. administration at a dosage of 80-90 mg/m2 every 1 to 2 weeks. Grade 4 leukopenia was observed in 1 patient, accompanied with massive ascites. Two other patients, who also had malignant peritoneal effusion, were treated with TXL via i.p. administration at a dosage of 60 mg/m2 every 1 to 2 weeks. All toxicities were mild in those two patients. TXL via i.p. administration at a dosage of less than 90 mg/m2 has never been reported to cause a grade 4 leukopenia. These results suggest that a phase I/II study of TXL via i.p. administration should be tried in gastric cancer patients with malignant peritoneal effusion.

Aged↗

PubMed2004

[Effectiveness of chemoradiotherapy for three cases of squamous cell anal carcinoma].

We report three patients with squamous cell anal carcinoma who were treated by chemoradiotherapy. Case 1: A 62-year-old female with squamous cell anal carcinoma invading the vagina underwent a posterior pelvic exenteration. She had paraaortic lymph node metastases. She was treated by chemoradiotherapy with 5-FU/CDDP and external irradiation (50 Gy) as an adjuvant therapy, and survived for 5 years. Case 2: A 74-year-old female with anal squamous cell carcinoma Stage II was treated by chemoradiotherapy with tegafur/uracil, external irradiation (30 Gy) and interstitial irradiation (24 Gy). She is currently living without any signs of recurrence for 3 years and 8 months. Case 3: A 53-year-old female with anal squamous cell carcinoma Stage IIIa was treated by chemoradiotherapy using 5'-DFUR and external irradiation (66 Gy). She is currently living without any signs of recurrence for 1 year and 9 months. The prognosis of anal squamous cell carcinoma that received Cur B or C resection was extremely poor with a median survival time (MST) of 7 or 6 months. Chemoradiotherapy seems to be effective as the first line treatment.

Aged↗

PubMed2004

[A case of disease-free survival of liver and lung metastases of rectal cancer resected for a total of five times].

We report a case of disease-free survival of liver and lung metastases of rectal cancer resected for a total of five times. A 54-year-old female with metastatic liver and lung tumors of rectal cancer was admitted to our hospital. After a radical resection of the original tumor was performed at a previous hospital, liver and lung metastases had been confirmed in 1 year and 9 months and in 2 years and 2 months, respectively, and that both metastases had been resected as well. On admission to our hospital, computed tomography (CT) showed a liver metastasis of 3-cm in diameter in segment 3 and a lung metastasis of 2-cm in diameter in lingular segment. Two surgeries were performed to resect both of them. Because of a recurrent liver metastasis observed in segment 4, we performed a right hepatic lobectomy and partial duodenectomy 2 years later from the surgeries. After the fifth surgery for metastatic lesions, no sign of recurrence has been observed in 2 years and 11 months.

Disease-Free Survival↗

PubMed2004

[A case of long-term survival with recurrence leiomyosarcoma of the rectum treated by repeated local resections].

A 47-year-old man was admitted to our hospital for anal pain and diagnosed with submucosal tumor by digital examination. Transsacral resection was performed because the patient refused a stoma. Leiomyoma with highly malignant potential was histologically diagnosed. Surveillance was performed by computed tomography, magnetic resonance imaging and digital examination, but a correct diagnosis was difficult. Due to local tumor increases in the resected region, trans-anal resection was performed 2 years later at the time of local recurrence diagnosis. Over the last 10 years, a total of 8 local resections have been performed since the first surgery. No distant metastases have been confirmed to the patient without a stoma. It appears that a local resection of leimyosarcoma of the rectum with a close surveillance was effective.

Gastrointestinal Stromal Tumors↗

PubMed2003

Portal vein thrombosis after splenectomy for gastric malignant lymphoma.

Portal vein thrombosis (PVT) has rarely been documented in patients after splenectomy for gastric malignancy. We report a case of PVT that occurred after splenectomy as part of an en-bloc node dissection performed to treat gastric malignant lymphoma. A 38-year-old man underwent total gastrectomy and splenectomy with en-bloc D2 lymph node dissection. The spleen weighed 480 g. On postoperative day (POD) 31, the patient complained of abdominal pain in the right upper quadrant accompanied by fever. Moderate elevations of C-reactive protein (CRP), aspartate transaminase (AST), and alanine transaminase (ALT) were noted. Contrast-enhanced computed tomography (CT) and ultrasonography disclosed thrombus in the portal vein and the splenic vein. There were no abnormalities in the levels of lupus anticoagulant, protein C antigen, protein S antigen, or antithrombin III (AT III). A diagnosis of PVT was made, and prompt treatment, including intravenous heparin combined with tissue plasminogen activator (tPA) was initiated, followed by longterm warfarin. This treatment resulted in clinical improvement, but failed to achieve thrombolysis in the portal vein. At follow-up after 6 months, the patient complained of postprandial abdominal pain with persistent peripheral edema and ascites. This case indicates that splenectomy for en-bloc node dissection in gastric malignancy is a possible cause of PVT. Because both the symptoms and the laboratory data in PVT are nonspecific, a high level of clinical suspicion and a low threshold for obtaining imaging examinations are important in the early diagnosis of PVT. Surgeons should remember PVT among several other complications whenever patients treated with radical gastrectomies are symptomatic and imaging studies are considered necessary.

