Biomedical subjects

Takeshi Nagahama

Publications and source records attributed to Takeshi Nagahama.

At least 19 recordsLinked to original sources

PubMed2006

[MTX-CDDP-5-FU double modulation intra aortic chemotherapy for advanced and metastatic gastric cancer--a comparison with an intra venous route].

We studied the efficiency of MTX-CDDP-5-FU intra aortic chemotherapy for advanced and metastatic gastric cancer patients (n=26), and compared the results with an intra-venous route (n=21) of MTX-CDDP-5-FU IV chemotherapy, given the same amount of drugs and the same time schedule with intra-aortic chemotherapy. The response rate of the IA group was 39%, and that of the IV group was 50%, which shows no significant difference between the 2 groups. Survival curves of the 2 groups were identical, which show no difference. We extracted the cases which had retroperitoneal lymph node metastasis, and compared IA and IV groups of these patients. For these patients with lymph node metastasis, the response rate of the IA group was 41%, and that of the IV group was 55%. The survival curves were identical. There was no significant difference not only of the response rate but of the survival rate. From a drug delivery point of view, intra-aortic chemotherapy seems superior to intra-venous chemotherapy. But, these results showed no difference between intra-aortic and intra-venous routes.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

[A case report of small cell carcinoma of the esophagus successfully treated by irinotecan and cisplatin].

Small cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent and early recurrence against various treatments. We have experienced a case of small cell carcinoma of the esophagus manifested by massive lymph node metastasis in the upper mediastinum successfully treated by CPT-11 and CDDP, and that a patient survived for 17 months after the initial treatment. A 62-year-old man underwent endoscopy due to a disturbance of the food passage. Pathological evaluation of biopsy specimen revealed small cell carcinoma of the esophagus. As he was diagnosed with bilateral lymph node metastasis in the upper mediastinum by CT scan, a systemic chemotherapy with CPT-11 and CDDP was adopted. After 2 courses of chemotherapy he could be discharged as the size of the tumor was reduced. After 3 courses of additional chemotherapy 8 months after the initial treatment, a recurrent tumor was indicated at the right side of the lymph node of the neck. A weekly radiation with concurrent administration of docetaxel was carried out as a second line treatment. He is surviving for 17 months after the initial treatment without any evidence of recurrence. Due to histo-pathological similarity, a treatment for small cell carcinoma of the esophagus resembles that of the lung. Recently, the combined treatment of CPT-11 and CDDP was reported to demonstrate a better influence on a patient's survival for small cell carcinoma of the lung. For the esophagus, CPT-11 and CDDP was also an effective treatment.

Antineoplastic Agents↗

PubMed2006

[A case of a gastric cancer patient who obtained good treatment in spite of a nontreatment decision].

The patient was a 57-year-old male who had received schizophrenia and alcoholism treatments for ten years. Hospitalization and release was repeated many times over in the psychiatry department of the hospital up to the present time. He received an upper endoscopy because of a stomach ache in May, 2004. He was diagnosed as having gastric cancer (L, post, Type 2, T2 (SS), N2, stage IIIA). Neoadjuvant chemotherapy TS-1+CDDP was begun from the beginning. However, he refused the operation afterwards and we changed the treatment. The chemotherapy was maintained until January, 2005, to enforce seven courses of the treatment and to maintain the long NC for about ten months. Afterwards, he refused the treatment again and did not come to the hospital. After six months, he came to hospital again for pyloric stenosis due to a stomach cancer that developed. We placed a PEG to keep the route for access to the pylorus in August. And we used it to induce the self-expandable metal stent (EMS) to the pylorus. As a result, oral ingestion became possible. He was able to obtain a good QOL for three months until dying thereafter. It is thought that stenting is one of the most effective treatments to correspond to the diversification of the treatment policy.

Alcoholism↗

PubMed2006

[A case of unresectable hilar cholangiocarcinoma treated with an insertion of biliary stent and herbal medicine obtaining a good quality of life].

An advanced hilar cholangiocarcinoma was poor in prognosis and required a biliary duct drainage tube insertion to prevent jaundice. An endoscopically placed metallic biliary stent is efficient for improving QOL of patients with the disease. This case was of a 65-year-old man. He was admitted to our hospital with obstructive jaundice. Hilar cholangiocarcinoma was diagnosed by computed tomography (CT) and MR cholangiopancreatography (MRCP). Abdominal angiography revealed an unresectable cholangiocarcinoma through the portal vein obstruction and stenosis of the left hepatic artery for tumor invasion. After a second opinion and informed consent, he was inserted a biliary stent (non-covered metallic stent) under an endoscopy. The jaundice was improved further and other laboratory data showed normal results except for tumor markers. After the patient left the hospital, he came to our hospital as an outpatient basis for observation. He was prescribed herbal medicine from the other hospital. Now after ten months since the biliary stent insertion, he has been free from symptoms with normal laboratory data.

