13542 Background: Since the advent of various novel (molecular target) agents, it has been inevitable to reassure the dose regimen of 5-FU, a key drug in CRC. Recently, we have achieved good clinical benefits and cost-effectiveness in the treatment of CRC using ‘Pharmacokinetic Modulating Chemotherapy (PMC)’, which was designed as a hybrid of lower continuous (metronomic) and higher shorter plasma 5-FU concentration (Cancer 89: 1228, 2000, Cancer Res 61:1029, 2001, Proc ASCO 22: 1175, 2003). To establish a safer and more efficacious dose and scheduling of 5-FU administration from the perspective of cell cycle regulation, we investigated their anti-tumor efficiency by dose-enhancement and drug holidays, and the adverse events. Methods: First, weekly PMC regimens with or without dose-intensification and drug holidays were designed according to the mathematical model, and, then, experimented on the cell growth in vitro. Secondly, we assessed the clinical effects of the PMC regimens between “Tsunami 7” without drug holidays and “Tsunami 5” with a 2-day break (d 5–6) before a 1-day intensification (d 7), in Dukes’ B or C CRC patients (n=179), by the end-points of adverse events and 5-yr disease-free survival (DFS). Results: Adding 24-hr pharmacokinetic modulation by higher-dose intensification to the existing lower continuous (metronomic) formula succeeded in abrogation of the cell cycle block, leading to a nip in the steady tumor growth in vitro. Furthermore, setting of drug holidays seemed to change the cell cycle in favor of maximization of the targeted fraction. The clinical outcome of “Tsunami 5” regimen showed a tendency of less adverse events and improved 5-yr DFS than that of “Tsunami 7” (85% vs 75%, P=0.113). Conclusions: These results suggest that weekly 5-FU administration with a 2-day break before a 1-day intensification can be acceptable as an outpatient clinic first- line option because of reduced adverse events and maintained efficacy. Availability of efficacious chemotherapy reproduced by only oral agents (e.g. fluoropyrimidine, and leucovorin) mimicking the pharmacokinetics in this cell-cycle-oriented dose-dense “Tsunami” regimen would be beneficial for many cancer patients. No significant financial relationships to disclose.
Primary cancer of the caudate lobe as well as rare metastatic caudate lobe cancer are expected to have poor prognosis because the anatomical specificity of the caudate lobe. We experienced a resected single metastasis in the caudate lobe from a colonic cancer. A 62-year-old male who had undergone total colectomy for multiple colorectal cancers 24 months before was found to have a 4cm mass lesion in the caudate lobe by ultrasonography. The mass was adjacent to the middle hepatic vein and left portal vein. The patient underwent an extended left lobectomy and caudate lobe resection under preparation of IVC shunt. Intensive hepatic arterial chemotherapy (5-FU+CDDP) was performed after the operation. Five cases of resected single caudate lobe metastasis from colonic cancer have been reported. Four of them had a recurrence in the residual liver and none of them survived for 3 years after the resection of the caudate lobe. Caudate lobe metastasis, adjacent to the main vessels, may possiblely spread to other liver tissue secondarily. We think that the co-resection of the hepatic lobe adjoining to the caudate lobe tumor should be performed in terms of probable intrahapatic extension of the tumor, surgical tecnhique and hepatic functional reserve and intensive adjuvant therapy should be added for the residual liver.
We report a case of multiple liver metastasis from ileac carcinoid treated with continuous intraarterial infusion of somatostatin analog. A 65-year-old man who complained of chest pain was admitted to Yamaguchi University Hospital School of Medicine for further examination of cardiac angina. Liver tumors, which were detected during ECHO cardiogram examination, were diagnosed as metastasis from carcinoid by percutaneous transhepatic liver biopsy. Primary tumor was found at the ileum by colonofiberscopy. We performed ileo-cecal resection and catheterization from the gastroduodenal artery for intraarterial chemotherapy under laparotomy. After the operation, the patient was treated with continuous intraarterial infusion of somatostatin analog (100 micrograms/day, 5 days/week for 16 weeks). The tumor in segment 6 (S6) disappeared, but the tumor in S2 enlarged after the therapy. Hepatic angiography confirming the drug distribution demonstrated the occlusion of the left hepatic artery. This drug was thus distributed to the tumor in S6 but not in S2. These results suggest that somatostatin analog may have a direct anti-tumor effect. Furthermore, no side effect was observed. Thus, intraarterial infusion of somatostatin analog may be a useful therapy for liver metastasis from carcinoid.
The ubiquitous network is, in a sense, the ultimate goal of communication services. As the desire for ubiquitous network becomes increasingly clear, network service providers are anticipated to develop a high performance network infrastructure for providing larger capacity and more flexible communication services. If such a communication infrastructure can be constructed inexpensively while retaining scalability, it should present a new business opportunity for network service providers. This paper presents a new network infrastructure that merges optics with IP, and then studies how to realize the infrastructure and what the component technologies are. In addition, this paper takes a look at the network elements that comprise an optical-IP merged network and services.
Monolithic path control and protection in a multi-layer optical network have been successfully demonstrated using a newly developed automatic-hierarchical-path-setup mechanism and protection mechanism. Fast recovery within 30 msec and efficient resource utilization were achieved in a 32-node test system
Fourteen patients who had liver metastases from breast cancer were treated with trans-arterial chemo-embolization (TACE) or intra-arterial chemotherapy via percutaneously inserted catheters. The patients were divided into two groups: Group A: Long-term survivors who lived longer than three years; and Group B: Short-term survivors who died within three years. Then we compared them based on the background factors, efficacy of intra-arterial chemotherapy, and so on. There was a tendency that Group A had a longer disease-free interval and took more time to formulate liver metastases than that of Group B. All of the four patients of Group A are alive, and the longest survivor is living six years and four months after being diagnosed with liver metastases. In Group B, every patient died from liver failure, but one had died from respiratory failure. The objective response rate was 38.5%, and four of the five responders were long-term survivors. Therefore, it is possible that a good prognosis can be obtained when the hepatic arterial infusion chemotherapy effectively controls liver metastases that regulate life.
