Publications by authors named "Ryuichi Nishimura"

22 Publications

  • Page 1 of 1

The anti-angiogenic agent lenvatinib induces tumor vessel normalization and enhances radiosensitivity in hepatocellular tumors.

Med Oncol 2021 Apr 21;38(6):60. Epub 2021 Apr 21.

Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.

The evaluation of angiogenesis inhibitors requires the analysis of the precise structure and function of tumor vessels. The anti-angiogenic agents lenvatinib and sorafenib are multi-target tyrosine kinase inhibitors that have been approved for the treatment of hepatocellular carcinoma (HCC). However, the different effects on tumor vasculature between lenvatinib and sorafenib are not well understood. In this study, we analyzed the effects of both drugs on vascular structure and function, including vascular normalization, and investigated whether the normalization had a positive effect on a combination therapy with the drugs and radiation using micro X-ray computed tomography with gold nanoparticles as a contrast agent, as well as immunohistochemical analysis and interstitial fluid pressure (IFP) measurement. In mice subcutaneously transplanted with mouse HCC cells, treatment with lenvatinib or sorafenib for 14 days inhibited tumor growth and reduced the tumor vessel volume density. However, analysis of integrated data on vessel density, rates of pericyte-covering and perfused vessels, tumor hypoxia, and IFP measured 4 days after drug treatment showed that treatment with 3 mg/kg of lenvatinib significantly reduced the microvessel density and normalized tumor vessels compared to treatment with 50 mg/kg of sorafenib. These results showed that lenvatinib induced vascular normalization and improved the intratumoral microenvironment in HCC tumors earlier and more effectively than sorafenib. Moreover, such changes increased the radiosensitivity of tumors and enhanced the effect of lenvatinib and radiation combination therapy, suggesting that this combination therapy is a powerful potential application against HCC.
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http://dx.doi.org/10.1007/s12032-021-01503-zDOI Listing
April 2021

[Ischemic Colitis after Closure of Temporary Ileostomy for Low Anterior Resection of Rectal Cancer in a Dialysis Patient-A Case Report].

Gan To Kagaku Ryoho 2021 Feb;48(2):279-281

Dept. of Surgery, Hachinohe City Hospital.

Dialysis patients are at increased risk of ischemic colitis and are likely to develop irreversible ischemic colitis. We report a rare case of ischemic colitis after the closure of a temporary ileostomy for low anterior resection(LAR)of rectal cancer in a dialysis patient. A 77-year-old man undergoing maintenance dialysis was diagnosed as having colorectal cancer with a type 2 tumor at the anastomosis site of high anterior resection performed for sigmoid colon cancer 14 years ago. After undergoing excision which included the anastomosis site of the previous operation, LAR with anastomosis in the transverse colon and rectum and temporary ileostomy were performed. Seven months later, closure of the temporary ileostomy was performed, which resulted in ileus and septic shock. Computed tomography(CT)revealed inflammation in the colon on the oral side of the anastomosis, which was diagnosed as ischemic colitis. Ischemic colitis did not improve with conservative treatment, and fever reoccurred at each maintenance dialysis session. Therefore, ileostomy was performed again, but multiple organ failure due to disseminated intravascular coagulopathy(DIC)progressed and he died. It is considered that Hartmann's operation should be selected for dialysis patients with serious underlying diseases, and if ischemic colitis is observed after closure of the stoma temporary colostomy in such patients, the lesion site of ischemic colitis should be excised promptly and colostomy should be performed again.
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February 2021

Chronic Active Antibody-Mediated Rejection With Donor-Specific Anti-HLA-DP Antibodies Following Living Donor Kidney Transplantation: A Case Report.

Transplant Proc 2020 Jul - Aug;52(6):1937-1939. Epub 2020 Jun 23.

Department of Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan.

Posttransplant donor-specific anti-HLA antibodies (DSA) cause chronic antibody-mediated rejection. Anti-DR and anti-DQ DSAs have especially been shown to be associated with negative graft function. In contrast, the prevalence and significance of anti-DP DSA have not been well established and remain unclear. We report a case of living donor kidney transplantation. The level of serum creatinine gradually became elevated because of chronic active antibody-mediated rejection, which was considered to be caused by anti-DP DSA. In this report, we indicate the significance of pretransplant screening for HLA-DP in donors to evaluate more comprehensively the donor specificity of posttransplant HLA antibodies.
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http://dx.doi.org/10.1016/j.transproceed.2020.02.130DOI Listing
November 2020

Risks of Living Donor Liver Transplantation Using Small-For-Size Grafts.

