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Intramedullary spinal cord metastasis(ISCM)often causes spinal cord neuropathy and should be treated as an oncologic emergency. However, it recurs in most cases after treatment, ISCM is a disease with a very unfavorable prognosis. Herein, we report a successfully treated case of ISCM with emergent and high-dose radiotherapy. A 53-year-old woman had difficulty walking without assistance 2 years after surgery for ovarian cancer. She received emergent radiotherapy at a total dose of 50 Gy in 25 fractions. Her neurological symptoms dramatically improved over 3 weeks after radiotherapy. ISCM has been controlled using the imaging tests at 5 years after radiotherapy. We believe that both emergent and high-dose radiotherapy were effective for ISCM.

A 34-year-old woman was referred to our hospital with ileus. She had undergone surgical resection following chemotherapy for yolk sac tumor at the age of 12 years, and had received additional surgery and radiation therapy for a local recurrence at age 13. Following evaluation, a sigmoid colon tumor was detected and was surgically resected. Histology proved well differentiated adenocarcinoma with chronic irradiation colitis, suggesting that irradiation may have induced the colon cancer.

Gynecologic cancers have been mainly treated by surgery and radiotherapy. Recently, many antineoplastic medications are available and chemotherapy becomes an important therapeutic method in the treatment of cervical, endometrial and ovarian cancer. Platinum derivatives, taxanes, alkylating agents and irinotecan are usually used. Because these chemotherapeutic agents have many toxicities such as myelo-suppression, hypersensitivity reaction, nausea, vomiting and diarrhea, the treatment was scheduled for an inpatient setting. During the recent 10 years, new chemotherapeutic agents without severe toxicity were applied and effective supportive therapies to prevent toxicity were investigated. Under these conditions, chemotherapy in an outpatient setting is available and an Outpatient Chemotherapy Center was established at Kitasato University Hospital. Patients with gynecologic cancers mainly receive weekly chemotherapeutic regimen at the Outpatient Chemotherapy Center and the number is increasing gradually. For safe and comfortable outpatient chemotherapy, it is important to control regimens and to go into partnership with co-medicals.

A 24-year-old female who had received hysterectomy and adnexectomy of bilateral appendages for yolk sac tumor at the age of 12 years, followed by repeated surgery and pelvic irradiation over a total of 100 Gy for relapse of tumor, suffered from a severely contracted bladder and renal dysfunction of serum creatinine level over 2.0 mg/dl. The diagnosis was radiation-induced contracted bladder with renal dysfunction due to vesicoureteral reflux. Since the small intestine was not considered suitable after high dose irradiation, the stomach was used to reconstruct the bladder. The vesical pressure, which was 70 cmH2O at the capacity of 30 ml, was decreased to 22 cmH2O at the capacity of 100 ml, 5 weeks after surgery. The renal function was stable with a serum creatinine level below 1.4 mg/dl and the bladder capacity was 200 ml, 15 months after surgery. This method using the stomach was considered valuable for bladder reconstruction after large dose pelvic irradiation.

The Gunma Prefectural Society for Study of Chemotherapy for Gynecological Cancer made a comparative study on postoperative supplementary chemotherapy including UFT and FT-E for gynecological malignant tumors. The number of cases registered totaled 182, which was broken down into ovarian cancer 53 cases, uterine cervical cancer 89 cases and endometrial cancer 30 cases. Complete cases among them consisted of ovarian cancer 53 cases, uterine cervical cancer 86 cases and endometrial cancer 27 cases for a total of 166 cases. Ovarian cancer was stratified into the completely and incompletely removed cases, uterine cervical cancer into postoperative non-irradiated and irradiated cases and endometrial cancer into the positive metastasis (+) group and negative metastasis (-) group. Then the UFT administration group and FT-E administration group were compared for postoperative survival. There were control groups for both ovarian and endometrial cancer. UFT administration showed a significant improvement in the survival rate (P < 0.05) compared to the FT-E administration group in the cases of ovarian cancer completely removed and the cases of endometrial cancer irradiated after operation. No significant difference was observed between other groups compared. The incidence of side effects was 20.6% (20/97) in the UFT administration group and 3.6% (2/55) in the FT-E group. Neither group showed any serious side effects.

From 1986 to 1992, seventeen patients with recurrent intrapelvic malignancies have been treated with intraoperative radiotherapy (IOR) in Saitama Cancer Center. They were 8 males and 9 females. The age ranged 44 to 83 (mean:61.6). The primary organs involved were rectum in 7, urinary bladder in 5, uterine cervix in 3 and ovary in 2. Invasion of recurrent disease into bony pelvis was noted in all but one patient. A total of 27 IORs were done on 18 occasions for 17 patients. The mean radiation dose was 25.6 Gy (range: 12-30). The cones used were 4 to 7 (mean: 5.4) cm in diameter. Debulking surgery was performed in 13 patients just before IOR. Chemotherapy and/or external radiotherapy were done in addition to IOR in most of the cases. As of May 1992, 14 patients had died with a mean survival time of 10 months (range:0.5-29.8). IOR seems to be useful in controlling the intrapelvic recurrent disease and may warrant further investigation.

