Primary squamous cell carcinoma of the stomach

Received for publication on Dec. 7, 1998; accepted on March 23, 1999     

Radical external beam radiotherapy for prostate cancer in Japan: preliminary results of the changing trends in the Patterns of Care process survey between 1996-1998 and 1999-2001

OBJECTIVE: To report the preliminary results of a study to delineate the changing trends in radical external beam radiotherapy usage for prostate cancer between the 1996-1998 and 1999-2001 survey periods in Japan. METHODS: The 1996-1998 Patterns of Care Study (PCS) and the 1999-2001 PCS in Japan reviewed the detailed information on 694 patients with prostate cancer treated with radiotherapy. Of them, 298 patients with clinically localized prostate cancer treated with radical external beam radiotherapy in A1 and B1 institutions were selected for analysis (1996-1998 PCS, 117 patients; 1999-2001 PCS, 181 patients). RESULTS: High-risk prostate cancer (defined as T3-T4 tumors, a pretreatment prostate-specific antigen level >20 ng/ml, and/or poorly differentiated adenocarcinoma) was diagnosed in 82.1% of the patients in the 1996-1998 PCS and in significantly less (70.2%) of those in the 1999-2001 PCS (P = 0.021). Moreover, significantly earlier T stages (T1-T2: 49.7%) and more well-differentiated tumors (24.7%) were found between 1999 and 2001 than between 1996 and 1998 (T1-T2: 31.9%, well-differentiated tumors: 13.9%). Although only 6.1% of patients were treated with radiotherapy by patient's choice in 1996-1998, a larger proportion (32.2%) chose this treatment in 1999-2001. The median radiation dose was 65.0 Gy (range, 24-74 Gy) in 1996-1998 and increased to 69 Gy (range, 14-80 Gy) in 1999-2001. The percentage of radiation doses <60 Gy was 20.5% in 1996-1998 but only 2.2% in 1999-2001. Moreover, the incidence of treatment with total doses of > or =70 Gy was higher in 1999-2001 (43.9%) than in 1996-1998 (19.7%). These increased radiation doses were predominantly observed in B1 institutions. Although the usage of > or =10 MV was significantly increased in 1999-2001 (82.0%) compared with that in 1996-1998 (65.8%), conformal therapy administered to 52.1% of patients in 1996-1998 was almost the same (55.8%) in 1999-2001. The median number of full-time equivalent (FTE) radiation oncologists (2.4 in A1 institutions and only 0.6 in B1 institutions) in 1996-1998 increased slightly in 1999-2001 (2.7 in A1 institutions, 0.7 in B1 institutions), but remained low in B1 institutions. CONCLUSIONS: In Japan, there is a trend to fewer high-risk prostate cancer patients being treated with radical external beam radiotherapy. An increasing percentage of patients chose radiotherapy and also increased radiation doses, which might reflect the growing acceptance of radical external beam radiotherapy as a treatment of choice for prostate cancer in Japan. Therefore, to optimize delivery of radiotherapy, more advanced equipment and more FTE radiation oncologists are warranted.     

Risk of second malignancies after surgical treatment for early gastric cancer

Received for publication on March 16, 1998; accepted on Dec. 1, 1998     

Inducement of canine gastric cancer by N-ethyl-N′-nitro-N-nitrosoguanidine (ENNG)

Received for publication on Apr. 13, 1998; accepted on Aug. 5, 1998     

Impact of erythropoietin on the reduction of blood transfusions and on survival of lung cancer patients receiving first-line chemotherapy

INTRODUCTION: Anaemia is a common problem in patients with cancer who receive chemotherapy and is normally associated with a negative impact on patients' quality of life (QOL), poor cancer control and diminished survival. In clinical trials, recombinant human erythropoietin has been shown to correct and prevent anaemia, decrease the need for blood transfusions and improve cancer patients' QOL. METHODS: A retrospective study followed lung cancer patients who received first-line chemotherapy in our hospital in 1998 and in 2005. The incidence of anaemia was analysed, as was the impact of incorporating erythropoietin into the treatment. RESULTS: The incidence of anaemia was 68% (69% of which reported asthenia) in 1998 vs. 54% (60% with asthenia) in 2005. The comparison of anaemia rates (1998 vs. 2005) were grade 1 (16% vs. 32%), grade 2 (36% vs. 16%), grade 3 (16% vs. 5%) and grade 4 (none). Treatment for anaemia included transfusion 52%, intravenous iron 5% and epoetin 4% in 1998. In 2005 anaemia was treated with transfusion 9%, intravenous iron 41%, and epoetin 49%. Median survival (1998 vs. 2005) was 242 days [95% confidence interval (CI) 217-329) vs. 356 days (95% CI 322-382). CONCLUSIONS: Erythropoietin is a valid alternative for cancer patients with anaemia undergoing chemotherapy. It can possibly avoid the need for transfusions without negatively impacting survival.     

