Influence of tamoxifen-medroxyprogesterone sequential therapy on estrogen and progesterone receptor contents of breast cancer

The influence of tamoxifen (TAM) and medroxyprogesterone acetate (MPA) sequential administration on the estrogen receptor (ER) and progesterone receptor (PR) contents of breast cancer was studied in 68 patients with operable breast cancer. TAM was used as a primer of PR induction in order to enhance the effects of MPA. Half of the patients (n = 34) were preoperatively treated with TAM (20 mg/day for 7 days) and sequentially with MPA (1200 mg/day for 17 (median) days). ER and PR of surgical specimens were assayed by enzyme immunoassay and the results were compared with those obtained from the other half of the patients (n = 34), who had not received any treatment before surgery. TAM-MPA treatment significantly lowered PR in the cytosol regardless of the menopausal status. On the other hand, TAM-MPA treatment significantly lowered ER in the cytosol only in the postmenopausals but not in the premenopausals. These results demonstrate that reduction of ER provoked by TAM-MPA treatment is dependent on menopausal status.     

Augmentation of anticancer effect with angiotensin II in intraarterial infusion chemotherapy for breast carcinoma

We investigated the effect of angiotensin II (AT II) on blood flow in breast cancer patients using 81mKr and found that it increased tumor blood flow 2.3-fold while decreasing blood flow in adjacent normal tissue 0.7-fold. We, then, used AT II in conjunction with intraarterial infusion chemotherapy (IAC) for locally advanced breast cancer in order to increase drug delivery to the tumor and enhance its anticancer effect. Eleven patients (from 1976-1981) received IAC with doxorubicin through the internal thoracic and subclavian arteries, alternately, for 10 days (AT II- group). Twenty-four patients (from 1981-1985) received IAC with doxorubicin and concomitant infusion of AT II (1.3 micrograms/min through the internal thoracic artery and 2.6 micrograms/min through the subclavian artery) (AT II+ group). The response rate of the primary breast tumor was higher in the AT II+ group (92%) than in the AT II- group (73%) (P = 0.66). Complete tumor necrosis was 46% in the AT II+ group, but only 27% in the AT II- group (P = 0.51). These preliminary results suggest that the anticancer effect of IAC for breast cancer can be enhanced with concomitant infusion of AT II.     

A clinicopathological study on conservative surgery and extended surgery for gastric cancer

There are two problems in conservative surgery for early gastric cancer. 1) To resect the stomach at a sufficient surgical margin, brushing cytodiagnosis of the gastric mucosa and frozen section examination at the stump are performed during operation. After all these examinations, the stomach is resected at a sufficient margin because of the possibility of multifocal cancer. 2) Regarding lymph node dissection, only N1 lymph nodes are to be removed in minute cancer (less than 5mm in diameter) which have no lymph node metastasis (0%). Thirty-one cases of Borrmann type 4 gastric cancer which underwent left upper abdominal evisceration plus Appleby's method (LUAE + Apl) were compared with 31 patients who had undergone total gastrectomy with pancreatico-splenectomy (TG) before LUAE + Apl series. The 3-year survival rate in stage II-III cases was higher with LUAE + Apl (77.8%) than with TG (35.0%). There was no difference between the two groups in the incidence of postoperative complications or the function after operation. Angiography must be performed before conducting operations by LUAE + Apl preventing liver necrosis. And for patients aged over 70, we propose to reduce the procedure of LUAE + Apl.     

A case of high-dose rate interstitial brachytherapy for locally recurrent rectal cancer

The patient was a 55-year-old female who underwent an abdomino-perineal resection for advanced lower rectal cancer. The tumor was a well differentiated adenocarcinoma, type 2 in the Japanese classification of colorectal carcinoma, and was measured 2.3 cm in size. Histologically, the tumor was considered to be stage IIIb (mp, n3(+), P0, H0, M(-)). She received adjuvant chemotherapy with 5'-DFUR. After 13 months from the surgery, the patient developed a hip pain. After 16 months from the surgery, a pelvic MRI scan revealed a 3 cm tumor in the perineum. Biopsy from the tumor revealed adenocarcinoma. Consequently, we diagnosed local recurrence in the perineum. Chemotherapy with CPT-11 (230 mg/body) and 5'-DFUR (800 mg/body) was administered for 2 cycles. Because the tumor was enlarged, high-dose rate interstitial brachytherapy was given to the recurrent site at a total dose of 54 Gy/9 fractions/5 days. There were no severe complications. CEA was decreased within normal range from a maximum of 9.3. No progress was detected on CT and MRI, and the hip pain had disappeared. The tumor marker is within normal range for about 2 years and QOL was improved. Hence, high dose rate interstitial brachytherapy appears to be effective for locally recurrent rectal cancer.