Search

Background: The dose exposure associated with digital breast tomosynthesis (DBT) is evaluated by multiplying the mean glandular dose (MGD) of mammography (MMG) with the correction coefficient of the angle of X-ray incidence. However, it has been pointed out that there are various problems when using the MGD as a standard for risk assessment in breast cancer screening. Therefore, the aim of this study was to assess the breast-absorbed dose for different breast sizes for dose assessment. Furthermore, in this study, by measuring the dose distribution three-dimensionally, we aimed to examine the MGD correction method using the breast size as a factor., Methods: A simulated breast phantom with a diameter of 40-160 mm and a total thickness of 40 mm, made with polymethyl methacrylate, was created by simulating the phantom shape used in the simulation calculation for calculating the MGD. It was made with polymethyl methacrylate. Radiochromic films were placed at different depths, which measured the breast-absorbed dose distribution three-dimensionally. The MGD was calculated from the breast-absorbed dose distribution obtained., Results: The three-dimensional dose distribution revealed that there was a difference in the distribution of MMG and DBT with increasing depth. In addition, a lower X-ray energy and a smaller breast size resulted in a greater difference in the absorbed dose between DBT and MMG., Conclusion: Incorporating the DBT correction according to the breast size into the MGD improves the accuracy of dose evaluation by the MGD. Additionally, a corrected MGD provides useful information for risk assessment when DBT is used for breast cancer screening.

Background: Because primary squamous cell carcinoma (SCC) of the breast is a rare disease, the standard therapy has not been established. We examined the clinical outcomes of postoperative adjuvant radiotherapy for breast SCC., Material and Methods: We conducted a multicenter retrospective cohort study. Patients diagnosed with primary breast SCC who received adjuvant radiotherapy as part of their primary definitive treatment were included. Overall survival (OS), breast cancer-specific survival (BCSS), and recurrence-free interval (RFi) were evaluated., Results: Between January 2002 and December 2017, 25 breast SCC patients received adjuvant radiotherapy as a primary treatment were included. Median follow-up time was 43.5 months. Three (12%), fifteen (60%) and seven (28%) patients had clinical stage I, II and III disease, respectively. Fourteen patients underwent breast-conserving surgery and subsequent adjuvant radiotherapy. Eleven patients underwent mastectomy and post-mastectomy radiotherapy. Ten patients received regional lymph node irradiation. Nine (36%) patients had disease recurrence. The first site of recurrence was locoregional in five, but distant metastasis arose in one. Concurrent local and distant metastasis were seen in two. Six cases of local recurrence occurred within the irradiated site. Seven patients died, and six of the deaths were due to breast cancer. Five-year OS, BCSS, and Rfi were 69%, 70%, and 63%, respectively. In multivariate analysis, age and lymphatic invasion were associated with increased risk of recurrence., Conclusion: Breast SCC has a high incidence of locoregional recurrence and poor prognosis. Age and lymphatic invasion are significant risk factors for recurrence., Competing Interests: Declaration of competing interest The authors have declared no conflicts of interest., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: The Japanese Breast Cancer Society (JBCS) Clinical Practice Guideline was revised in 2018. This article describes the revise points in the section on radiation therapy (RT)., Methods and Materials: The JBCS formed task force to update the JBCS Clinical Practice Guideline 2015 edition. Background questions (BQs) deal with standard treatments of breast cancer in clinical practice. Clinical questions (CQs) highlight the important treatments in which controversy remains. The task force for RT section addressed the 10 BQs, the 10 CQs, and the 4 Future reseach questions (FQs). For each CQ, systematic literature reviews and meta-analyses were conducted, and recommendations, strength of recommendation and strength of evidence were determined according to the protocol in Morizane et al. (Minds Handbook for Clinical Practice Guideline Development, 2014)., Results: The recommendations, the strength of recommendation and the strength of evidence were determined based on the systematic literature reviews and the meta-analyses for each CQ., Conclusion: The JBCS updated the Clinical Practice Guideline. RT represents a significant portion of the breast cancer treatment, and these recommendations regarding RT will be useful in individualized, shared decision making between physicians and patients.