Acquired hypertrichosis lanuginosa: Case report and review of the literature

Acquired hypertrichosis lanuginosa is a rare cutaneous disorder usually associated with internal malignancy that consists of the development of abnormal hair growth of the lanugo type, often confined to the skin of the face and neck, although other areas also may be involved. We report on a 66-year-old woman with a metastatic ductal infitrating carcinoma of the breast who developed growth of fine lanugo type hair on her face and progressive growth of the hair of eyebrows and eyelashes. We review the literature on this uncommon paraneoplastic cutaneous disorder emphasizing the pathogenic mechanisms that have been proposed to explain the striking overgrowth of lanugo type hair. J. Surg. Oncol. 1998;68:199–203. © 1998 Wiley-Liss, Inc.     

Carcinosarcoma of the liver with an osteosarcomatous component

We report a case of hepatocellular carcinoma associated with mesenchymal differentiation, which was identified as a true carcinosarcoma based on thorough pathologic examination. A 48-year-old man presented with a giant mass in the lateral segment of the liver. It was resected by lateral segmentectomy combined with total gastrectomy. Microscopically, the tumor consisted of hepatocellular carcinoma, osteosarcoma, and undifferentiated sarcomatous components. The undifferentiated sarcomatous components were positive for cytokeratin, whereas the osteosarcomatous components were negative for cytokeratin and positive for S100. To our knowledge, this is only the second known case in which mesenchymal differentiation was immunohistochemically demonstrated in liver carcinosarcoma. Received: May 21, 1998 / Accepted: October 28, 1998     

Prognostic factors in node-positive carcinoma of the penis

BACKGROUND: Lymph node metastasis is the most important prognostic factor in patients with carcinoma of the penis. In this article, we have reviewed the outcome of the patients with pathologic node-positive carcinoma of the penis after groin dissection performed at the Cancer Institute (WIA) between 1987 and 1998. METHODS: The case records of all patients who underwent groin dissection for carcinoma of the penis between 1987 and 1998 were analyzed. RESULTS: Between 1987 and 1998, 128 patients underwent groin dissections for carcinoma of the penis at Cancer Institute (WIA), Chennai. Out of them, 102 patients had pathologic node-positive disease. The 5-year overall survival (OS) for these patients was 51.1%. Patients with metastasis only to inguinal nodes had a 5-year OS of 64.6% whereas none of the patients with pelvic nodal metastasis survived for 5 years. Among the pathologically node-positive patients, the factors adversely influencing survival on multivariate analysis were bilateral nodal metastases, number of positive inguinal nodes, pelvic nodal metastasis, and extranodal extension. CONCLUSIONS: Groin dissection is an effective treatment for nodal metastasis from carcinoma of the penis. However, innovative approaches are needed for the subset of patients with dismal outlook.     

Epstein-Barr virus and gastric carcinoma

Received for publication on Jun. 1, 1998; accepted on Sept. 3, 1998     

Adrenal leiomyoma: A case report and review of the literature

We describe a case of a 65-year-old Caucasian woman found to have an enlarging mass of the left adrenal gland. Laboratory examination revealed the mass to be nonfunctional. The patient underwent an uneventful left adrenalectomy. Pathological examination revealed the mass to be a leiomyoma. These tumors are benign and develop from smooth muscle cells. They can occur in any part of the body where smooth muscular layers exist, but occur frequently in the uterus and gastrointestinal tract. This case report presents a review of the recent literature on this rare entity. J. Surg. Oncol. 1998;69:111–112. © 1998 Wiley-Liss, Inc.     

Study of completeness of registration at the Estonian cancer registry.