Aged↗

PubMed2005

[A case of ascities decrease in malignant peritoneal mesothelioma by weekly intra-peritoneal administration of cisplatin and paclitaxel].

We report a case of malignant peritoneal mesothelioma (MPM) in a 63-year-old man. He had body weight loss and abdominal distension for one month, and was admitted to our hospital. Abdominal sonography showed a large mass occupying the right lower abdomen and an existence of a lot of ascites. Computed tomography and magnetic resonance image showed a lot of ascites and omentum cake. Cytology of the ascites was Class V but its histological classification was unknown. Then we performed biopsy of the tumor into the omentum with abdominal sonography. The histological diagnosis was MPM because the tumor cells showed positive for calretinin. He received a combination chemotherapy of weekly intra-peritoneal administration of cisplatin (70 mg/ day) and paclitaxel (100 mg/day). The ascites was decreased and per os (PO) was possible, but omentum cake was not changed. MPM was poor in prognosis and the control of ascites was difficult. We suggest that the chemotherapy of intra-peritoneal administration was a better procedure than others to control ascites with malignant tumors.

Antineoplastic Agents↗

PubMed2005

[The docetaxel radiosensitization experience for the treatment of unresectable esophageal cancer].

BACKGROUND: Docetaxel is an increasingly important drug for the treatment of esophageal cancer. The docetaxel radiosensitization has been established in cancer cell lines. The therapeutic response and toxicity of a weekly docetaxel in combination with radiotherapy for unresectable esophageal cancer were examined. METHODS: Ten patients with locally advanced or metastatic squamous cell esophageal cancer were recruited in the following protocol. The median age was 65.7 years. Patients received radiation in 2 Gy single daily fractions to a total dose of 60 Gy. Docetaxel (10 mg/m2) was administered weekly for 6 consecutive weeks. RESULTS: One patient could not be evaluated. The overall response rate was 77% with 11% CR and 66% PRs. Mild grade 2 leukocytes toxicity was observed in 2/10 patients, which enforced the treatment absence for 7-14 days. Grade 2 stomatitis was noted in one patient. No severe grade 3 adverse effects were observed. CONCLUSION: It is concluded that low dose docetaxel with radiotherapy is feasible and, a high response rate can be expected. Toxicity is modest, and this protocol may be useful for the outpatients or neoadjuvant chemotherapy.

Aged↗

PubMed2005

[Weekly docetaxel in combination with concomitant radiotherapy for esophageal cancer].

Docetaxel (DOC) has demonstrated an activity as a radiation sensitizer in head and neck cancer. We have experienced four cases of esophageal cancer treated by weekly DOC in combination with concomitant radiotherapy. Three cases of advanced esophageal cancer and a case of relapsed esophageal cancer after administration of 5-FU and CDDP were enrolled in this pilot trial. The schedule of treatment included a weekly administration of DOC (10 mg/m2/w) and six weeks of radiotherapy in 2.0 Gy daily fractions up to 60 Gy. Combination treatments were completed successfully without any side effects except a case of developed grade 1 dysphagia. Two cases showed a complete response and others showed a partial response. One case showed a complete response developed abdominal para aortic lymph node and liver recurrence 12 months after the treatment. However, the targeted lesion within radiotherapy for this patient still showed a complete response. A weekly administration of low dose DOC in combination with radiotherapy was very effective for advanced esophageal cancer. DOC has demonstrated an activity as a radiation sensitizer.

Aged↗

PubMed2004

[CPT-11 hepatic arterial infusion chemotherapy for metastatic liver tumor from gastric cancer].

We have experienced a case of gastric cancer with multiple liver metastases resistant to combined treatment of TS-1 and CDDP. After the treatment with TS-1 and CDDP, abdominal CT demonstrated a progressive growth of metastatic liver tumor. Administration of CPT-11 (80 mg/body) by a hepatic arterial infusion inhibited the growth of metastatic liver tumor and decreased serum levels of CEA and CA19-9 for several months without a significant adverse side effect.

Aged↗

PubMed2004

[A case of gastric cancer with peritoneal dissemination which shows a remarkable efficacy by a weekly administration of paclitaxel intraperitoneally].

