Comparison of cisplatin and 5-fluorouracil chemotherapy protocols combined with concurrent radiotherapy for esophageal cancer

Purpose  The optimal chemotherapeutic protocol for the treatment of esophageal cancer has not yet been established. This study was performed to identify the differences in toxicity and completion rates of various chemotherapy protocols with that goal in mind. Materials and methods  A total of 61 patients with esophageal cancer were enrolled in this study between June 2002 and January 2004. The total radiotherapy dose was 64 Gy. Three chemotherapy protocols were used. Arm A comprised daily low-dose cisplatin (CDDP) and 5-fluorouracil (5FU) (CF protocol) (3 mg/m² and 180 mg/m², respectively). Arm B was intermediate between arm A and C (CDDP 7 mg/m² and 5FU 250 mg/m² on days 1–5, 8–12, 29–33, and 36–40). Arm C comprised two courses of standard CF (CDDP 70 mg/m² on day 1 and 5FU 600 mg/m²/24 h on days 1–4). Results  Although there were no significant differences in hematological toxicity between the protocols, leukocytopenia was slightly milder in arm A. Nausea was significantly more severe in arm C. The completion rate was higher in arm A. The 3-year survival rates were 40%, 31%, and 62%, respectively. Conclusion  The daily low-dose CF protocol showed a trend of mild toxicity regarding leukocytopenia. However, we could not find statistical difference between arms. It also showed a better completion rate than the other two arms.     

Variation of clinical target volume definition among Japanese radiation oncologists in external beam radiotherapy for prostate cancer

Background: We investigated the interobserver variation in the prostatetarget volume and the trend toward the use of diagnostic computedtomography (CT) or magnetic resonance (MR) images for treatmentplanning. Methods: Twenty-five radiation oncologists were asked to draw the externalcontour of the prostate on CT images (0.3 cm spacing) of a patientwith localized prostate cancer. They also answered a questionnaireregarding the use of diagnostic CT or MR images for the contouring. Results: Of the 25 physicians, 28% rarely or never referred to the diagnosticCT images. In contrast, the physicians tended to refer to theMR images more frequently. Approximately 50% of the physiciansbelieved in the usefulness of contrast-enhanced images for thedelineation of the prostate. As for the variation of the prostatecontouring, the median craniocaudal prostate length was 36 mm(range, 21–54 mm), and the median prostate volume was43.5 cm³ (range, 23.8–98.3 cm³). The interobserver variabilitywas not significant in the duration as a radiation oncologist,the board certification status as radiation oncologists, andthe number of treatment plans developed for prostate cancerduring the last 1 year. Conclusion: A wide variety of the definitions of the prostate was foundamong Japanese radiation oncologists.     

Preoperative chemoradiotherapy for advanced lower rectal carcinoma

Preoperative chemoradiotherapy in combination with radiation of 30 Gy and chemotherapy with oral uracil-tegafur for 14 patients with advanced lower rectal carcinoma was performed. Tumors were located at RaRb in 5 cases, RbRa in 2, Rb in 3, and RbP in 4 with a mean diameter of 3.8 cm. Preoperative lymphnodes were diagnosed as cN0 in 8 cases, cN1(metastases of perirectal nodes)in 4, cN1(perirectal and along superior rectal artery nodes)in 1, and cN3(perirectal and lateral nodes)in 1. Efficacy for primary carcinomas was evaluated as Partial Response in 9 cases, Stable Disease in 5 and perirectal nodes were down-sized in 4 without down-sizing of either along superior rectal artery nodes or lateral nodes. Margins of primary carcinomas to anal verge were prolonged in 7 cases with a mean prolongation of 0.81 cm. Autonomic nerve-preserving resections with lymphadenectomy of perirectal and along superior rectal artery nodes were performed. Histopathologically efficacy for primary tumors was diagnosed to as not effective in 9 cases, partially effective in 5, and all lymphnodes were combined with necroses and fibrosis. Preoperative chemoradiotherapy is safe for preserving autonomic nerves and serves to preserve the sphincter. A forthcoming study with more appropriate radiation, chemotherapy and lymphadenectomy is being considered.     

Clinical Significance of Interruption of Therapy with Allylestrenol in Patients with Benign Prostatic Hypertrophy

Background: A multicenter, clinical trial investigated the effects of an interruption of antiandrogen therapy on subjective and objective clinical parameters in patients with benign prostatic hypertrophy (BPH).
Methods: Patients were given antiandrogen therapy with allylestrenol (50 mg/day) for 16 weeks. The medication was then withheld and the patients were carefully monitored for an additional 1 6 weeks. There were 34 BPH patients ranging in age from 55 to 82 years (mean, 66.1 years). The efficacy of allylestrenol was evaluated by its effects on prostate volume, maximum urinary flow rate (MFR), and symptom scores at the end of 16 weeks of treatment and then again at 32 weeks (16 weeks after cessation of therapy).
Results: Allylestrenol was effective in the treatment of BPH, and was still effective 16 weeks after the cessation of medication. The prostate volume did not change after treatment cessation nor did the total symptom score, but the MFR reversed to the pretreatment level. Serum testosterone (1.95 ng/mL), dihydrotestosterone, and gonadotropin levels decreased on therapy, but were completely reversed by the end of this study. A prostate needle biopsy revealed that after 16 weeks without therapy, some glands showed regressive glandular changes, while some glands showed slight hyperplastic changes of the secretory epithelium. Eight per cent of patients complained of loss of libido during this study.
Conclusions: Allylestrenol is an effective and safe medical treatment for patients with symptomatic BPH. Hormonal and histopathologic findings suggest that the prostate gland may regrow after discontinuation of medication.     