Background: To define the factors associated with increased risk of isolated locoregional failure that may justify postmastectomy radiotherapy in patients with T1/2 breast cancer and 1-3 positive lymph nodes., Methods: Between 1990 and 2002, 248 patients who had pT1-2 breast cancer and 1-3 positive lymph nodes were treated with mastectomy without radiotherapy (age 32-84, median 54)., Results: Median follow-up time was 82 months (range 2-189 months). For all patients, the 8-year isolated locoregional failure-free rate was 95 %. In univariate analysis, hormone receptor status and administration of hormone therapy were statistically significant factors, and vascular invasion was the borderline significant factor for isolated locoregional failure-free rates (P = 0.0377, 0.0181, and 0.0555, respectively). The 8-year isolated locoregional failure-free rates were 98 % for patients with positive hormone receptor status and 90 % for patients with negative hormone receptor status, 97 % for patients who received hormone therapy and 89 % for patients who did not receive hormone therapy, 92 % for patients with vascular invasion and 97 % for patients without vascular invasion. In multivariate analysis for hormone receptor status and vascular invasion, the former was statistically significant (P = 0.0491) and the latter was borderline significant (P = 0.0664). When patients had both negative hormone receptor and positive vascular invasion status, the 8-year isolated locoregional failure-free rates decreased to 83 %., Conclusions: With regard to patients who had pT1/2 breast cancer and 1-3 positive lymph nodes, isolated locoregional failure was not common in general; however, patients who had both negative hormone receptor status and vascular invasion were comparatively high-risk patients for isolated locoregional failure.

Purpose: To determine whether volume-based parameters on pretreatment (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence., Methods and Materials: We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes., Results: The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (≥53.1; n=8; P<.0001, log-rank test). The 3-year DFS rate for patients with both ER-positive status and MTV<53.1 was 98.2%; and for those with ER-negative status and MTV≥53.1 it was 25.0% (P<.0001)., Conclusions: Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has potential benefits to identify a subgroup at higher risk for recurrence., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: The impact of aggregate of risk factors on isolated locoregional failure after mastectomy without radiotherapy was assessed., Methods: We reviewed 1091 patients who had stage I-III unilateral breast cancer and received mastectomy between 1990 and 2002., Results: Median follow-up time was 67 (1-175) months. On multivariate analysis, four or more positive axillary lymph nodes (AXLN ≥4), pT4, primary tumor larger than 5 cm (T >5 cm), severe lymphatic invasion (ly2-3), and negative hormone receptor status (HR negative) were the statistically significant risk factors (hazard ratios 5.78, 2.31, 2.47, 2.99, and 3.40, respectively). The 8-year isolated locoregional failure-free rates of patients with single risk factor were 88% for AXLN ≥4, 93% for pT4, 93% for T >5 cm, 98% for ly2-3, and 97% for HR negative. Considering impact on isolated locoregional failure, AXLN ≥4 was termed the major risk factor and other factors were termed minor risk factors. The 8-year isolated locoregional failure-free rates were 98% for patients with only 0-1 minor risk factors (low-risk group), 86% for patients with the major risk factor alone or with only 2-4 minor risk factors (intermediate-risk group), 72% for patients with the major risk factor plus 1-2 minor risk factors (high-risk group), and 28% for patients with the major risk factor plus 3-4 minor risk factors (very high-risk group)., Conclusions: Aggregate of risk factors increased the risk of isolated locoregional failure significantly. Patients with the major risk factor plus one or more minor risk factors seemed to be candidates for postmastectomy radiotherapy.

Background: There is still controversy concerning the indication of postmastectomy radiotherapy (PMRT) for pT3N0M0 breast cancer. To identify the candidates for PMRT in this subset, we investigated failure patterns, and searched for risk factors for isolated locoregional failure in pT3N0M0 breast cancer after mastectomy without PMRT., Methods: Among 1,176 patients who received mastectomy without PMRT for untreated unilateral breast cancer between 1990 and 2002, 64 patients (5%) had pT3N0M0 breast cancer (age 30-81 years; median 52.5 years)., Results: Isolated locoregional failure as the initial failure occurred in three patients. For all 64 patients, the 8-year failure-free survival rate, the isolated locoregional failure-free rate, and the distant failure-free rate were 76, 93, and 82%, respectively. Incidence of isolated locoregional failure as the initial failure was 18% (2/11) for patients 40 years or younger and 2% (1/53) for patients older than 40 years. The 8-year isolated locoregional failure-free rates were 73% for patients 40 years or younger and 98% for patients older than 40 years (p = 0.0135)., Conclusion: Concerning pT3N0M0 breast cancer, incidence of isolated locoregional failure was comparatively low after mastectomy without PMRT. Routine use of PMRT for all pT3N0M0 patients seemed to be unacceptable. PMRT may be useful for younger patients because of the comparatively high incidence of isolated locoregional failure. Because of the small number of cases in our series, further studies are necessary to determine the usefulness of PMRT for younger patients with pT3N0M0 breast cancer.