Transplant Proc 2020 Jul - Aug;52(6):1825-1828. Epub 2020 May 21.

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.

Background: In living donor liver transplantation (LDLT), a graft-to-recipient weight ratio (GRWR) of under 0.8 is recognized as the critical graft size. Our aim was to compare the survival rates of recipients with small-for-size grafts (SFSG: GRWR <0.8), normal-sized grafts (NSG), and large-for-size grafts (LFSG: GRWR ≥ 3.5) and to investigate the mortality risk with SFSG.

Methods: Between 1991 and April 2019, we performed 188 LDLT surgeries. Recently, we added splenectomy when portal vein pressure is high (>17 mm Hg) to interrupt the splenic bloodstream. We divided all LDLT cases retrospectively into 3 groups: an SFSG group (n = 22), NSG group (n = 154), and LFSG group (n = 12). We investigated the survival rates in these groups. Furthermore, we divided the SFSG group into 2 subgroups: an SFSG with splenectomy (SFSG+S) group (n = 7) and an SFSG without splenectomy group. We investigated the occurrence rates of lethal complications such as portal vein thrombosis, hepatic artery thrombosis, and hepatic vein thrombosis.

Results: The 5-year survival rate in the SFSG group was significantly lower (52.8%) than in the other groups (NSG: 84.5%; LFSG: 83.3%), but that of the SFSG+S group was similar (80.0%) to that of other groups. There was no difference in the occurrence of postoperative complications such as portal vein thrombosis, hepatic artery thrombosis, or hepatic vein thrombosis between the SFSG+S group and other groups.

Conclusions: Graft survival of LDLT using SFSG+S was as good as that of normal-sized grafts. Reducing portal vein pressure was important for SFSG.
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http://dx.doi.org/10.1016/j.transproceed.2020.01.136DOI Listing
November 2020

Characteristics and predictive value for graft fibrosis of the complement-binding capacity of donor-specific human leukocyte antigen antibodies after pediatric liver transplantation.

Pediatr Transplant 2020 02 29;24(1):e13648. Epub 2019 Dec 29.

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.

Background: Donor-specific HLA antibodies (DSAs) have detrimental effects on short- and long-term outcomes after organ transplantation. Despite evidence that the complement-binding capacity of DSAs has predictive power in kidney transplantation, its clinical impact during long-term follow-up after LT remains unclear. In this study, we assessed the complement-binding capacities of DSAs and their association with histological findings.

Methods: In total, 72 patients who underwent pediatric LT at our institution between July 1991 and October 2013 were retrospectively reviewed. A subgroup analysis of histological findings was performed for 37 subjects who underwent liver graft biopsy. Patients were divided into two groups based on the degree of graft fibrosis, and clinical characteristics were assessed.

Results: All anti-class I DSAs were C1q-negative. Anti-DR and anti-DQ DSAs were identified in 34% and 41% of patients, respectively; however, only three of 25 patients with anti-DR DSAs exhibited a positive C1q-binding assay, whereas, 25 of 29 anti-DQ DSAs showed C1q-binding capacity. MFI values for DSA were significantly higher for patients with C1q-binding capacity than for those without (P < .0001). Complement-binding anti-DR DSA was relatively rare in both groups. Regarding anti-DQ DSA, there were no differences between fibrosis and non-fibrosis groups, irrespective of complement-binding capacity.

Conclusions: The association between anti-DR DSA and liver fibrosis, which was supported in this cohort, was not strengthened but rather impaired when accounting for complement-binding capacity due to low positive detection. Further studies of the association between complement-binding anti-DQ DSA and histological findings in LT are needed.
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http://dx.doi.org/10.1111/petr.13648DOI Listing
February 2020

Effects of a new perioperative enhanced recovery after surgery protocol in hepatectomy for hepatocellular carcinoma.

Surg Today 2020 Jun 3;50(6):615-622. Epub 2019 Dec 3.

Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-0872, Japan.

Purpose: Enhanced recovery after surgery (ERAS) protocols are becoming the standard of care in many surgical procedures, although data on their use following hepatectomy for hepatocellular carcinoma (HCC) are scarce. This study aimed to evaluate the effects of a new ERAS pathway in terms of the patient nutrition status after hepatectomy for HCC.

Methods: This is a retrospective analysis of 97 consecutive patients treated with open or laparoscopic hepatectomy for HCC between January 2011 and August 2014. We compared the perioperative outcomes between patients whose treatment incorporated the ERAS pathway and control patients. The nutritional status was evaluated using the controlling nutritional status score.