Mean corpuscular volume (MCV) and the risk of colorectal adenoma in menopausal women

BACKGROUND/AIMS: It has been reported that alcohol intake and folate deficiency are associated with an increased risk of colorectal adenomas and carcinomas. Mean corpuscular volume is increased under these conditions. We have reported that the mean corpuscular volume was higher in patients with adenoma than without adenoma in middle-aged men. The aim of this study was to assess the association between mean corpuscular volume and risk of colorectal adenoma in menopausal women. METHODOLOGY: The subjects were 415 menopausal women who underwent both barium enema examination and total colonoscopy, and their blood samples were analyzed. The subjects were divided into two groups with or without adenoma, and were divided into four groups according to the mean corpuscular volume value. Various variables were compared among the groups, and the odds ratios of adenoma were calculated. RESULTS: The mean corpuscular volume was higher in patients with adenoma than without adenoma (P = 0.002). As for the mean corpuscular volume value, the odds ratio (95% CI) of patients with adenoma was 1.00 (referent); (mean corpuscular volume (fl) < 90), 1.50 (0.93-2.07); (> or = 90 but < 92.5), 1.52 (0.97-2.07); (> or = 92.5 but < 95) and 2.87 (2.25-3.45); (> or = 95). CONCLUSIONS: Mean corpuscular volume > or = 95 may be used as an index of the risk for colorectal adenomas in menopausal women.     

Loss of all ndh genes as determined by sequencing the entire chloroplast genome of the black pine Pinus thunbergii.

The complete nucleotide sequence (119,707 bp) of the black pine (Pinus thunbergii) chloroplast genome has been determined. It contains 4 rRNA genes and 32 tRNA genes. To our knowledge, the tRNAPro (GGG) gene has not been found in any other chloroplast genome analyzed. Sixty-one genes encoding proteins and 11 conserved open reading frames are also found. Extensive rearrangements are apparent in the chloroplast genome relative to those of other land plants. The most striking feature is the loss of all 11 functional genes (ndh genes) for subunits of a putative NADH dehydrogenase that are found in the chloroplast genomes of angiosperms and a bryophyte. Four ndh genes were completely lost and the other 7 genes remain as obvious pseudogenes. This unexpected finding raises the possibility that all ndh genes have been transferred to the nucleus or that an NADH dehydrogenase is not essential in black pine chloroplasts.     

Bortezomib-induced pneumonitis during bortezomib retreatment in multiple myeloma

Bortezomib is a proteasome inhibitor and is active against multiple myeloma. Most toxicities associated with bortezomib are mild to moderate and manageable; however, bortezomib-induced pneumonitis has been reported in some multiple myeloma cases. Bortezomib-induced pneumonitis was reported to occur relatively soon after the first administration of bortezomib. A 64-year-old Japanese man with multiple myeloma received low-dose dexamethasone followed by bortezomib monotherapy as the initial therapy. He had no pulmonary complications during bortezomib treatment. Thereafter, he was treated with high-dose chemotherapy, followed by autologous peripheral blood stem cell transplantation. Ten months after autologous peripheral blood stem cell transplantation, his disease relapsed and he received bortezomib retreatment. On the fifth day after the second dose of weekly bortezomib, he complained of mild dyspnea, dry cough and fever. High-resolution computed tomography of the chest showed bilateral infiltrates with partial ground glass appearance in the lower lobes. The diagnosis of bortezomib-induced pneumonitis was made. His bortezomib-induced pneumonitis responded to steroid therapy and his respiratory symptoms disappeared. This is the first report in which bortezomib-induced pneumonitis occurred during bortezomib retreatment for relapsed multiple myeloma. Careful management is needed during bortezomib retreatment, even after the previous course of bortezomib was administered safely.     

Invasive ductal carcinoma of the pancreas showing exophytic growth

BACKGROUND:Invasive pancreatic carcinoma generally appears as poorly defined mass reflecting the infiltrative growth.We aimed to identify the histological and immunohistochemical features in a rare case of pancreatic carcinoma showing exophytic growth. METHODS:A 67-year-old woman presented with a mass of 5.0 cm in diameter in the pancreatic head.Preoperative computed tomography revealed a well-demarcated, primarily solid mass with a central low-density area. Magnetic resonance cholangiopancreatography revea...