We treated a 65-year-old female with gastric cancer who underwent peritoneal dissemination after 6 successive weeks of paclitaxel intraperitoneal therapy (90 mg/body), and obtained a disappearance of ascites and a reduction of the primary carcinoma. Operative findings: U ant, type 5, 26x20 mm, por, T2, n1(+), H0, P0, CY0, M0, stage II, and grade 2. A weekly paclitaxel intraperitoneal therapy could be a useful for both peritoneal dissemination and the primary carcinoma of advanced gastric carcinoma.

Aged↗

PubMed2003

[Experimental study on intraperitoneal versus intravenous CPT-11 for peritoneal seeding and liver metastasis].

Paclitaxel is an effective antitumor agent that shows ideal pharmacological characteristics for intraperitoneal chemotherapy. Intraperitoneal administration of this agent was compared with intravenous administration in mouse models of peritoneal seeding and liver metastasis. The peritoneal seeding model and liver metastasis model were established by inoculation of Colon 26 tumor cells into the peritoneal cavity and spleen of female BALB/c mice, respectively. Paclitaxel (20 mg/kg) was injected into the peritoneal seeding model intraperitoneally or intravenously on day 2 and 4 after inoculation of tumor cells. Paclitaxel (30 mg/kg) was injected into the liver metastasis model intraperitoneally and intravenously on days 4 and 8 after inoculation of tumor cells. Median survival time for intraperitoneal administration (17.50 +/- 0.86 days) was longer than that for intravenous administration (13.70 +/- 0.47 days) in the peritoneal seeding model experiment. Median survival time for intraperitoneal administration (19.78 +/- 0.74 days) was longer than that for intravenous administration (17.50 +/- 0.54 days) in the liver metastasis model experiment. Intraperitoneal administration of paclitaxel may be a more efficient form of adjuvant chemotherapy for prevention of both peritoneal seeding and liver metastasis in patients with gastrointestinal cancer.

Animals↗

PubMed2003

[A case of liver and lung metastases of rectal cancer responding well to 5-FU hepato-arterial infusion (HAI) with combined use of oral UFT].

We have studied the pharmacokinetics of 5-FU hepato-arterial infusion (HAI) with combined use of oral UFT for colorectal cancer cases previously. The plasma 5-FU concentration in cases of 5-FU HAI plus UFT is 1.5-6 times as high as with 5-FU HAI only. We report a rectal cancer case with liver and lung metastases treated successfully with this protocol. A 75-year-male underwent low anterior resection for rectal cancer as Rab, 3.5 x 3 cm, well, ai, n2, P0, H3, M1 on March 26, 2002. For synchronous hepatic and lung metastases, he received weekly 5-FU 1,000 mg HAI, UFT 4T 2 x postoperatively. As a result, liver and lung metastases disappeared over 6 months. We recommend weekly 5-FU HAI with combined use of UFT, which can be more effective not only for liver metastases but also for extra-hepatic lesion of colorectal cancer.

Administration, Oral↗

PubMed2003

[Complication after self expandable metallic stent for esophageal cancer].

Major complications after placement of esophageal stent and airway stent were reviewed and evaluated. Four patients, including two patients with perforations and two patients with fistula formation, developed major complications after placement of a self expandable metallic stent. Two patients underwent additional radiation to improve stricture after stent placement. In one patient, stent placement was selected to improve esophageal stricture that occurred after radical radiation therapy. In one patient, migration of stent into the lesion caused a perforation. It can be concluded that additional radiation after stent placement increases the risk of complication. Stent migration also can lead to the risk of perforation.

Aged↗

PubMed2002

[A case report of intra-hepatic arterial infusion of mitomycin C with degradable starch microspheres for liver metastases of sigmoid colon carcinoma].

A 46-year-old man underwent polypectomy of sigmoid colon in January 1996. The adenocarcinoma invaded the submucosal layer, and sigmoidectomy and D2 lymph node dissection were performed one month later. Follow-up CT revealed liver metastases, and partial hepatectomy was performed in January 1998. Afterward, weekly high dose intra-hepatic arterial chemotherapy (5-FU: 1,000 mg/body) was performed 41 times, but CT revealed multiple liver metastases in October 1998. Therefore, intra-hepatic arterial infusion of mitomycin C (MMC) with degradable starch microspheres (DSM) was given in November 1998. As follow-up CT revealed that the liver metastases were growing, partial hepatectomy was performed again in March 1999. No carcinoma was seen in the resected liver. After the second hepatectomy, intra-hepatic arterial infusion of MMC with DSM was performed five times. No evidence of recurrence has been seen. Intra-hepatic arterial infusion of MMC with DSM is recommended for liver metastases of colorectal cancer as a second line treatment.

