5'-deoxy-5-fluorouridine (5'-DFUR) has a potent antitumor activity and a negligible effect on the host immune system. No previous studies have been performed on combination therapy with 5'-DFUR and biological response modifiers. In the present study, we evaluated immunochemotherapy with 5'-DFUR and a streptococcal preparation (OK-432). AH66 ascites hepatoma cells were subcutaneously injected into the backs of Donryu rats. 5'-DFUR was administered orally and OK-432 was injected intramuscularly. The tumor size, survival rate, and immune function (lymphocyte subsets in the peripheral blood and chemotactic activity of peritoneal macrophages) were examined. The results were as follows: (1) The antitumor effect and survival rate were significantly (P<0.05) better in the combination therapy group than in the 5'-DFUR group or the control group. (2) The percentage of helper T cells in the combination therapy group was significantly (P<0.05) higher than in the 5'-DFUR group. (3) The decrease of macrophage chemotactic activity in the combination therapy group and the 5'-DFUR group was negligible compared with that in the control group. These findings suggested that immunochemotherapy with 5'-DFUR and OK-432 deserved clinical assessment.
A 54-year-old woman was referred to our hospital with well differentiated adenocarcinoma of the left lung and multiple metastases to both lungs. On November 7, 1991, chemotherapy with cisplatin, vindesine, and adriamycin was started. After two courses, the metastatic lesions showed complete disappearance, while the primary tumor showed a partial response. On January 13, 1992, partial resection of the left upper lobe was performed to remove the residual primary tumor. Histologic examination of the resected specimen demonstrated degenerative carcinoma. After surgery, five more courses of chemotherapy were given. On February 2, 1993, magnetic resonance imaging of the brain showed multiple metastases. The same chemotherapy was given again and complete disappearance of the brain metastases was noted after two courses. Four additional courses of chemotherapy with cisplatin and vindesine were given. In January 1994, she had a relapse of brain metastases. Three courses of chemotherapy were given, but the metastases showed no response. Thus, more than three years after the initiation of chemotherapy, the patient is alive with brain metastases and there has been no relapse of the lung tumor.
A rare case of gastrointestinal hemorrhage due to rupture of a pseudoaneurysm into the pancreatic duct in a patient with undifferentiated carcinoma of the pancreas is described. The diagnosis was made by recognizing bleeding from the papilla of Vater at duodenoscopy and was corroborated by the findings of selective angiography and CT scanning. Review of the previously reported cases was also performed, and the pathogenesis, diagnosis, and treatment of hemosuccus pancreaticus are discussed in relation to the present case. This unusual cause of gastrointestinal bleeding should be considered when the common diseases have been excluded.
An immunohistochemical investigation of neuron-specific enolase (NSE), a specific neural isomer of the widely distributed glycolytic enzyme 2-phospho-D-glycerate hydolase, was carried out in the pancreatic tissue of 41 patients with ductal carcinoma of the pancreas. Silver staining technique for argyrophilic nucleolar organizer regions (AgNOR) was also performed, and the AgNOR count and area of each patient were calculated by computer imaging analysis. Then, the relationship between the immunohistochemical expression of NSE and the AgNOR count and area were investigated. Immunoreactivity for NSE was observed in 21 of the 41 ductal carcinomas (51.2%), and the incidence of NSE positivity was higher in tubular adenocarcinoma. The mean AgNOR count and area in the NSE positive patients were higher than those in the patients without immunoreactivity for NSE (AgNOR count: 4.71±1.09vs. 4.20±0.79; AgNOR area: 3.38±1.08μm2vs. 2.77±0.83μm2). The differences in AgNOR count and area between these groups suggest that neoplastic cells expressing NSE have a higher malignant potential than those without NSE. After postoperative deaths were excluded, we stratified the patients into two groups according to NSE immunoreactivity. Patients without NSE immunoreactivity survived longer than those with immunoreactivity. In conclusion, the NSE immunoreactivity of ductal carcinoma of the pancreas may directly reflect the malignant potential of neoplastic cells and may be a useful prognostic parameter.
We assessed the impact of two cycles of preoperative chemotherapy (OOS-B) with intraarterial doxorubicin (50mg/m2/day×2) plus intravenous cisplatin (100mg/m2) and high-dose methotrexate (300mg/kg) in 35 patients with stage II B osteosarcoma of the extremities who underwent limb-saving surgery. In 26 (74%) of the 35 patients, necrosis of over 90% of the tumor tissue was achieved by preoperative chemotherapy. The 5-year disease-free survival rate was 68.6%. Local recurrence developed in two patients (5.7%), one of whom had previously received inappropriate surgery. The 5-year continuously disease-free survival rate of good responders (>90% tumor necrosis) and poor responders (<90% tumor necrosis) was 80.8% and 33.3%, respectively, and the difference was statistically significant (P=0.003). There were no complications of intraarterial doxorubicin that were severe enough to influence the treatment program. These results suggest that preoperative chemotherapy with intraarterial doxorubicin combined with systemic adjuvant chemotherapy might improve outcome of osteosarcoma as well as making limb salvage safer and easier.