Every cancer registry should be able to quantify the level of completeness of registration. The current study describes a routine quality control procedure in the Estonian Cancer Registry (ECR) for assessing the completeness of registration. The registry's database was compared with the databases of the Tartu University Lung Clinic and the Maarjam?isa Hospital of the Tartu University Clinics, and active retrieval to obtain missing cancer cases diagnosed in 1998 was carried out. The overall completeness of case ascertainment based on this study was 90.8%. As a result of this procedure, 67 cases of malignant neoplasms (1.1% of the total number of incident cancer cases for 1998) and 11 cases of other reportable neoplasms were detected and recorded at the ECR. Cancers of the lung, thyroid gland and prostate were most frequently under-notified. For these sites, the number of cancer cases for 1998 for Estonia as a whole increased 2.6%, 11.8% and 2.2%, respectively. To conclude, the existence of electronic databases is a positive development, but cancer registrars still need to employ labour-intensive methods to validate diagnostic codes and to decide whether to include in the ECR cases found by active retrieval. Based on the findings of our study, which is the first one of its kind in Estonia, the completeness of cancer reporting varied by cancer site, and it appeared to be a substantial concern for several sites.     

Trends in the practice of radiotherapy for localized prostate cancer in Japan: a preliminary patterns of care study report

BACKGROUND: This is the first study to examine the characteristics and changes of the patterns of radiotherapy for prostate cancer in Japan. METHODS: The Japanese Patterns of Care Study (PCS) conducted a random survey of 84 institutions nationwide. Detailed information was collected on prostate cancer patients without distant metastases, who received radiotherapy during 1996-1998 and 1999-2001. RESULTS: The patients were divided into three groups: The Fresh Group (n = 338) was treated with radical radiotherapy with photon beams; the Surgery Group (n = 115) was treated after prostatectomy; and the Hormone-Refractory Group (n = 117) was treated after progression from hormonal therapy. In the Fresh Group, there was a decline in the fraction of patients with T3-4 tumors, from 65.2% in 1996-1998 to 43.9% in 1999-2001. In 1999-2001, a higher median dose of 69 Gy was irradiated as compared to 65 Gy in 1996-1998. In particular, the fraction of the patients treated with doses >or=70 Gy increased from 16.4% to 46.3%. In the Surgery Group, the percentage of clinical T3-4 tumors before prostatectomy decreased from 71.4% in 1996-1998 to 16.2% in 1999-2001. The median radiation dose of 60 Gy did not change, but the 1999-2001 results showed a decrease in the use of doses <60 Gy. In the Hormone-Refractory Group, the median dose increased from 60 Gy in 1996-1998 to 67 Gy in 1999-2001. CONCLUSION: These data suggest that radiation doses for prostate cancer in Japan have increased dramatically within a short period of time.     

The effect of radiotherapy on the use of immediate breast reconstruction.

BACKGROUND: Immediate breast reconstruction techniques include tissue-expansion, latissimus dorsi flap with or without an implant, pedicled TRAM flap and free tissue-transfer. Adjuvant radiotherapy decreases loco-regional recurrence and increases overall survival. Radiotherapy in the presence of a tissue-expander or an implant can lead to an increased number of complications and poor cosmetic outcome. AIM OF THE STUDY: To study the relationship between radiotherapy and the choice of the immediate breast reconstruction technique in view of the increased number of breast cancer patients receiving adjuvant radiotherapy. PATIENTS AND METHODS: An audit of 121 patients who had immediate breast reconstruction over a period of 2 years was reviewed retrospectively. In March 1998, the radiotherapy protocol was revised. Forty-two patients operated on between January 1997 and March 1998 were compared to 79 patients operated on between April 1998 and June 1999. RESULTS: The percentage of patients receiving adjuvant radiotherapy increased in the second period as well as the proportion of autologous breast reconstruction. A small percentage of patients required unexpected radiotherapy after insertion of tissue expanders, due to narrow excision margins or unexpected pathology. Only two patients had tissue-expansion although radiotherapy was likely. CONCLUSION: The choice of the immediate breast reconstruction technique was satisfactory in most patients. The use of implants is best avoided in patients who may require adjuvant radiotherapy. Autologous immediate breast reconstruction, either free or pedicled flaps, is a safer choice for those patients.     