Adenocarcinoma↗

PubMed2002

[5-FU pharmacokinetic study of 5-FU hepato-arterial infusion with oral UFT].

5-FU hepato-arterial infusion (HAI) is powerful chemotherapy for liver metastases of colorectal cancers. Event though hepatic lesions are controlled by 5-FU HAI, we have found that extra-hepatic lesions are the limiting factor for colorectal cancer patients. General chemotherapy is necessary in addition to 5-FU HAI. The chemotherapy of 5-FU venous infusion plus oral UFT is called "pharmacokinetic modulating chemotherapy (PMC)." This protocol is very effective for colorectal cancers, because UFT reduces the rate of metabolism of infused 5-FU. We studied the plasma 5-FU concentration at the time of weekly high dose 5-FU HAI plus oral UFT. The plasma concentration of 5-FU in 5-FU HAI plus UFT is 1.5-6 times as high as with 5-FU HAI only. 5-FU concentration in the liver tissue is likely to be much higher at the time of 5-FU HAI. 5-FU HAI plus oral UFT can be more effective for not only liver metastases but also for extra-hepatic lesions than 5-FU HAI alone.

Administration, Oral↗

PubMed2002

[Pharmacokinetic study of CPT-11, SN-38 and SN-38 glucuronide in the ascites, plasma and bile after intraperitoneal administration of CPT-11].

We studied the pharmacokinetics of CPT-11 with intraperitoneal administration in a patient with a PTCD tube. The patient had advanced gastric cancer with peritoneal metastasis. CPT-11 was administrated in a dose of 40 mg and the intraperitoneal, plasma and bile levels of CPT-11, SN-38 and SN-38 glucuronide (SN-38 GLU) were measured periodically. The results showed that the periodical concentration pattern of CPT-11, SN-38 and SN-38 GLU in the bile was closely related to that of CPT-11 in the abdominal cavity.

Aged↗

PubMed2002

[Pharmacological study on levofolinate in intraperitoneal leucovorin-5-FU chemotherapy].

We report the pharmacological findings on levofolinate after the intraperitoneal administration of leucovorin-5-FU. Levofolinate 300 mg/saline 500 ml and 5-FU 750 mg/saline 500 ml were administered intraperitoneally over 1.5 h. The plasma and intraperitoneal concentrations of levofolinate at 0, 0.5, 1, 2, 4, 8, 22(20) h after the administration were evaluated at 6 points with HPLC analysis. The intraperitoneal levofolinate concentration went up as high as 100 micrograms/ml and remained above 10 micrograms/ml over 8 hours. This suggested that intraperitoneal administration elevated the portal vein and abdominal lymphatic levofolinate levels. Intraperitoneal levofolinate-5-FU is a promising protocol for gastro-intestinal cancers.

Aged↗

PubMed2002

[Staging laparoscopy for advanced gastric cancer].

Staging laparoscopy was carried out for 12 cases of advanced primary gastric cancer to evaluate the condition of peritoneal seeding. Peritoneal seeding was indicated in five cases. Abdominal lavage sampling was positive in six cases. Among six cases with positive cytology, surgery was adopted in three cases to lessen bleeding or stricture. Chemotherapy were carried out for the other three cases. Radical lymph node resection was carried out in six cases without peritoneal seeding. Laparoscopic observation was easier and more feasible under general anesthesia than local anesthesia. Preoperative staging laparoscopy for advanced gastric carcinoma can evaluate the condition of peritoneal seeding. Based on the results, a suitable treatment plan for each patient can be determined.

Anesthesia, General↗

PubMed2002

[Airway stent for airway obstruction caused by esophageal carcinoma].

The result of airway stent and adjuvant therapy for airway obstruction caused by advanced esophageal carcinoma was evaluated. In Tokyo Metropolitan Ohkubo Hospital, four cases of esophageal carcinoma with airway obstruction were treated by tracheo-bronchial stent. Two were primary cases and the others were recurrent cases. Three of the patients demonstrated progressive dyspnea due to airway obstruction, and the other complained of bloody discharge. An ultraflex non-covered stent was used cases. After insertion of the airway stent. The patients' dyspnea improved immediately. One patient was discharged without adjuvant treatment, and died of the cancer one month later. Adjuvant treatment was adopted in the other three cases. The size of the tumor decreased, but fistula formation was observed in two cases. An airway stent is an effective treatment with immediate results for dyspnea caused by airway obstruction. Adjuvant treatment after stent placement is often associated with fistula formation. It should be considered carefully.

Airway Obstruction↗