单纯髂骨切除术治疗髂骨原发恶性骨肿瘤

目的：探讨单纯髂骨切除术治疗髂骨原发恶性肿瘤的手术方法,分析其肿瘤学结果及骶髂关节连续性对患者肢体功能的意义。方法回顾分析1983年6月至2011年6月,诊断为髂骨原发恶性肿瘤并于我院骨肿瘤科行单纯髂骨切除术且资料完整的患者25例。分析该术式对髂骨恶性肿瘤的治疗效果及手术后骶髂关节连续性对患者肢体功能的影响。结果25例均于我院进行手术治疗,男19例,女6例。病例分布为软骨肉瘤13例,骨肉瘤6例,尤文肉瘤2例,梭形细胞肉瘤2例,未分化多形性肉瘤2例。随访14.2～127.9个月,平均41个月。截止随访期末,18例未发现肿瘤复发或转移。1例骨肉瘤患者于术后9个月出现肺转移,行胸腔镜肺部病灶切除,1例尤文肉瘤患者术后58个月出现肺部转移,行化疗,1例软骨肉瘤患者术后23个月出现局部复发,再次手术切除,此3例目前均存活。4例死亡,1例骨肉瘤患者术后10个月出现肺部转移,术后18个月死亡;1例软骨肉瘤患者术后12个月出现肺部转移,术后15个月死亡;1例术后29个月发现局部复发及肺部转移,术后39个月死亡;1例骨肉瘤患者术后26个月因肝功能衰竭死亡。15例可行MSTS评分系统进行评分,平均为27.5（24～30）分。其中10例骶髂关节连续性存在,MSTS评分平均为28.8分,5例骶髂关节连续性破坏,MSTS评分为25.0分。结论单纯髂骨切除术是治疗髂骨原发恶性肿瘤的有效术式,骶髂关节失去连续性对行走功能有一定影响。其功能可满足日常生活需要。     

A case of advanced gastric cancer with peritoneal dissemination effectively treated with fourth-line chemotherapy of S-1 alone

The patient was a 42-year-old female diagnosed with unresectable highly advanced gastric cancer complicated by peritoneal dissemination. We performed systemic chemotherapy with MTX+5-FU as the first-line treatment, which stabilized the disease. Since the patient initially wished a radical resection, we tried chemotherapy with weekly PTX as a second-line treatment. Her therapeutic response remained between a partial response and a stable disease for about five months, followed, however, by progressive disease. The result of the third-line treatment with CPT-11+CDDP was again a progressive disease, so we switched her regimen to single-agent S-1 as a fourth-line treatment. The ascites disappeared three months after the change in regimen. As of March 2006, the patient had survived for 17 months since diagnosis (8 months since the ongoing S-1 therapy started) and the disease is currently stabilized, and preserving a favorable performance status. However, in June 2006, the patient died of pneumonia 20 months after the diagnosis.     

Usefulness of the nude mouse model in mesothelioma based on a direct patient-xenograft comparison

A patient with malignant mesothelioma experienced tumor recurrence 3 months after pleuropneumonectomy. Samples of the tumor were transplanted into nude mice to assess chemosensitivity. There was close concordance between the results in xenografts and the clinical outcome in this patient. Both mitomycin and to a lesser extent cisplatin were effective as single agents against the nude mouse xenografts, and the combination of these two drugs produced a complete response both in the patient and in the xenografts. The patient survived 18 months from onset of chemotherapy and 24 months from diagnosis. The duration of clinical complete response to chemotherapy was 14 months, despite the fact that mitomycin, the most effective agent against the xenografts, was discontinued after only two cycles because the patient developed pulmonary toxicity. This direct patient-xenograft correlation further validates the usefulness of the nude mouse model in the search for effective therapies for malignant mesothelioma, a tumor characterized by frequent refractoriness to most available agents.     

Effect of intraarterial noradrenaline-induced hypertensive chemotherapy of hepatic metastasis in gastric cancer

Four patients with hepatic metastasis of gastric cancer (one synchronous, three metachronous), received intraarterial noradrenaline-induced hypertensive chemotherapy. The outlet of the indwelling catheter was placed in the proper hepatic artery in two patients, in the thoracic aorta in one patient and in both places in one patient. When the systolic blood pressure rose 50 percent above the level in the untreated state, mitomycin C via the catheter was administered for 10 minutes. Partial remission was found in 2 patients, NC in one patient and PD in another. One patient showing PR died of a relapse of hepatic metastasis 8 months after treatment. Another patient with PD died of multiple bone metastases after 12 months. The two other patients are alive 19 months after treatment. Intraarterial noradrenaline-induced hypertensive chemotherapy is one of the useful treatments of choice for hepatic metastasis of gastric cancer.     