Thirty-six patients with ovarian endometriosis were treated with Nd:YAG laser contact irradiation under laparoscopic control. Indications for laparoscopy were infertility (n = 20) and dysmenorrhea (n = 16). The laparoscopic procedures so far undertaken in our clinic include: Aspiration of chocolate cyst, removal of ovarian endometriosis, adhesion-lysis, uterine nerve ablation, coagulation of peritoneal endometriosis and irrigation. No complications were seen. After undergoing this procedure, eight of 20 patients achieved pregnancy and 15 of 16 patients obtained pain relief. Serum CA125 levels were significantly decreased postoperatively. We confirmed that contact irradiation with a cone-shaped sapphire probe provides adequate incision and lysis at lower power levels, and that this method is an effective treatment for ovarian endometriosis.

D-glucose absorption in vivo in mice decreased as a function of dose and time after irradiation returning to normal within a week after irradiation. The lamina propria is seen full of polymorphonuclear leukocytes, other infiltrative cells, capillary and lymphatic network, which seem closely related to chronic enteritis. Since acute and chronic diarrhea after irradiation can be reduced by cholestyramine or acetylsalicylate, malabsorption of bile salts or prostaglandin E of the luminal content has been regarded as a cause of radiation-induced diarrhea. LD 50 of irradiated mice was increased by SOD. From the clinical data, thin physique, previous operation, and total dose of more than 50 Gy could be predisposing factors of radiation-related enteritis.

We report a 47-year-old woman who developed a slowly progressive lumbosacral plexopathy with mixed sensorimotor losses in the lower extremities. The symptoms were apparent 8 years after x-ray irradiation for an ovarian carcinoma. Neurological examination showed mild weakness and absent deep tendon reflexes of bilateral lower extremities, and hypesthesia to all modalities in anterior aspects of bilateral lower thighs, in dorsum pedis and soles. Extensive investigations regarding the possibility of tumor recurrence were negative. Computed tomography of pelvis showed abnormal soft tissue densities around the lumbosacral plexus. Intravenous pyelography showed bilateral hydronephrosis and narrowed ureters at the first sacral vertebra level. These findings are consistent with radiation-induced fibrosis rather than tumor infiltration. The results suggest the entrapment lumbosacral plexopathy due to surrounding fibrosis after irradiation. We speculated the sensorimotor losses caused by entrapment of the lumbosacral plexus.

One hundred seventeen patients with postoperative ovarian cancer who were treated with whole abdominal irradiation by the open-field technique were analyzed as to the effectiveness of combined therapy with or without OK-432. OK-432, 0.2 to 2.0 (KE) (kev) daily, has been used to prevent bone marrow suppression since 1978 at NIRS. Cumulative five-year survival rates were 63.6% in the OK-432 group (37 patients) and 54.5% in the NON-OK-432 group (34 patients). The complete rates of previously arranged treatment schedules were 81% and 66% in the two groups, respectively, as we originally intended.

As a treatment for malignant ovarian tumor, whole abdominal irradiation including the upper abdomen is more useful. Between December, 1975 and November, 1980, we additionally applied whole abdominal irradiation by the moving strip technique (1,600 rad) after operation and whole pelvic irradiation (3,000 rad) to 43 cases of malignant ovarian tumor (serous cystadenocarcinoma-24, mucinous cystadenocarcinoma-7, mesodermal mixed tumor-3, clear cell carcinoma-2, endometrioid carcinoma-2, malignant granulosa cell tumor-1, malignant Brenner tumor-1 and metastatic tumor-3). Out of 10 cases with complete resection of the tumor, nine patients are surviving without recurrence, and also some advanced cases with incomplete operation have shown a remarkable reduction in the tumor size. As to complications, diarrhea during lower abdominal irradiation as well as nausea and vomiting during upper abdominal irradiation were observed, but no characteristic changes were observed upon checking peripheral blood, liver and renal function; thus most cases completed the whole therapy without interruption. Some cases that had appeared to respond favorably course showed a rapid recurrence after 1.5-2 years, so four cases were given repeated irradiation, but results were not so satisfactory. Further study of radiation and combinations with other therapies is now being tried.

One hundred and fifty patients with malignant ovarian tumors were treated in the Cancer Institute Hospital between 1949 and 1977. Most (103; 68.7%) of the patients had simple primary ovarian cancer. A retrospective study was performed in these 103 patients to investigate the relationship between the 5-year survival rate and the clinical stage and primary treatment. The 103 patients were classified according to FIGO criteria. The survival rates for stages I, II, III and IV were 73.7%, 50.5%, 17.4% and 0%, respectively. As the primary treatment, operations were performed on 92 of the 103 patients. To conclude, of primary importance in the treatment of ovarian cancer is the surgical, complete as possible removal of the tumors. Postoperatively, radiotherapy and chemotherapy should be used. Recently, second look operations have come into wider use. General procedures for the surgical and postoperative treatment of progressive ovarian cancer have been established. Although surgical procedures for the treatment of early ovarian cancer have also been established, there are no consistent procedures for postoperative treatment. Since the incidence of ovarian cancer is increasing, the development of appropriate methods for early diagnosis and treatment of this carcinoma is eagerly awaited.