A 63-year-old female, who had undergone a modified radical mastectomy for breast cancer at the age of 45, was suffered from trachyphonia due to left recurrent nerve paralysis at the age of 53. She presented left phrenic nerve paralysis and dysphagia at the age of 61. Computed tomography (CT) revealed mediastinal fibrosis, stenosis of esophagus and superior vena cava, and slight lymph nodes swelling. Video-assisted thoracoscopic mediastinal biopsy was performed and the mediastinal fibrosis was diagnosed as recurrence of breast cancer 17 years after the breast cancer operation. She underwent mediastinal radiation and chemotherapy for mediastinal recurrence and stenting for esophageal stenosis.

Breast carcinoma is usually accompanied by an invasive component with an intraductal component, and each component shows different morphological features. We evaluated whether the presence or absence of comedonecrosis is correlated with prognosis and biological features in node-negative invasive breast carcinoma. Ninety-four node-negative breast carcinomas with an intraductal component were classified into two types: comedo type (n = 36) showing comedonecrosis partly or extensively in the intraductal component, and non-comedo type (n = 58) showing either an absence or small foci of necrosis. The Kaplan-Meier method was used to calculate disease-free survival. Immunohistochemical examination for p53 and HER-2 was conducted on the comedo (n = 35) and non-comedo (n = 47) type tumor specimens. Disease-free survival was significantly shorter in the comedo type than in the non-comedo type (P = 0.019). The expression of p53 was observed in 16 (45.7%) of the 35 comedo type cases, but only in two (4.3%) of the 47 non-comedo type cases (P < 0.0001). HER-2 overexpression was observed in seven (20.0%) of the 35 comedo type cases, while none of the 47 non-comedo type cases overexpressed HER-2 (P < 0.0001). These results suggest that the presence of comedonecrosis may be predictive of an unfavorable prognosis with aggressive biological behavior in node-negative invasive breast carcinoma.

We evaluated the usefulness of adjuvant chemotherapy with low-dose epirubicin (EPI) as a key drug in patients with axially-node positive breast cancer. All the 24 patients who were entered in the study between January 1991 and December 1992 were shown histologically to have more than 4 axially-node involvement and underwent curable resection for the breast lesions. Twenty mg/m2 of EPI was administered intravenously every 4 weeks as ambulatory treatment for 1 year and 5-fluorouracil (5-FU) and tamoxifen (TAM) were concomitantly administered at a dose of 150 mg/day and 20-40 mg/day, respectively, daily for 2 years. The median follow-up period was 70 months with a 55.1% 5-year relapse-free survival and 67.4% 5-year survival rate. One patient developed Grade 3 nausea.vomiting, anorexia and general fatigue; however, the other toxicities were mild, such as Grade 1 leukopenia, liver dysfunction, nausea.vomiting, anorexia and general fatigue. This adjuvant therapy with low-dose EPI was safely administered to outpatients, and is considered to be useful for the treatment of axially-node positive breast cancer.

Background: Reports of morphometric analysis using computerized digitized images of fine needle aspirates of breast cancer are rare. We aimed to evaluate whether quantitative morphometric estimations of cytological nuclear features could be used for preoperative prediction of the risk of recurrence as well as chemosensitivity., Methods: Seventy consecutive breast cancer patients were treated with preoperative chemotherapy (Doxifluridine 800 mg/body/day, orally) for 4 weeks and subsequently they underwent surgery. Using Papanicolaou-stained cytological materials, computerized morphometric analyses were performed. Mean nuclear area (NA) was measured and the coefficient of variation of NA (NACV) was calculated as the quantitative parameter of nuclear atypism. NA and NACV were compared with prognostic factors (tumor size, histological grade, hormone receptor status, nodal status, and ploidy status), and with the response to the chemotherapy., Results: NA and NACV were significantly associated with hormone receptor status and ploidy status (p<0.05). NACV correlated with histological grade (p<0.05). Neither NA nor NACV were associated with tumor size and nodal status. Patients with high NACV (>35%) had lower rates of disease-free survival (p<0.05) than those with low NACV (< or =35%). Responders to preoperative chemotherapy had statistically larger NA, higher NACV and higher S-phase fraction at the time of diagnosis compared with non-responders (p<0.001, p<0.0005, and p<0.05 respectively)., Conclusions: Morphometric analysis of preoperative fine needle aspirates reflects important clinical information, such as the risk of recurrence, and particularly, chemosensitivity.