Palliation of esophageal malignancy with photoradiation therapy

Seven patients with severe or complete obstruction of the esophagus by malignancy were treated with photoradiation after presensitization of the tumor with intravenous hematoporphyrin derivative. The 625- to 635-nm therapeutic light was delivered from a tunable dye argon laser system coupled through quartz fibers, passed through the biopsy channel of a flexible esophagoscope, with local anesthesia. All tumors (adeno, squamous, and melanoma) responded, and swallowing was improved. Although tumor is still present, one patient is 11 months from initial treatment and is eating a regular diet. Another patient is 8 months from initial treatment and has no dysphagia. One patient died of aspiration of gastric tube feedings and 3 others died of their disease at 3 weeks, 3 months, and 6 months, respectively, from their initial treatment. Another patient died 11 months from his initial treatment due to a cardiac arrhythmia. During the 11 months after his initial treatment he continued to eat a regular diet.     

Treatment of metastatic chemodectoma.

Six patients were treated for metastatic chemodectoma at Memorial Sloan-Kettering Cancer Center from 1971 through 1988. Four patients' primary tumors arose in the cervical region, and two arose in the retroperitoneum. Four patients received a total of eight different chemotherapeutic regimens, including cisplatin, doxorubicin, cyclophosphamide, and dacarbazine. Metastatic sites treated included bone, liver, lung, and retroperitoneum. No patient had a response to chemotherapy. Four patients received a total of nine courses of radiation therapy for palliation of bone metastases. Pain relief was complete in eight patients and partial in one. One patient was irradiated for a mass in the left psoas muscle, with stabilization of disease for 6 months after treatment. One patient was irradiated for epidural compression at T6, with resolution of neurologic symptoms and 50% clearing of the spinal block on follow-up myelogram. Recurrence or progression of disease in a previously irradiated site occurred in one patient 2 years after treatment. One patient was lost to follow-up 3 months after radiation therapy for epidural compression. The other five patients died of widespread metastatic disease 6 months to 9 years after initial treatment for their metastatic disease.     

A child with successfully treated posterior mediastinal endodermal sinus tumor

A 15-month-old boy with posterior mediastinal endodermal sinus tumor is reported. The patient was admitted with recurrent hemothorax, and his serum alpha-fetoprotein level was 29,520 ng/ml. After removal of the posterior mediastinal tumor, VAC therapy (vincristine, actinomycin D, cyclophosphamide) was started. The chemotherapy was continued 18 months. The patient continues to do well with no sign of tumor and a normal alpha-fetoprotein level 53 months after the operation and 35 months after the completion of therapy. He is the youngest patient documented in the literature and successfully treated for mediastinal endodermal sinus tumor.     

Induction of peptide-specific immune response in patients with primary malignant melanoma of the esophagus after immunotherapy using dendritic cells pulsed with MAGE peptides

Primary malignant melanoma of the esophagus (PMME) is a very rare disease with an extremely poor prognosis. Surgery is currently considered its best treatment, while any other measures are ineffective. We studied the effect of active specific immunotherapy using monocyte-derived dendritic cells (DCs) pulsed with the epitope peptides of melanoma-associated antigens (MAGE-1, MAGE-3) in patients with PMME after surgery, for the first time. The patient received passive immunotherapy with lymphokine-activated killer cells concomitantly. Two HLA-A24-positive patients with PMME were treated. Both patients initially received radical esophagectomy with regional lymphadenectomy, followed by adjuvant chemotherapy with dacarbazine, nimustine, vincristine and interferon-alpha. In the case 1 patient, active specific immunotherapy was used to treat a large abdominal lymph node metastasis that became obvious 21 months after surgery. The disease remained stable for 5 months, and the patient survived for 12 months after the initiation of immunotherapy. In the case 2 patient, immunotherapy was tried as post-operative adjuvant treatment after adjuvant chemotherapy. There was no tumor recurrence for 16 months after the immunotherapy. As of 49 months after esophagectomy, the patient is still alive. In both patients, the ability of peripheral lymphocytes to produce IFN-gamma in vitro in response to peptide stimulation was significantly enhanced and delayed-type hypersensitivity skin test response to MAGE-3 peptide was turned positive after immunotherapy. In conclusion, active specific immunotherapy for PMME with the use of DCs and MAGE peptides was safe and capable of inducing peptide-specific immune responses. This case report warrants further clinical evaluation of this immunotherapy for PMME.     