Results: The length of hospital stay (LOS) after both open and laparoscopic hepatectomy was shorter for the ERAS group than the control group. The days of ambulation and cessation of intravenous infusion were earlier and the postoperative nutrition status was statistically better in the ERAS group than in the control group. A multivariate analysis showed that being in the non-ERAS group was a risk factor of delayed discharge. There were no marked differences in the rate of severe complications between the two groups.

Conclusions: The ERAS pathway seems feasible and safe and results in a faster recovery, reduced LOS, improved nutrition status, and fewer severe complications.
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http://dx.doi.org/10.1007/s00595-019-01930-6DOI Listing
June 2020

Intraoperative modulation of arterial blood flow in a hybrid operating room: A report of three cases.

Clin Case Rep 2019 Oct 15;7(10):1839-1843. Epub 2019 Aug 15.

Department of Surgery, Graduate School of Medicine Tohoku University Sendai Japan.

The preoperative modulation of arterial blood flow is widely performed to prevent massive intraoperative hemorrhage and unstable circulatory dynamics; however, this may cause complications. The intraoperative modulation of arterial blood flow can be performed with operation to reduce the physical and psychological stresses on the patients and improve intraoperative safety.
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http://dx.doi.org/10.1002/ccr3.2355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787820PMC
October 2019

Pediatric Living-Donor Liver Transplant Recipients without Transition After Reaching Adulthood.

Ann Transplant 2019 Jan 8;24:18-24. Epub 2019 Jan 8.

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

BACKGROUND Transition to adult care can trigger certain problems for pediatric liver transplant recipients. At our institution, the same transplant team performs both adult and pediatric liver transplantation and post-transplant care; thus, pediatric liver transplant recipients do not have to be transferred. However, it is unclear whether this system affects the recipient's outcome during the transition period. Therefore, we retrospectively assessed pediatric liver transplant recipients who reached adulthood at our institution. MATERIAL AND METHODS This was a single-center, retrospective study involving consecutive pediatric living-donor liver transplant recipients who reached the age of 18 by October 2017. A total of 36 recipients, 20 females and 16 males, were included in the study. RESULTS The 5- and 10-year patient survival after reaching the age of 18 was 100% and 93%, respectively. All of the 3 patients who died had been suffering from secondary biliary cirrhosis due to biliary stricture. In 5 patients (13.9%), biliary stricture became symptomatic or recurred after reaching the age of 18 years. Late-onset acute rejection and chronic rejection developed in 2 (5.6%) and 4 patients (11.1%), respectively. Only 4 (11.1%) patients were obviously noncompliant. We found no significant association between compliance and rejection or survival. Among the patients who are 18 years old and older, 5 (13.9%) had a psychiatric diagnosis. CONCLUSIONS Pediatric liver transplant recipients who underwent transplant surgery and received post-transplant care at our institution have good long-term outcomes. This suggests that having the same team perform both adult and pediatric transplantation and post-transplant care is beneficial for young adult recipients.
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http://dx.doi.org/10.12659/AOT.911544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338013PMC
January 2019

Surgical strategy for an adult patient with a catecholamine-producing ganglioneuroblastoma and a cerebral aneurysm: a case report.

Surg Case Rep 2018 Sep 17;4(1):119. Epub 2018 Sep 17.

Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.

Background: Ganglioneuroblastomas, particularly those that produce catecholamine, are extremely rare in adults. Here, we report an interesting surgical case of an adult patient with a catecholamine-producing ganglioneuroblastomas in her adrenal gland, suspected to be a pheochromocytoma, and with a cerebral aneurysm.

Case Presentation: The patient was a 73-year-old woman under treatment for hypertension. During a health check-up, a cystic retroperitoneal tumor was incidentally found in the superior pole of her right kidney. Her blood adrenaline level was slightly elevated, and her urinary adrenaline, noradrenaline, and dopamine levels were above the upper reference limits. In addition, 24-h urinary excretion of metanephrine, normetanephrine, and vanillylmandelic acid were all increased. 123I-Meta-iodobenzylguanidine scintigraphy showed an abnormal accumulation of the marker in the cyst wall. She was, therefore, diagnosed with a pheochromocytoma and scheduled for tumor resection. However, preoperatively, 8-mm-diameter cerebral aneurysm was incidentally found in her basilar artery. This required careful preoperative discussion. The aneurysm was difficult to approach and treat, and based on its position, shape, and size, the risk of rupture was low. Because hypertension is a major risk factor for aneurysmal rupture, we decided to proceed with the tumor resection. A lumbar catheter was placed to monitor the cerebral aneurysm for intraoperative rupture, and her transcranial motor-evoked potential and somatosensory-evoked potentials were monitored to track her intraoperative neurological function. During surgery, we carefully monitored fluctuations in blood pressure and resected the tumor with minimal mobilization. Postoperatively, head computed tomography confirmed that there was no sign of rupture. Histopathologically, the tumor was diagnosed as a catecholamine-producing ganglioneuroblastoma. The postoperative course was good, and the patient's blood pressure improved.