There are many problems that, the timing of S.L.O. the range of reduction, and side effects etc., we studied retrospectively for the S.L.O. The number of subjects were 302 of common epithelial and 251 of germinal cell tumors, totalling 553 cases. Among them, 41 cases were common epithelial and 49 cases germ cell origine respectively, totalling 90 cases of S.L.O. were carried out. Conclusion The 5 year survival rate of S.L.O. was observed to a significant extent. The mean survival time of S.L.O. group: were significantly prolonged. Complete surgery at the S.L.O. of the patient with epithelial and germinal affected the survival rate significantly.

In recent years, chemotherapy has markedly advanced after cisplatin became available. In addition, it has recently been found that the efficacy of chemotherapy differs according to the diameter of the residual tumor (less than 2 approximately 3 cm). For these reasons, debulking or cytoreduction surgery has been frequently carried out in advanced cancer cases to reduce the diameter of tumors. Basic procedures adopted by an increasing number of medical institutions are bilateral adnexectomy + simple total hysterectomy and omentectomy. In addition, since lymph node metastasis is found even in early cancer cases, dissection of lymph nodes extending from the pelvic lymph node to the paraaortic lymph node is now considered to be essential, and is referred to also by the FIGO's new classification of cancer stages. SLO is also important in judging the necessity of excising a residual tumor and assessing therapeutic efficacy. In chemotherapy, high effectiveness rates have been reported chiefly for cisplatin + CAP therapy in epithelial tumor cases and cisplatin + VAC or VBP therapy in germ cell tumor cases. However, since the effect of cisplatin in second and third lines is not satisfactory, development of new platinum compounds and studies of more effective regimens (such as massive cisplatin therapy) are now being performed. Radiation therapy, on the other hand, is merely an auxiliary therapy at present.

Total body irradiation of 10 rad showed an enhancement effect on tumor cell killing when given 12 hours before local tumor irradiation. In order to clarify the mechanism of this kind of effect, some immunological studies were performed using several immunological procedures, and the results suggested that 10 rad of total body irradiation caused increasing tumor immunity in irradiated tumor bearing mice. Clinical trials in some patients with advanced tumors are now being undertaken on the basis of these experimental data, and the effect of total body irradiation tumor control appears promising although it is too early to draw conclusions.

Total body irradiation (TBI) is considered to bring about an immunosuppressive effect on an organism, on the basis of data obtained from sublethal doses of TBI. However, there are no data on how low-dose TBI affects an organism. Over the last five years, we have been studying the effects of low-dose TBI on normal or tumor-bearing mice and the immunological background of these effects. In experimental studies, an increase in the TD50 value (the number of cells required for a tumor incidence of 50%) in mice exposed to 10 rad was recognized and showed a remarkable increase at 6 hours to 15 hours after irradiation. TBI of 10 rad also showed an enhancement effect on tumor cell killing when given 12 hours before local tumor irradiation. In order to clarify the mechanism of this kind of effect, some immunological studies were performed using several immunological procedures, and the results suggested that 10 rad of TBI caused increasing tumor immunity in irradiated mice. Clinical trials in some patients with advanced tumors are now being undertaken on the basis of these experimental data, and the effect of TBI on tumor control appears promising, although it is too early to draw conclusions.

74 cases of primary ovarian cancer treated here previously were classified into three groups, no residual (corresponding to Stage Ia, Ib), cell residual (Ic-IIc) and mass residual (III, IV), and prognoses were compared. The 5 year survival rates were 83.3%, 29.4% and 12.6% respectively. In Stage I and II cases, almost all of the tumor mass would be removed by operation. Therefore the target of postoperative treatment should be the residual cancer as cell units spread widely throughout the abdominal cavity. For this purpose, IPCP has been performed on 35 cases of Stage I and II since 1977. The 3 year survival rate for this series is as good as 88.6%, and the sites of recurrence were localized in the small pelvic cavity adjacent to the Douglas pouch in 5 out of 6 relapsed cases. This fact suggests that IPCP is capable of controlling the cancer cells in the upper abdominal cavity, but still insufficient to control them in the pelvic cavity where deeper invasion is suspected. In order to improve the local control ability, utilization of the uterus as the applicator for prophylactic intracavitary irradiation came to be considered. The spread of cancer to the uterus was found in 5 out of 38 cases in Stage I and II(13.2%), but silent invasion was found in only one case. These results suggests that the utilization of the uterus as the applicator for prophylactic intracavitary irradiation would be feasible if no macroscopical cancer extention to the uterus exists and the uterus is suitable for application. Several combinations with Tandem and Ovoid have been tested and an adequate method has been proposed.