Clinicopathological analysis of two patients with local recurrence after microwave coagulation therapy for liver metastases from colorectal cancer

We analyzed the clinicopathological factors in two cases of local recurrence after a disease-free interval (DFI) of more than 12 months following microwave coagulation therapy (MCT) for liver metastases from colorectal cancer. Case 1: A local recurrence was diagnosed at 14 months after MCT for a liver metastasis of 20 mm in diameter from rectal cancer. Following liver resection, the patient remains alive without recurrence at 9 months. Case 2: A local recurrence was diagnosed at 19 months after MCT for a liver metastasis of 20 mm in diameter from rectal cancer. After MCT, the patient remains alive without recurrence at 36 months. CONCLUSION: We treated two patients with local recurrence who have more than 12 months' DFI after MCT for liver metastases from colorectal cancer. MCT or liver resection was performed as a curative therapy in these cases. Caution is recommended for local recurrence at more than 12 months after MCT for liver metastases from colorectal cancer.     

Post-transplant acute myeloid leukemia (PT-AML).

Acute myeloid leukemia following organ transplantation (PT-AML) is a rare event with only a few published cases in the literature. We present three patients who developed AML (FAB M1, M5, M4) after renal, double lung or liver transplantation. Molecular analysis detected a t(9;11) in one patient and documented the recipient origin of AML in a second patient. All patients were treated with chemotherapy. Immunosuppression was reduced to cyclosporin A (CsA) and prednisone in two patients and to prednisone alone in one patient. Two patients achieved a complete remission (CR), with a remission duration of 4.6 months in one patient, the other patient died from septicemia after 15.2 months in CR. One patient was refractory to chemotherapy and died from septicemia. This report together with the documented cases in the literature suggests that PT-AML (1) develops after a median interval of 5 years after transplantation with variable latency (range, <1-17 years); (2) is heterogeneous with respect to FAB classification; (3) shows chromosomal and molecular changes typical of therapy-related AML (t-AML: -7, +8, 11q23, inv16, t(15;17)); (4) standard chemotherapy is feasible after reduction of immunosuppression and produces a CR rate of 56% with a median remission duration of 4.6 months and an overall survival of 2.6 months; (5) the major complications are early death (25%), gram-negative septicemia, progressive disease or relapse. This review provides diagnostic and therapeutic experiences and guidelines for the management of this increasing group of post-transplant patients.     

Intracranial Hodgkin disease: case report]

Hodgkin disease intracranial lesions are uncommon. We report the case of a 24-year-old man who presented with an intracranial relapse without other evidence of disease 24 months after multiple drug therapy and extended field radiation therapy for stage III Bb type 3 Hodgkin disease. The patient was treated by whole brain irradiation (40 Gy/20 fractions/4 weeks). Six months after completion of therapy, the patient had a second relapse, with bilateral inguinal metastatic nodes, which were treated by a second line polychemotherapy. The patient was free of disease 9 months later.     

A case of stage IV gastric cancer treated sequentially for over two years by TS-1, paclitaxel, and CPT-11

We report a patient with advanced stage IV gastric cancer treated by chemotherapy for over two years. The patient was a 69-year-old man with paraaortic lymph node metastasis of gastric cancer. He underwent a distal gastrectomy in non-curative resection. After surgery, chemotherapy with TS-1 (100 mg/body/day) was performed. At 7 months after surgery, progression of lymph node metastasis in porta hepatis was recognized, and paclitaxel was administered at a weekly dose of 80 mg/m(2) for 3 weeks followed by one week rest. He remained stable for 12 months under paclitaxel treatment. At 26 months after surgery, progression of lymph node metastasis in porta hepatis was recognized again, and CPT-11 was administered at a bi-weekly dose of 80 mg/m(2). Although the patient died two years seven months after surgery, the chemotherapy with sequential administration of TS-1, paclitaxel and CPT-11 was thought to be effective for advanced gastric cancer.     