Conclusions: Careful perioperative management is needed for a patient with both a catecholamine-producing tumor and cerebral aneurysm.
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http://dx.doi.org/10.1186/s40792-018-0529-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141414PMC
September 2018

Amyand's hernia complicated with appendix perforation treated by two-stage surgery consisting of laparoscopic appendectomy followed by elective inguinal hernioplasty: A case report.

Int J Surg Case Rep 2018 21;47:11-13. Epub 2018 Apr 21.

Department of Surgery, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami-shi, Iwate 024-8507, Japan.

Introduction: An inguinal hernia with an incarcerated appendix is defined as Amyand's hernia, and it is relatively rare. Amyand's hernia complicated with appendicitis, especially perforated appendicitis, is even rarer. Postoperative surgical site infection (SSI) is a dangerous complication, especially in Amyand's hernia with appendix perforation. The selection of an appropriate surgical approach is necessary to prevent postoperative SSI. Here, we report a case of Amyand's hernia complicated with appendix perforation that was successfully managed using a two-stage surgical approach consisting of laparoscopic appendectomy followed by elective inguinal hernioplasty.

Presentation Of Case: A 70-year-old male presented with fever and right lower quadrant pain from the day before. After the patient was diagnosed with acute appendicitis within a right inguinal hernia, emergency laparoscopy was performed. The appendix was incarcerated in the right internal inguinal ring and perforated at the base. We decided to take a two-stage surgical approach to avoid postoperative SSI and performed only laparoscopic appendectomy. No postoperative complications occurred. Inguinal hernioplasty was performed 1 month after the first operation. There were no adhesions in the preperitoneal space, and no adverse events occurred postoperatively.

Conclusions: A two-stage surgical approach consisting of laparoscopic appendectomy followed by elective inguinal hernioplasty was used successfully to treat Amyand's hernia complicated with appendix perforation without causing postoperative SSI.
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http://dx.doi.org/10.1016/j.ijscr.2018.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994868PMC
April 2018

Treatment of nonocclusive mesenteric ischemia with type B aortic dissection using intra-arterial catheterization after trauma surgery: case report.

Surg Case Rep 2018 Jan 8;4(1). Epub 2018 Jan 8.

Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.

Background: Nonocclusive mesenteric ischemia (NOMI) is a mesenteric arterial spasm and intestinal ischemia. This disease is a highly lethal disease because diagnosis and decision of appropriate treatments are often difficult. Operations cannot resolve the spasms and may worsen the situation. However, the safety and effectiveness of catheterization for NOMI with aortic dissection (AD) have not yet been elucidated. Here, we report a successful case of early diagnosis and treatment of NOMI with type B AD involving the superior mesenteric artery (SMA) using the intra-arterial infusion of a vasodilator via the SMA.

Case Presentation: An 83-year-old man was admitted to our hospital because of abdominal pain after a motor accident. We performed intestinal resection and splenectomy for intestinal perforation and splenic hemorrhage and treated conservatively for acute AD, liver injury, renal hematoma, and pneumothorax. On postoperative day (POD) 2, the patient had localized abdominal pain. Follow-up computed tomography suggested a smaller superior mesenteric vein sign and segmental lack of enhancement in the intestinal wall and ascites without SMA occlusion. Thus, the patient was diagnosed with NOMI. Although the patient had type B AD including the SMA, we performed selective mesenteric arteriography and transcatheter papaverine infusion via the SMA and prostaglandin via the peripheral vein. Seven days post treatment, mesenteric blood flow improved and intestinal wall enhancement was restored.

Conclusion: The intra-arterial infusion of a vasodilator is highly efficient and safety treatment option for NOMI with type B AD. Prompt and accurate management can prevent massive small bowel resection, and this procedure is essential in resolving a spasm independent of whether a necrotic bowel has been resected.
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http://dx.doi.org/10.1186/s40792-017-0412-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758487PMC
January 2018

Radiation therapy for nasopharyngeal carcinoma: the predictive value of interim survival assessment.

J Radiat Res 2016 Sep 29;57(5):541-547. Epub 2016 May 29.

Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.