Radical external beam radiotherapy for clinically localized prostate cancer in Japan: changing trends in the patterns of care process survey between 1996-1998 and 1999-2001

BACKGROUND: This report presents results of a study delineating changing trends in radical external beam radiotherapy usage for prostate cancer between the 1996-1998 and 1999-2001 Patterns of Care Study (PCS) survey periods in Japan. MATERIALS AND METHODS: Out of the 694 patients comprising the 1996-1998 and 1999-2001 PCS surveys, the current study analyzed data for 444 patients with clinically localized prostate cancer treated with external beam radiotherapy (1996-1998 PCS: 161 patients; 1999-2001 PCS: 283 patients). RESULTS: Significantly higher percentages of patients had earlier T stages (T1-T2: 48.2%) and well-differentiated tumors (23.6%) between 1999 and 2001 than between 1996 and 1998 (T1-T2: 34.6%, well-differentiated tumors: 15.1%). Although only 5.9% of patients were treated with radiotherapy by their own choice during 1996-1998, a larger proportion (26.5%) chose this treatment during 1999-2001. The median radiation dose was 65.0 Gy during 1996-1998, increasing to 68.4 Gy during 1999-2001. Moreover, the incidence of total treatment doses of > or = 70 Gy was higher during 1999-2001 (38.0%) than during 1996-1998 (17.5%). On the other hand, the percentage of patients receiving conformal therapy during 1996-1998 (49.1%) was almost the same as during 1999-2001 (50.2%). The median numbers of full-time equivalent (FTE) radiation oncologists increased in academic institutions (1.8 in 1996-1998; 2.4 in 1999-2001), while those in non-academic institutions remained low (0.5 in 1996-1998; 0.45 in 1999-2001). CONCLUSION: In Japan, fewer prostate cancer patients treated with radical external beam radiotherapy had advanced diseases. Increasing percentages of patients chose radiotherapy and received increased radiation doses, which might reflect the growing acceptance of radical external beam radiotherapy as a first-line treatment for prostate cancer in Japan.     

Changes in breast cancer incidence and stage distribution in Modena,Italy: the effect of a mammographic screening program

OBJECTIVE: Assessing changes in breast cancer (BC) incidence and stage distribution in the District of Modena, Italy, during the period 1992–1998, and their relationship to a mammographic screening program launched in 1995.METHODS: Demographic, clinical, and pathological data of all BC cases reported to the population-based Modena Cancer Registry between 1992 and 1998 were collected and linked to the screening database.RESULTS: A total of 3429 women were diagnosed with BC in the District of Modena between 1992 and 1998. In this period the incidence rate increased by 15.7% (from 134.3 in 1992 to 155.4 per 100,000 in 1998). The increase began in 1995 and exclusively included women aged 50–69; the incidence rose by 30.4%. Moreover, the rise was confined to early tumors, with more than half (54%) of all cases reported in 1998 diagnosed as stage 0 or I disease, compared with 42% in 1992. Screen-detected tumors were significantly smaller (13.2 mm) than other tumors diagnosed in women aged 50–69 (18.5 mm), with 46% of screen-detected tumors smaller than 10 mm. Overall, a decline in the average tumor diameter was shown (from 20.2 mm in 1992–1994 to 18 mm in 1996–1998).CONCLUSIONS: Our data confirm that mammographic screening leads to an increase in the incidence of early-stage BC cancers.     

Incidence patterns of invasive and borderline ovarian tumors among white women and black women in the United States. Results from the SEER Program, 1978-1998

BACKGROUND: Malignant tumors of the ovary are the leading cause of death from gynecologic malignancies in the United States. Population-based incidence data for these neoplasms by histopathologic type and race are limited. Variation in rates may provide clues for future etiologic studies. METHODS: The authors performed a detailed, population-based analysis of U.S. incidence rates by histologic type, race, and age for invasive ovarian tumors that were diagnosed during 1978-1998 and for borderline ovarian tumors that were diagnosed during 1992-1998 using data from the U.S. Surveillance, Epidemiology, and End Results (SEER) Program. RESULTS: White women had significantly higher rates compared with black women of all types of epithelial tumors, with the white:black rate ratios ranging from 1.23 to 2.56. Black women had higher rates of gonadal stromal tumors. Among both white women and black women, total carcinoma rates did not change greatly from 1978-1982 to 1995-1998. Among white women, the reported incidence rates for invasive serous, endometrioid, and clear cell tumors increased during 1978-1998, whereas the rates of mucinous; papillary, not otherwise specified (NOS); and other epithelial tumors declined. Among black women, the reported rates of papillary, NOS tumors decreased significantly, whereas the rates of other tumor types fluctuated. Incidence rates of borderline ovarian tumors were higher among white women compared with black women and did not change significantly during 1992-1998. Serous and mucinous tumors were the predominant tumors reported for women age < 45 years, whereas serous; papillary, NOS; and other epithelial tumors predominated among older women. CONCLUSIONS: Incidence rates for malignant ovarian tumors have remained relatively stable, with higher rates for white women compared with black women. The reported rates for some specific histopathologic tumor types have changed over time, in part reflecting more specific pathologic classification. The possible effect of shifting exposure prevalence on incidence patterns warrants further study.     