Acute myelogenous leukemia with t(6;9)(p23;q34): Report of three patients

Acute myelogenous leukemia (AML) with the translocation t(6;9)(p23;q34) is a rare disease entity with a poor prognosis. We report three patients; two were diagnosed with AML of French-American-British (FAB) Cooperative Group type M2 and one with refractory anemia with an excess of blasts (RAEB) followed by AML type M2. The first patient, a 22-year-old man, achieved complete remission (CR) after three courses of chemotherapy. Two months after the CR was achieved, cytogenetic analysis showed t(6;9) in his morphologically normal bone marrow. After 5 months of remission, the AML relapsed and was resistant to further chemotherapy. The second patient, a 19-year-old man who had not achieved remission after two courses of chemotherapy, was treated with allogeneic bone marrow transplantation (BMT). The transplant resulted in CR and the disappearance of t(6;9). Seventeen months after the transplant, polymerase chain reaction analysis revealed molecular remission, confirmed by the absence of DEK-CAN mRNA. This patient has been in a leukemia-free state for more than 3 years. The third patient, a 54-year-old woman, was diagnosed with RAEB. AML developed 6 months later and she died 12 months after the diagnosis of RAEB. We suggest that BMT should be performed if a suitable donor can be found, otherwise the outcome is poor. Received: October 4, 1996 / Accepted: May 15, 1998     

Primary pericardial mesothelioma

Primary pericardial mesothelioma is a rare clinical entity; about 150 cases have been described in literature. It is a highly aggressive tumour with global survival under 6 months. We present a 44-year-old man with a primary pericardial mesothelioma who received treatment under clinical essay with carboplatinum and pemetrexed reaching tumoral response; consolidation radiotherapy was administered. Ten months after end of radiotherapy, tumoral progression was detected, and patient received second line of chemotherapy. The patient died 16 months after diagnosis. New cytotoxic drugs can improve the prognosis of this rare entity.     

The detection of residual acute lymphoblastic leukemia cells with immunologic methods and polymerase chain reaction: a comparative study

In this study we applied double color immunofluorescence analysis and polymerase chain reaction (PCR) amplification of rearranged TCR delta genes for detecting residual leukemia in the posttreatment bone marrow (BM) samples taken from four patients in morphological remission. In three of these patients (nos. 1-3; T-ALL) a combination of CD3 and anti-TdT antibodies (Abs) was used to identify residual blasts while in patient 4 (B lineage ALL) the combination CD13/TdT served to detect residual disease. Two rounds of PCR primed by nested amplimers were carried out to prepare clonospecific probes from presentation DNA and to investigate the follow-up samples. In patients 1 and 2 no cCD3+/TdT+ cells were seen posttreatment, but PCR amplification of the TCR V delta 1-D-J delta 1 region revealed residual disease in both patients. Patient 1 underwent allogeneic BM transplant (BMT) 8 months after diagnosis and is well 3 months post-BMT while patient 2 relapsed 12 months after presentation. In patient 3 the remission samples investigated 2 and 3 months after diagnosis did not contain cCD3+/TdT+ cells, but in the sample collected at 4 months a few such cells (0.0001-0.001%) could be detected. In the same sample, PCR amplification of the TCR V delta 2-D-J delta 1 region indicated the presence of 10(-4)-10(-3) residual leukemic cells. These findings predicted full morphological relapse which occurred 2 months later. In patient 4 CD13/TdT double positive cells were clearly seen 2 and 3 months after presentation. PCR amplification of the V delta 2-D delta 3 recombination also revealed residual blasts when applied to one of such "remission" samples. After further remission induction treatment, no immunologic evidence of residual disease was detected. This patient received an allogeneic BMT 8 months after diagnosis and is disease free 4 months after BMT. Our data indicate that both double color immunofluorescence and PCR analysis offer powerful tools to study residual leukemia and highlight the advantages as well as the potential limitations of each technique.     

Sapphire probe laser surgery for localized carcinoma of the penis

Cancer of the penis is an uncommon disease in the western world, but it causes significant morbidity and mortality worldwide. Discussions have tended to centre around issues of local tumor control and the functional status of the penis after treatment. Since November 1982 we have treated localized squamous cell penile cancer (Tis, T1 and T2, Classification UICC, Geneva 1978) with the Nd-YAG laser. Sixteen patients (3Tis, 5T1 and 8T2 tumors) are included in this study with a follow-up of 4 to 36 months (mean 17 months). Eight out of 16 patients were treated with the sapphire probe exclusively, the other eight patients by scalpel excision followed by laser irradiation. No recurrent tumor was observed in 13 patients, one patient developed a recurrence at a non-treated part of the glans penis after 14 months, one patient showed Tis after 5 months near the treated side and in one patient an incomplete laser resection was followed by partial penectomy after 1 month. Sapphire probe laser excision is a safe procedure leading to a good cosmetic aspect with maintenance of the functional integrity of the penis.     