Pretreatment characteristics are suggested as predictive and/or prognostic factors for nasopharyngeal carcinoma (NPC); however, individual tumor radiosensitivities have previously not been considered. As boost planning is recommended for NPC, we performed interim assessments of magnetic resonance (MR) images for boost planning and retrospectively evaluated their predictive value for the survival of NPC patients. Radiation therapy via elective nodal irradiation (median dose: 39.6 Gy) with/without chemotherapy was used to treat 63 NPC patients. Boost irradiation (median total dose: 70 Gy) was performed based on the interim assessment. The largest lymph node (LN) was measured on MR images acquired at the time of interim assessment. The site of first failure was local in 8 (12.7%), regional in 7 (11.1%), and distant in 12 patients (19.0%). All 7 patients with regional failure harbored LNs ≥15 mm at interim assessment. We divided the 63 patients into two groups based on LN size [large (≥15 mm), n = 10 and small (<15 mm), n = 53]. Univariate analysis showed that 5-year overall survival (OS) and cause-specific survival (CSS) rates for large LNs were significantly lower than for small LNs (OS: 12.5% vs 70.5%, P < 0.001 and CSS: 25.0% vs 80.0%, P < 0.001). Multivariate analysis showed that large LNs were a significantly unfavorable factor for both OS (hazard ratio = 4.543, P = 0.002) and CSS (hazard ratio = 6.020, P = 0.001). The results suggest that LN size at interim assessment could predict survival in NPC patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045073PMC
http://dx.doi.org/10.1093/jrr/rrw038DOI Listing
September 2016

Tacrolimus inhibits the revascularization of isolated pancreatic islets.

PLoS One 2013 17;8(4):e56799. Epub 2013 Apr 17.

Division of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan.

Aims: Immunosuppressive drugs could be crucial factors for a poor outcome after islet allotransplantation. Unlike rapamycin, the effects of tacrolimus, the current standard immunosuppressant used in islet transplantation, on graft revascularization remain unclear. We examined the effects of tacrolimus on islet revascularization using a highly sensitive imaging system, and analyzed the gene expression in transplanted islets by introducing laser microdissection techniques.

Methods: Islets isolated from C57BL/6-Tg (CAG-EGFP) mice were transplanted into the nonmetallic dorsal skinfold chamber on the recipients. Balb/c athymic mice were used as recipients and were divided into two groups: including a control group (n = 9) and tacrolimus-treated group (n = 7). The changes in the newly-formed vessels surrounding the islet grafts were imaged and semi-quantified using multi-photon laser-scanning microscopy and a Volocity system. Gene expression in transplanted islets was analyzed by the BioMark dynamic system.

Results: The revascularization process was completed within 14 days after pancreatic islet transplantation at subcutaneous sites. The newly-formed vascular volume surrounding the transplanted islets in the tacrolimus-treated group was significantly less than that in the control group (p<0.05). Although the expression of Vegfa (p<0.05) and Ccnd1 (p<0.05) was significantly upregulated in the tacrolimus-treated group compared with that of the control group, no differences were observed between the groups in terms of other types of gene expression.

Conclusions: The present study demonstrates that tacrolimus inhibits the revascularization of isolated pancreatic islets without affecting the characteristics of the transplanted grafts. Further refinements of this immunosuppressive regimen, especially regarding the revascularization of islet grafts, could improve the outcome of islet allotransplantation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0056799PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629082PMC
November 2013

Radiation therapy for lymph node metastases from hepatocellular carcinoma.

Hepatogastroenterology 2009 Mar-Apr;56(90):476-80

Department of Radiation Oncology, Kumamoto University Hospital, Japan.

Background/aims: Recent improvements in the prognosis of patients with hepatocellular carcinoma (HCC) render the discovery and treatment of lymph node (LN) metastasis increasingly important. We retrospectively evaluated the treatment outcomes of radiation therapy (RT) for LN metastases from HCC.

Methodology: Twenty-three patients with LN metastases from HCC underwent RT. A daily dose of 1.8-4 Gy was administered to deliver a total dose of 28-56 Gy, which was a biologic effective dose (BED) of 36-67.2 Gy10 (median 58.5 Gy10) with an alpha/beta ratio of 10. We evaluated predictive factors for local control and survival.

Results: A complete response and partial response were recorded for 5 and 14 patients, respectively. The response rate was 83%; it was significantly higher in patients who had received > or =58 Gy10 rather than <58 Gy10 (P = 0.014). The median survival time was 19 months. Univariate analysis revealed that the Child-Pugh's classification, status of the liver tumor, and LN metastasis site were significant factors for survival. Multivariate analysis showed that the status of the liver tumor was the only independent predictor of survival.