Adult↗

PubMed2003

Pharmacokinetic study of two infusion schedules of irinotecan combined with cisplatin in patients with advanced gastric cancer.

OBJECTIVE: Irinotecan (CPT-11) in combination with cisplatin (CDDP) has shown promising antitumor activity for advanced gastric cancer, but the optimal administration schedule of CPT-11 is still controversial. To clarify the pharmacokinetic effects of different CPT-11 administration schedules, we compared two different regimens (continuous infusion of CPT-11 for 24 h and CPT-11 infusion for 90 min) combined with CDDP in patients with advanced gastric cancer. PATIENTS AND METHODS: Five patients were treated with CPT-11 at a dose of 60 mg/m(2) delivered by continuous infusion for 24 h on day 1 and by a 90-min infusion on day 15, together with CDDP daily administered at a dose of 10 mg/m(2) on days 1-3 and days 15-17 for 4 weeks. The pharmacokinetics of CPT-11 and its metabolites, SN-38 and SN-38 glucuronide (SN-38G), were investigated, as well as the toxicity of therapy. RESULTS: Grade 3 leukopenia was observed in 1 patient after 24-hour infusion and in 1 patient after 90-min infusion of CPT-11. In addition, grade 3 thrombocytopenia was observed in 1 patient after the 90-min infusion. Other adverse reactions were mild, and the planned dose was delivered to all patients. The area under the plasma concentration-time curve of SN-38, the active metabolite from CPT-11, was increased by 24-hour infusion when compared with the 90-min infusion, and there was no increase in toxicity. CONCLUSION: Protracted infusional CPT-11 combined with CDDP is a practical regimen, and may be appropriate for a future phase II trial.

Aged↗

PubMed2003

[A patient with gastric cancer complicated with severe DIC and multiple bone metastasis showing a high response to combination of TS-1 and CDDP].

We report a 48-year-old male with gastric cancer who was suffering from acute onset of DIC due to multiple bone metastases. Treatment with TS-1 + CDDP was started with the following regimen: daily oral administration of 80 mg/m2 TS-1 for 21 days, followed by a 14-day rest and CDDP 60 mg/m2 infusion on day 8. The DIC was suddenly resolved and bone metastases were well controlled after the chemotherapy combined with anticoagulant therapy and bisphosphonate. The combination of TS-1 and CDDP can be applied for the management of DIC caused by multiple bone metastases.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

[Evaluation of arterial infusion chemotherapy for liver metastasis from gastric cancer].

We evaluated the effectiveness of arterial infusion chemotherapy for liver metastasis from gastric cancer. Nineteen patients (9 synchronous cases, 10 metachronous cases) were treated with hepatic arterial infusion chemotherapy (HAIC). The response rate was 26% (CR 3, PR 2, PD 14), and the median survival time was 357 days after the diagnosis of liver metastasis. The treatment was discontinued in 8 patients because of treatment associated complications and disease progression. Absence of extrahepatic lesion, response of HAIC, and hepatectomy did not improve the prognosis. The combination of systemic chemotherapy with HAIC tended to improve the prognosis. It may be necessary to reevaluate HAIC as a treatment modality for liver metastasis from gastric cancer.

Aged↗

PubMed2002

[Adjuvant chemotherapy after curative resection for gastric cancer-5'-DFUR + cisplatin vs 5'-DFUR].

A prospective randomized study involving gastric cancer patients was conducted to evaluate combined adjuvant chemotherapy. Forty-two patients under 80 years of age who underwent a curative resection of pathologic stage II or III gastric cancer were randomly assigned to receive adjuvant chemotherapy containing the following two regimens from 1993 to 1996. A) Oral 5'-deoxy-5-fluorouridin (5'-DFUR) plus cisplatin: 5'-DFUR, daily administration, combined with CDDP 15 mg/m2/day, 30-min drip infusion, fortnightly for 8 weeks, repeated every 16 weeks. B) Oral 5'-DFUR alone: 5'-DFUR, daily administration. The dosages of 5'-DFUR were assigned according to the patients' body surface area (BSA): BSA < 1.7 m2, 600 mg and BSA > or = 1.7 m2, 800 mg, daily administration, bid. Twenty patients were assigned to regimen A, and 22 to regimen B. All clinicopathological factors were equally distributed in each regimen. No adverse reactions greater than grade 3 occurred in either regimen. There was no significant difference between the two regimens in overall survival or overall disease-free survival. For patients with positive nodes, the 5-year disease-free survival rates were 56.4% in A and 38.3% in B (p = 0.29). In stage III patients, the 5-year disease-free survival rates were 55.6% in A and 20.7% in B (p = 0.26). No significant survival benefit was observed with the combined chemotherapeutic regimen, 5'-DFUR plus cisplatin, compared with 5'-DFUR alone.

Adult↗