Case report of nab-paclitaxel in metastatic pancreatic cancer

The first biologically interactive albumin-bound paclitaxel in a nanometer particle is described in a patient with metastatic pancreatic cancer. The aim of this report is to underline the efficacy and tolerability of the new chemotherapy option. A 78-year-old male patient with metastatic pancreatic cancer received third-line nab-paclitaxel monotherapy in September 2011 until October 2012 in weekly or bi-weekly intervals. A partial response was detected by computed tomography scan 2 months after start of therapy, and this was confirmed after 5 and 8 months. While on therapy, 30 applications of nab-paclitaxel monotherapy allowed the patient to experience a solid partial response and a progression-free survival of 12 months. During treatment, the patient did not develop any side effects and experienced excellent quality of life. This experience emphasizes the potential clinical utility of nab-paclitaxel chemotherapy in the setting of metastatic pancreatic cancer.     

Consequences of breast irradiation in patients with pre-existing collagen vascular diseases

Exaggerated acute and late effects were observed in three of four women with pre-existing collagen vascular disease (CVD) within 2 years after definitive megavoltage radiation therapy for breast carcinoma. Five women with breast carcinoma, who developed CVD 3 months to 10 years after radiation therapy, had no complications. An abnormally severe reaction was observed during treatment of one patient with discoid lupus. The patient developed moist desquamation that persisted for a month, requiring early termination of treatment. One year after treatment, the patient developed paresthesias in the ipsilateral arm. A planned reduction of the prescribed dose in a second patient with progressive systemic sclerosis did not prevent intense erythema at the end of treatment, followed 14 months later by chest wall necrosis, which eventually required multiple surgeries including chest wall resections. The third patient, who had systemic lupus erythematosis, developed necrosis 2 years after treatment, which progressed over 12 years to osteoradionecrosis of the clavicle, sternum and rib cage. Multiple surgeries to repair the defect were complicated by flap necrosis and pleurocutaneous fistulas. The fourth patient died 6 months after radiotherapy without apparent sequelae. None of the patients had evidence of recurrent carcinoma. A history of collagen vascular disease appears to be a contraindication to breast conservation or for elective irradiation for breast cancer.     

Iron chelation therapy with deferasirox induced complete remission in a patient with chemotherapy-resistant acute monocytic leukemia

BACKGROUND: A patient with chemotherapy-resistant acute monocytic leukemia who achieved complete remission (CR) after iron chelation therapy (ICT) with deferasirox is reported for the first time. A 73-year-old Japanese man with acute monocytic leukemia who was refractory to conventional remission induction chemotherapies achieved a partial response, with some improvement of his hemoglobin level and white blood cell count after gemtuzumab ozogamicin (GO) treatment. Seven months after GO treatment, the disease relapsed and the patient developed pancytopenia. He declined further chemotherapy, and started receiving 1,200-1,800 ml of packed red blood cell transfusion per month together with ICT with deferasirox (baseline serum ferritin level was 1,412 ng/ml). Twelve months after the initiation of deferasirox, the patient's serum ferritin level decreased to below 1,000 ng/ml and deferasirox was discontinued. Four months after discontinuation of deferasirox, the blood cell count normalized and the patient became transfusion-independent. Bone marrow aspiration and biopsy revealed hematological and cytogenetic CR. CONCLUSION: CR was achieved after ICT with deferasirox in a patient with acute myelogenous leukemia, suggesting that deferasirox may have an antileukemic effect in the clinical setting.     

Four cases of successful multidisciplinary treatment for hepatocellular carcinoma with portal venous thrombus

CASE 1: TAI and radiation therapy were performed for a lateral segment and tumor thrombus extended into the left portal branch. Then, we diagnosed a tumor thrombus that extended into the right portal branch and TAI and operation were performed. The patient died about 9 months after the diagnosis of tumor thrombus. CASE 2: An operation was performed for hepatoma involving the right lobe and the tumor thrombus extended into the right portal branch. TAI and TAE were performed for residual tumor. The patient died about 12 months after diagnosis of tumor thrombus. CASE 3: An operation was performed for hepatoma involving an anterior segment and tumor thrombus extended into the right portal branch. Then, TAI, TAE and PMCT were performed for residual tumor. The patient is alive for 33 months with recurrence after the diagnosis of tumor thrombus. CASE 4: An operation was performed for hepatoma involving a posterior segment and tumor thrombus extended into the right portal branch. For recurrent TAI and TAE, radiation therapy was performed. The patient is alive for 20 months without recurrence after the diagnosis of tumor thrombus.