Background: A retrospective study was performed to determine whether preoperative quantitative ultrasound assessment could predict axillary lymph node metastases and prognosis in patients with breast cancer. We focused on the presence of a halo, which is one of the features of breast cancer on ultrasound and represents reflections from the invading margin around infiltrating malignancies., Methods: We evaluated ultrasonography from 187 infiltrating breast carcinoma patients with tumors 5 cm or less in greatest dimension (T1, T2). Using computer image analysis, the halo area (H) and the sum of the area of halo and internal echo (total tumor area (T)) were measured, and the ratio of halo to entire tumor (H/T, halo ratio) was calculated and compared with lymph node status and prognosis., Results: The mean of the halo ratio was 0.38+/-0.13. Using the value of 0.42 as a cut-off, the high halo ratio group had significantly worse prognoses for both overall and disease-free survival at 49 months in median follow-up (p <0.001 and p <0.0005, respectively). The specificity of a high halo ratio in the T1 classification for predicting axillary node metastasis was 83.1%, with a negative predictive value of 86.8%. In patients with tumors 1.0 cm or smaller, the negative predictive value was 100%. In a multivariate analysis, halo ratio was an independent predictor of disease-free survival of breast carcinoma patients (p =0.0232)., Conclusions: Preoperative quantitative ultrasound may be a useful non-invasive method for predicting the presence of axillary lymph node metastases and prognosis in patients with primary breast cancer.

Background: Although cytologic examination has been an indispensable procedure for the diagnosis of various breast diseases, it is often difficult to make a precise diagnosis of intraductal proliferative breast lesions preoperatively. The present study attempts to clarify the differentiation of the lesions by the cytologic morphometric approach., Methods: Cytologic specimens from 21 intraductal lesions, including nine ductal carcinomas in situ (DCIS), seven ductal hyperplasias (DH), and five papillomas were evaluated. Using a microscope connected to a computerized video system, the mean nuclear area, the perimeter, the form factor, the largest to smallest diameter ratio of the nuclei (LS ratio), and the coefficient of variation of the nuclear area (NACV) were measured and analyzed., Results: The mean nuclear area and perimeter were significantly higher in the cases of DCIS than in DH (p < 0.01) and papilloma (p < 0.005). Similarly, DCIS had higher NACV values than the other groups (p < 0.05 and p < 0.005, respectively). There were no significant differences in form factor or LS ratio., Conclusions: The quantitative estimation of cytologic nuclear features is useful for preoperative differential diagnosis of intraductal proliferative lesions of the breast.

Background and Objectives: We evaluated the clinical efficacy of adoptive immunotherapy using in vitro activated cytotoxic T lymphocytes (CTL) in the treatment of patients with advanced cancer., Methods: CTL were induced with the mixed lymphocyte and tumor cell culture method, in which lymphocytes isolated from patient peripheral blood mononuclear cells were mixed with inactivated autologous tumor cells. Activated lymphocytes were administered intravenously to 11 patients once every 2 weeks for 10 weeks (i.e., 5 doses)., Results: Tumor reduction and decreased tumor marker were observed in 4 patients. Notably, successful CTL induction was identified in all of these patients. In patients who did not show induction of CTL response, a decreased proportion of lymphocytes, especially CD8(+) cells, and increased levels of CD14(+) cells were frequently observed. Fluorescence-activated cell sorter analysis indicated that expression of HLA class I and costimulatory factor B7-1 molecules was diminished on tumor cells. This was partly recovered with interferon-gamma, which resulted in successful induction of a CTL response., Conclusions: It was suggested that in vitro CTL induction is difficult in patients with advanced cancer. However, once the cells were induced successfully, some favorable clinical effects were seen by the adoptive transfer of such cell populations., (Copyright 1999 Wiley-Liss, Inc.)

In primary breast cancer, mutations of the p53 tumor suppressor gene lead to loss of growth-suppressive properties and poor outcome. Recently, a p53-related gene, termed p73, has been cloned and its gene product possesses a function similar to p53. p73 has been mapped at chromosome 1p36.3, a region frequently deleted in breast cancer, neuroblastoma and other malignancies. To elucidate the functional significance of p73 in the oncogenesis of breast cancer, we have studied genetic alterations of p73 in tissue specimens obtained from 87 patients with primary breast cancer. Thirteen percent of informative cases showed loss of heterozygosity (LOH) at the p73 gene. However, there was no correlation between the p73 LOH and clinical features such as histopathological types, metastatic behavior or expression of estrogen or progesterone receptor. The levels of p73 transcript in primary breast cancer were not significantly different from those in normal breast tissue. Moreover, PCR-SSCP analysis failed to detect any missense or frameshift mutations in the p73 gene. Our observations suggest that allelic loss, expression levels and mutations of the p73 gene may not contribute to oncogenesis of primary breast cancers.