Conclusions: RT is effective for the local control of LN metastases from HCC without a confirmed survival effect. RT doses greater than 58 Gy10 are required for a better local response.
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August 2009

Usefulness of diffusion-weighted imaging in the localization of prostate cancer.

Int J Radiat Oncol Biol Phys 2009 Jun 18;74(2):399-403. Epub 2008 Nov 18.

Department of Radiology, Kumamoto Chuo Hospital, Japan.

Purpose: Advances in high-precision radiation therapy techniques for patients with prostate cancer permit selective escalation of the radiation dose delivered to the dominant intraprostatic lesion and improve the therapeutic ratio. We evaluated the value of diffusion-weighted imaging (DWI) for dominant intraprostatic lesion assessment.

Methods And Materials: The study population consisted of 23 patients with early prostate cancer. Before undergoing total prostatectomy, they were evaluated by means of magnetic resonance imaging, including DWI. T2-weighted imaging (T2WI) with and without DWI were retrospectively assessed by six independent observers. Imaging findings were compared with pathologic results from whole prostate specimens on a lesion-by-lesion basis.

Results: Pathologic study identified 43 lesions in 23 patients. On magnetic resonance imaging, the six observers correctly identified 11-22 of 43 lesions (sensitivity, 26-51%) on T2WI alone and 20-31 (sensitivity, 47-72%) on T2WI plus DWI. Positive predictive values were 42-73% on T2WI alone and 58-80% on T2WI plus DWI. For all observers, detection was higher on combined T2WI and DWI than on T2WI alone.

Conclusion: Because the addition of DWI to T2WI improves the detectability of prostate cancer, DWI may offer a promising new approach for radiation therapy planning.
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http://dx.doi.org/10.1016/j.ijrobp.2008.08.017DOI Listing
June 2009

Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma.

Radiother Oncol 2007 Sep 22;84(3):266-71. Epub 2007 Aug 22.

Department of Radiation Oncology, Kumamoto University Hospital, Honjo, Kumamoto, Japan.

Background And Purpose: The prognosis of patients with portal vein tumor thrombosis (PVTT) from hepatocellular carcinoma (HCC) is poor; without treatment, their survival is less than 3months. We retrospectively evaluated the treatment outcomes of conformal radiation therapy (CRT) in patients with HCC-PVTT.

Materials And Methods: Thirty-eight HCC patients with PVTT in whom other treatment modalities were not indicated underwent CRT. The total dose was translated into a biologic effective dose (BED) of 23.4-59.5Gy(10) (median 50.7Gy(10)) as the alpha/beta ratio=10. Predictive factors including the age, performance status, Child-Pugh classification, PVTT size, and BED were evaluated for tumor response and survival.

Results: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 6 (15.8%), 11 (28.9%), 17 (44.7%), and 4 (10.5%) patients, respectively. The response rate (CR+PR) was 44.7%. The PVTT size (<30 vs. 30mm) and BED (<58 vs. 58Gy(10)) were significant factors for tumor response. The median survival and 1-year survival rate were 9.6months and 39.4%. The Child-Pugh classification (A vs. B) and BED were significant factors for survival.

Conclusions: CRT is effective not only for tumor response but also for survival in HCC-PVTT patients in whom other treatment modalities are not indicated.
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http://dx.doi.org/10.1016/j.radonc.2007.07.005DOI Listing
September 2007

Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma.

Int J Radiat Oncol Biol Phys 2007 Jun 22;68(2):377-82. Epub 2007 Feb 22.

Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.

Purpose: To evaluate the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging on nodal staging for head-and-neck squamous cell carcinoma (SCC).

Methods And Materials: The study population consisted of 23 patients with head-and-neck SCC who were evaluated with FDG-PET/CT and went on to neck dissection. Two observers consensually determined the lesion size and maximum standardized uptake value (SUVmax) and compared the results with pathologic findings on nodal-level involvement. Two different observers (A and B) independently performed three protocols for clinical nodal staging. Methods 1, 2, and 3 were based on conventional modalities, additional visual information from FDG-PET/CT images, and FDG-PET/CT imaging alone with SUV data, respectively.