Cost-effectiveness of new guidelines for adjuvant systemic therapy for patients with primary breast cancer.

BACKGROUND: In this study, the potential impact of a new national guideline for adjuvant systemic therapy in breast cancer (introduced in The Netherlands in 1998) was assessed, as well as the modifications of this guideline, issued in 2001. Both the change in total number of patients eligible for adjuvant therapy, as well as the cost-effectiveness of the changed clinical management of these patients were analysed. PATIENTS AND METHODS: Percentages of patients who would be eligible for adjuvant therapy in 1994, 1998 and 2001 were estimated, based on clinical data from 127 patients, who were operated on in 1994. Ten-year overall survival rates were used as a measure of effectiveness, based on the two most recent EBCTCG meta-analyses. Actual resource costs were calculated. With a decision analytic model, the incremental cost-effectiveness ratios (1998 versus 1994, and 2001 versus 1998) were calculated. RESULTS: The introduction of the 1998 guideline resulted in a relative increase of 80% in the total number of patients eligible for adjuvant therapy, compared with 1994 (from 40% to 72% of all patients with primary breast cancer). With an estimated absolute increase of 10-year overall survival of 2%, the 1998 guideline was found to have an expected incremental cost-effectiveness ratio of about 4837 per life-year gained. CONCLUSIONS: Introduction of the new guideline considerably affected the number of patients eligible for adjuvant systemic therapy for breast cancer. The associated incremental cost-effectiveness ratio is well within the range of values that are generally considered acceptable.     

Establishment of the Japanese Radiation Oncology Study Group

The Japanese Radiation Oncology Study Group (GROSG) which conducts multi-center trials, was organized in July, 1998 in order to establish standards' for radiation therapy. These standards must be based on the results of high quality trials, and the quality of radiotherapy must be assured in each hospital.     

Two giant cell tumors arising from the ribs: Two case reports

Giant cell tumors of bone are a relatively common type of proliferative neoplasm. These tumors usually arise in the epiphyseal region of limbs and their occurrence in the ribs is unusual. This report describes two rare cases of giant cell tumor of the ribs. The tumors were resected with the ribs, and chest wall defects were covered with Marlex mesh. Both patients remained free of local recurrence. In one patient, however, multiple pulmonary metastases were detected on a computed tomography scan of the chest 14 months after surgery. Received: February 4, 1998 / Accepted: October 13 1998     

Barrett's adenocarcinoma associated with acquired eventration of the diaphragm

We report a rare case of Barrett's adenocarcinoma asso-ciated with acquired eventration of the diaphragm in a 71-year-old woman. She initially developed dysphagia and epigastric discomfort in May, 1997. On July 9, she was referred to our Department of Surgery at the Ryukyus University Hospital for thorough examination and treatment. Esophageal adenocarcinoma and eventration of the diaphragm were revealed by exhaustive examinations, including chest X-ray, computed tomography, and magnetic resonance imaging, and proximal gastrectomy with reconstruction of jejunal interposition was performed, on August 8. Histologically, the tumor revealed that the adenocarcinoma arose from short-segment Barrett's esophagus (SSBE). It thus appears that eventration of the diaphragm may induce SSBE and Barrett's adenocarcinoma. We therefore recommend that periodic examinations of the esophagus and stomach be performed in patients with eventration of the diaphragm. Barrett's adenocarcinoma associated with acquired eventration of the diaphragm is reported. Patients with eventration of the diaphragm should undergo periodic examinations of the esophagus and stomach. Received for publication on Mar. 26, 1998; accepted on Aug. 11, 1998