The local hyperthermochemotherapy for pleural carcinomatosis]

Local hyperthermochemotherapy was performed in 17 cases to control malignant effusion and intrathoracic disseminated lesions. Of these 15 patients, 11 cases primary lung cancer, 4 cases metastatic lung cancer had pleural carcinomatosis and 2 cases were malignant diffuse mesotheliomas. The procedure was radiofrequency hyperthermia (13.56 MHz) maintaining the peripleural temperature at 42-43 degrees C for 45-60 minutes, combined simultaneously with the intrathoracic administration of cisplatin (1-2 mg/m2, bolus) through a thoracic double lumen trocar tube. The treatment was repeated from 2 to 4 times at 7-day intervals. In 14 cases (87.5%) complete or partial response according to the criteria of the Japan Lung Cancer Society were obtained. There were 2 cases of no change and one case that was impossible to evaluate. In one lung cancer case, the disappearance of pleural disseminated lesions was confirmed by flexible thoracoscopy after the procedure. In 12 cases, there were abdominal complaints due to side effects of the hyperthermochemotherapy, such as vomiting and nausea, but these symptoms were milder than those caused by intravenous injection of anti-cancer agents, for example cisplatin, in conventional chemotherapy treatment. The median survival time and 2 years survival of the patients with the present procedure were 15 months and 41.7% respectively. Although distant metastases appeared in most cases, none had local recurrence and particularly noteworthy pleural effusion was well controlled. The above experience suggested that the local hyperthermochemotherapy is useful to control pleural effusion and can improve the quality of life of patients with pleural carcinomatosis.     

Hypogonadism of male prolactinomas: Relation to pulsatile secretion of LH: Hypogonadisms des Mannes mit Prolaktinomen: Beziehungen zur pulsatilen LH-Sekretion

In order to investigate whether a hypothalamic disorder cause hypogonadism in male prolactinomas, LH pulsatile secretion was studied in 13 male patients. Serum PRL levels ranged from 186 to 45,000 ng ml-1 before treatment, and all the tumors were macroadenomas. Reduced LH secretion was revealed in 5 of 13 patients, and FSH was reduced in 1 of 13. Serum testosterone (T) levels were lower than the normal limit in all the patients. HCG tests in 3 patients showed good responses, but the peak values of T were lower than those of normal men. LH pulsatilities were examined in 5 hyperprolactinemic patients before treatment, in 4 hyperprolactinemic patients after operation, and in 8 normoprolactinemic patients after operation and/or bromocriptine treatment. There was no significant difference of the mean LH values, the frequencies of LH pulses, and amplitudes among the hyperprolactinemic patients before operation (n = 5), the normoprolactinemic patients after operation (n = 8), and normal men (n = 7). From these results, it was evident that the hypothalamus and pituitary function of male prolactinomas were well preserved, in spite of higher serum PRL levels and larger tumor size than those reported in females. It is suggested that the main cause of hypogonadism in these patients is due to testicular dysfunction resulting from excessive serum PRL.     

Effect of circumstances and/or organs on the grade of cancer growth and malignancy

The effect of circumstances and/or organs on the grade of cancer growth and malignancy was studied, using hereditarily identical VX2 cancer. VX2 cancer cells, 10(6) cells/0.1 approximately 0.2 ml, were injected into the liver, portal vein, stomach- and colon-walls of Japanese white rabbits. Each of the experimental groups consisted of 14, 12, 19 and 24 animals, and 3 or 4 animals of each groups were sacrificed 7, 14, 21 and 28 days after the implantation. All the animals of portal vein and liver groups died of cancer within 3 and 4 weeks respectively. However, all the animals of stomach and colon groups survived during 4 weeks. Although cancer volume doubling time was not calculated in portal group because of the multiple and diffuse tumor-formation, the time was 2.6 days in liver, 4.3 days in colon and 5.9 days in stomach groups in which a single tumor developed. Lymphatic and/or hematogenous metastases were found at the same time after the implantation as vascular invasion occurred. Metastases were confirmed in 100% in liver group and 40% in portal group 2 weeks after the implantation, and 80% and 50% in colon and stomach groups respectively 4 weeks after the implantation. The results suggested that hereditarily identical VX2 cancer was variable in the different organs and circumstances, and that the growing circumstances strongly affected the cancer malignancy. It was also suggested that the malignancy was correlated with the growth rate and the time of metastasis of cancer.     

A clinicopathological study of prognostic factors in esophageal cancer

To evaluate the malignancy of esophageal cancer, we made a statistical clinicopathological study on 66 patients resected with definite operative and histological findings. The cumulative 5-year survival rate was 26.1%. By Cox's proportional hazard model depth and lymph node metastases were the prognostic factors in "Guide Lines for the Clinical and Pathological Studies on Carcinoma of the Esophagus". New histological factors for quantity idea: 1) depth judged by presence of cancer cells before irradiation; 2) intramural spreading characteristics; 3) volume of tumor measuring the infiltrating area of each layer; 4) distribution of metastatic lymph nodes set up by anatomical restriction and surgical risk; 5) number of metastatic lymph nodes. By analyzing the interaction of these 5 factors, the depth was correlated with the volume and the intramural spreading characteristics. The lymph node metastases were correlated significantly with the volume but not with the depth. The depth and the distribution of metastatic lymph nodes influenced prognosis according to Cox's proportional hazard model. Estimated survival rates of these factors were fitted to actual survival rates respectively. Postsurgical survival and adjuvant therapy may be determined by histological factor analysis.