Results: All primary tumors were visualized with FDG-PET/CT. Pathologically, 19 positive and 93 negative nodal levels were identified. The SUVmax overlapped in negative and positive nodes <15 mm in diameter. According to receiver operating characteristics analysis, the size-based SUVmax cutoff values were 1.9, 2.5, and 3.0 for lymph nodes <10 mm, 10-15 mm, and >15 mm, respectively. These cutoff values yielded 79% sensitivity and 99% specificity for nodal-level staging. For Observer A, the sensitivity and specificity in Methods 1, 2, and 3 were 68% and 94%, 68% and 99%, and 84% and 99%, respectively, and Method 3 yielded significantly higher accuracy than Method 1 (p = 0.0269). For Observer B, Method 3 yielded the highest sensitivity (84%) and specificity (99%); however, the difference among the three protocols was not statistically significant.

Conclusion: Imaging with FDG-PET/CT with size-based SUVmax cutoff values is an important modality for radiation therapy planning.
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http://dx.doi.org/10.1016/j.ijrobp.2006.12.032DOI Listing
June 2007

Concurrent chemoradiation therapy with low-dose CDDP and UFT for glottic carcinomas: evaluation using the sixth edition of the UICC TNM staging system.

Acta Oncol 2006 ;45(2):162-7

Department of Radiation Oncology, Kumamoto University Hospital, Japan.

We evaluated whether low-dose chemotherapy could improve effects of radiation therapy for glottic carcinoma with different prognostic factor based on the UICC 6th edition. Fifty-one patients with T2N0 glottic carcinoma classified by the UICC 5th edition underwent chemoradiation therapy with low-dose CDDP (4 mg/m(2)) and oral UFT (450 mg of tegafur) continuing for four weeks (CRT group). The historical control consisted of 49 patients treated with radiation therapy alone (RT group). Forty-six tumors with the adjacent sign, i.e. tumors located adjacent to the thyroid cartilage on radiological examinations, were classified as T3 according to the 6(th) edition. The 5-year local control and laryngeal preservation rates of the T2 (n=54) vs. T3 (n=46) lesions were 87% vs. 50% (p<0.0001) and 94% vs. 61% (p<0.0001), respectively. Among the T3 lesions, CRT (n=24) yielded significantly higher laryngeal preservation rates than did RT alone (n=22) (83% vs. 40%, p=0.0063), and the local control rates were higher in the CRT- than the RT group (62% vs. 36%, p=0.0882). While such benefits of CRT were not observed in patients with T2 lesions.
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http://dx.doi.org/10.1080/02841860500490269DOI Listing
July 2006

Prognostic factors of glottic carcinomas treated with radiation therapy: value of the adjacent sign on radiological examinations in the sixth edition of the UICC TNM staging system.

Int J Radiat Oncol Biol Phys 2005 Feb;61(2):471-5

Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan.

Purpose: To evaluate the predictive value of the adjacent sign, the tumor adjacent to the thyroid cartilage on radiologic examinations, in the new sixth edition of the International Union Against Cancer (UICC) staging system of glottic carcinoma.

Methods And Materials: Between 1989 and 1998, 130 patients with T1-2N0 glottic squamous cell carcinoma, classified according to the fifth edition of the UICC staging system and evaluated by computed tomography or magnetic resonance imaging, were treated with radiation therapy (RT). Factor analysis included clinical, radiologic, and treatment characteristics. Tumors with the adjacent sign, considered representative of paraglottic space invasion with or without minor thyroid cartilage erosion, were retrospectively classified as T3-stage tumors by the UICC sixth edition.

Results: The 5-year local control rate after RT was 76%. Univariate analysis showed that the T stage according to the UICC fifth edition, supraglottic extension, subglottic extension, tumor size, adjacent sign, total dose, fraction size, field size, and overall treatment time were significant factors for the local control rate. Multivariate analysis confirmed the adjacent sign as the only independent predictor. According to the UICC sixth edition, the 5-year local control, laryngeal preservation, cause-specific survival, and overall survival rates of the T3 (adjacent sign-positive) vs. T1 and T2 (adjacent sign-negative) lesions were 37% vs. 87% (p < 0.0001), 47% vs. 95% (p < 0.0001), 75% vs. 99% (p < 0.0001), and 54% vs. 81% (p = 0.0180), respectively.

Conclusion: Factor analysis confirmed the adjacent sign as an independent prognostic factor. The UICC sixth edition appears to identify correctly patients with T3 lesions as a high-risk group.
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http://dx.doi.org/10.1016/j.ijrobp.2004.05.024DOI Listing
February 2005

[Survival of glottic carcinoma patients treated with definitive radiation therapy: value of the Sixth edition of the UICC TNM staging system].

Nihon Igaku Hoshasen Gakkai Zasshi 2004 Nov;64(8):570-4

Department of Radiation Oncology, Kumamoto University Hospital.

