Search

With the advances in early diagnosis and treatment of cancer, prognosis of cancer patients has been improved significantly. Therefore improvement of QOL for cancer patients has become an important issue. Prevention of skeletal related event is one of the major factors to improve QOL in patients with bone metastasis. Since the clinical introduction of zoledronic acid, management of bone lesions has been improved and decreased SRE significantly. The specialists from four disease area which is multiple myeloma, urological cancer, lung cancer and breast cancer have discussed the benefits (and risks?) of the zoledronic acid with the current status of bone management in each cancer.

Bone pain and pathological fractures due to spinal metastases result in severe disorders of ADL (activities of daily living). Osteoclastic pathology by metastases is local bone metabolism disorders by an activation of osteoclast by oncocyte. Therefore, early detection and treatment are important, and radiation therapies and stabilization surgeries have been performed as local treatment. Bisphosphonate therapy to plan pain relief and prevention of enlargement of metastases came to be performed recently by depression of bone resorption. We should aggressively perform combination therapies against bony pain due to metastases.

Since 1987, the operative procedure for a metastatic spine tumor has been decided on the basis of a scoring system for the preoperative evaluation of prognosis. Six parameters which affected the prognosis were employed in this assessment: 1) the general condition, 2) the number of extraspinal bone metastases, 3) the number of metastases in the vertebral body, 4) incidence of metastasis to a major internal organ (lungs, liver, kidneys, and/or brain), 5) the primary site of the cancer, and 6) the severity of spinal cord palsy. Each parameter was scored from 0 (high risk) to 2 (low risk) points. An excisional operation was performed when the total score was above 9 points, while a palliative operation was indicated for those who scored under 5 points. This assessment system was evaluated for 113 cases who had undergone surgery according to this criterion. The survival period of 92.3% of patients who scored less than 6 points was less than 6 months, while that of 78.3% of patients who scored more than 8 points was more than one year. The total score obtained for each patient correlated with the prognosis, and was valuable in predicting prognosis for a lesion at any stage. In conclusion, it was appropriate to indicate the operative procedure for a metastatic spine tumor according to this scoring system.

A trial of assessment system for the prognosis of metastatic spine tumor was evaluated in 47 cases who underwent surgery. Six parameters were postulated in the evaluation system; 1) general condition, 2) number of extraspinal bone metastasis, 3) number of metastasis in the vertebral body, 4) metastasis to the major internal organs (lung, liver, kidney and brain), 5) primary site of cancer, and 6) severity of spinal cord palsy. Each parameter ranged from 0 to 2 points. Total scores obtained in each patient can correlate with prognosis and are valuable to predict prognosis, however, the prognosis could not predicted from a single parameter. In conclusion, excisional operation should be performed in those cases scored above 11 points, and palliative operation will be indicated for those under 5 points. However, this assessment system will further remain useful with some items modified.

A quantitative evaluation of sensory disturbance of the fingers was attempted in 68 cervical myelopathy using Biothesiometer, Semmes-Weinstein aesthesiometer (SW), pain 1 g, light touch, static-and moving-2 PD, tuning fork, and dermatomal somatosensory evoked potentials (DSSEPs). DSSEPs was the most sensitive among these tests, and Biothesiometer and SW reflected an immediate change of the sensory function. It is important to understand the characteristics of each test and to choose informative tests for clinical use. We classified the grades of sensory disturbance in patients with cervical myelopathy into 3 categories in combination with the findings of DSSEPs and the value of Biothesiometer and SW.

The pharmacokinetics and metabolism of carmofur (HCFU) were studied. Sixty-six patients were administered 100 mg of HCFU orally, and the plasma levels of the HCFU fraction (HCFUf) and 5-fluorouracil (5-FUra) were determined at 0, 1, 2, 4 and 6 hours. The average half-life of HCFUf and 5-FUra were 1.05 and 1.31 hours, and the average areas under the curves (AUC) of the plasma concentration were 6.51 hr X mcg/ml and 0.46 hr X mcg/ml, respectively. Surgical specimens of the tumors were obtained about three hours after the administration and assayed for HCFUf. 5-FUra fluorodeoxyuridine-monophosphate (FdUMP), deoxyuridine-monophosphate (dUMP), total thymidylate synthetase (TS total), and non-FdUMP-bound free enzyme (TS free). The TS inhibition rate (IR) was calculated by the follow method: IR = (TS total-TS free)/TS total X 100 levels of the TS total varied from not-detected (less than 0.10 pmol/g) to 20.5 pmol/g. The average FdUMP: dUMP ratio was 3.44 X 10(3), However, more than 80% inhibitions of TS were observed in nine cases (21.4%). The correlation indicates between TS IR and tissue FdUMP level or FdUMP: dUMP ratio were 0.57 and 0.62 in ovarian malignancies respectively. No significant correlations were observed between TS inhibition and levels of tissue 5-FUra or AUC of 5-FUra.

The prognosis of patients with ovarian carcinoma is believed as worst among malignant diseases in the field of gynecology. Multiple factors including clinical stage, histologic type and grade may play an important role in the prognosis of patients. Because of these factors and the few cases of ovarian carcinoma seen in any one center over a short period, the ability to make valid evaluation of these factors has been limited. We organized ovarian tumor studying group in Tokai district with eleven member hospital and analyzed 453 cases of solid ovarian tumor retrospectively. 1) Cumulative survival rate was calculated according to the clinical stages. Five year survival rate of stage 1 was about 80%, that of stage 2 was about 30% and that of stage 3 and stage 4 were around 10% respectively. 2) Cumulative survival rate was calculated according to histologic types. There was minor variation of survival by histologic types. When we compared with different histologic types by same clinical stages such as stage 1 and stage 3 there was no definite differences of survival rate except slightly poor prognosis in case of mucinous cystadnocarcinoma. 3) Cumulative survival rate was calculated according to histologic grading. Histologic grade affects the prognosis of patients with ovarian carcinoma.