Purpose: To evaluate the survival of glottic carcinoma patients treated with radiation therapy (RT). The predictive value of the new sixth edition of the UICC staging system was also evaluated.

Methods And Materials: 193 patients with T1-2N0 glottic squamous cell carcinoma, classified according to the fifth edition of the UICC staging system, were treated with definitive RT. Of them, 130 patients evaluated with pretreatment radiological examinations (CT and/or MR) were retrospectively classified according to the UICC sixth edition.

Results: According to the UICC fifth edition, 132 lesions were staged as T1 and 61 as T2. Thirty lesions were categorized as stage T3 according to the UICC sixth edition. Of all patients, 13 died of glottic carcinoma, 25 of second malignancy, and 20 of intercurrent disease. Second primary sites included lung (n=8), esophagus (n=4), liver (n=4), pancreas (n=3), and others (n=6). The 10-year overall survival rate was 66%, and cause-specific survival rates of glottic carcinoma and second malignancy were 91% and 86%, respectively. Multivariate analysis confirmed T-stage in the UICC sixth edition as an independent predictor for death from glottic carcinoma. Although there were no significant factors for second malignancy, there was no death from second malignancy in non-smoking patients.

Conclusion: Second malignancy was the most frequent cause of death, and an association with smoking was suggested. The UICC sixth edition appears to correctly identify patients with T3 lesions as a high-risk group not only for local failure but also for survival.
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November 2004

Intraarterial infusion chemotherapy for head and neck cancers: evaluation of tumor perfusion with intraarterial CT during carotid arteriography.

Radiat Med 2004 Jul-Aug;22(4):254-9

Department of Radiology, Kumamoto University School of Medicine, JAPAN.

Purpose: To evaluate drug distribution in carcinomas of the head and neck region with CT during intraarterial contrast-material injection for superselective intraarterial infusion of anti-cancer agents, and to evaluate perfusion in the carcinomas with intraarterial dynamic CT, using a combined CT and angiography system.

Materials And Methods: Twenty-three consecutive patients underwent conventional angiography as well as intraarterial injection CT using a combined CT and angiography system. Contrast material enhancement on intraarterial CT images was evaluated qualitatively and quantitatively with the following parameters: enhanced pattern, delineation and extent of tumor, peak CT value, peak time, maximum inclination of wash-in and washout, and transfer index (k) using a Patlak plot method. After the feeding vessels had been identified by enhancement of the tumor on CT of the selected vessel, relatively low-dose cisplatin was injected through the microcatheter placed in each artery depending on tumor location. Histopathologic effects were evaluated after surgery and compared with CT findings.

Results: In the qualitative evaluation, tumors showed early, strong enhancement as well as rapid washout compared with the adjacent normal tissues, and dynamic CT was useful for evaluation of the extent of the tumor. When multiple feeders existed, the dose of cisplatin for each feeder could be determined by the percentage of tumor enhanced with CT on each vascular injection. The mean values of quantitative parameters, however, were not significantly different between the good and poor response groups.

Conclusion: Intraarterial CT was useful for evaluation of the arterial supply and drug distribution of the tumor. However, quantitative data did not provide additional information for prediction of the treatment effect. This might indicate that the effectiveness of intraarterial chemotherapy is not directly related to the perfusion of head and neck cancers.
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November 2004

[Clinical evaluation of esophageal cancer complicated with head and neck cancer].

Nihon Igaku Hoshasen Gakkai Zasshi 2003 Mar;63(4):148-53

Department of Radiology, Kumamoto University School of Medicine.

We prospectively investigated endoscopic findings of the upper digestive tract in patients with head and neck (H & N) cancer, from 1992 to 2001. Of 687 patients with H & N cancer, esophageal cancers were found to affect 74 patients (10.8%). The 74 patients consisted of 49 (66.2%) with the superficial type and 25 (33.8%) with the advanced type. Other additional cancers were detected in 32 cases (4.7%), including 21 gastric cancers. The incidence was highest in patients with hypopharyngeal cancer (32.4%), whereas the incidences in those with oral floor cancer and mesopharyngeal cancer were 14.3% and 13.1%, respectively. The incidence of stage I cancers was lower than that of stage II, III, or IV cancers. Therapy for superficial esophageal cancers consisted of trisection for endoscopic mucosal resection (EMR), surgery, and no treatment. Surgery, radiation therapy, or no treatment was selected in advanced type. For double cancers of H & N and esophagus, treatment should be selected in consideration of the prognosis of the disease. These findings suggest that endoscopy with the Lugol-spraying method should be performed in H & N cancers for early detection of esophageal cancers.
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March 2003