One of the striking microscopic appearances of breast carcinoma is malignant transformation of the epithelium of an entire lobule, although the lobular architecture is still preserved. We termed this pathological feature 'lobular involvement'. An investigation was carried out to determine whether lobular involvement would be a useful prognostic indicator for invasive ductal carcinoma. One hundred and fifty cases of invasive ductal carcinoma were included in this study. The lobular involvement, as well as the conventional prognostic factors, was evaluated to find out the correlation with the overall and relapse-free survivals by univariate and multivariate analyses. The lobular involvement was identified in 31 of 150 patients (20.6%). Of the patients with lobular involvement, two had experienced recurrence (6.5%) and one had died (3.2%). The lobular involvement and lymph node metastases were significantly and independently correlated with the overall and relapse-free survivals. The presence of lobular involvement was statistically correlated with the favorable outcome. Lobular involvement can be assumed as a new prognostic indicator for invasive ductal carcinoma.

Background: Positron emission tomography (PET) with 2-deoxy-2-fluoro[18F]-D-glucose (FDG) can provide quantitative information about tumor glucose metabolism. The prognostic value of this technique was evaluated for breast carcinoma patients., Methods: FDG PET was performed on 70 patients with primary breast carcinoma, and the differential absorption ratio (DAR) was calculated as an index of FDG uptake. Overall and relapse free survival curves were created by the Kaplan-Meier method, and differences between the curves were analyzed with the log rank test. For multivariate analysis, the Cox proportional hazards regression model was used., Results: The mean DAR was 2.61+/-1.61 standard deviation (range, 0.65-9.39). According to the grade of DAR, patients were then classified into high DAR (> or =3.0) and low DAR (<3.0) groups. The high DAR group had significantly worse prognoses for both overall and relapse free survival (P < 0.0005 and P < 0.0001, respectively). In multivariate analysis, DAR was an independent predictor of the relapse free survival of breast carcinoma patients (P=0.0377)., Conclusions: DAR, as determined by FDG PET, may be useful as a prognostic indicator for patients with primary breast carcinoma.

The patient was a 73-year-old woman who was admitted to our hospital for epigastric discomfort and body weight loss. She had undergone radical right mastectomy in March 1982. Ultrasonography and computed tomography revealed multiple tumors in the liver. Three of the tumor markers (CA-125, CA 19-9, and CA 15-3) were positive. US-guided fine needle aspiration biopsy of the liver tumor showed small atypical cells with solid cell nests. Immunohistochemical tests revealed estrogen receptor was positive. We diagnosed the patient as recurrent breast cancer metastatic to liver, 14 years postoperatively. The liver tumors were successfully controlled with the combination of intra-arterial infusion chemotherapy (5-fluorouracil, epirubicin, and mitomycin C) along with systemic endocrine therapy (medroxyprogesterone acetate and fadrozole hydrochloride hydrate).

To evaluate peripheral infiltrative growth (inf) of breast catrcinomas as a prognostic factor, overall survival probabilities in 169 patients with tumor less than 5 cm in diameter were analysed in relation to the degree of inf (alpha, beta, gamma) using Kaplan-Meier method. There were statistically significant correlations between inf alpha and beta, inf alpha and gamma. On the other hand, the boundary echo (BE) observed at the peripheral margin of tumor in ultrasonogram is considered to reflect inf patterns of breast carcinomas. Therefore, BE was classified into three types as follows. Type I; negligible or regular thin marginal hyperecho. Type II; irregular thick marginal hyperecho. Type III; radiating boundary echo. These three types were matched to the patterns of infiltration so as to find any correlation between ultrasonogram and a corresponding histrogical specimen. Three types of ultrasonographic infiltrative grades (U-INF alpha, beta, gamma) were defined as follows. U-INF alpha; Type I BE is observed almost all surface of tumor. U-INF beta; Type II or III BE is observed in less than 50% of tumor surface. U-INF gamma; Type II or III BE is observed in over 50% of tumor surface. Total of 108 cases with tumor less than 3cm in diameter were received preoperative ultrasonographic studies. U-INF had highly significant correlation with inf and the occurrence of lymph node metastasis.

The correlation between angiographic tumor blushing and underlying pathologic factors was studied. Twenty female patients with breast cancer were divided into three groups according to the degree of tumor blushing. Primary tumors were divided into three areas: marginal, central and intermediate areas. In each area, the number of blood vessels per 10(4) mu 2 was randomly counted in 10 fields and a mean value of vessels was compared among the three groups. It was found that the following pathologic findings were significantly related to strong angiographic staining: (i) well-circumscribed border; (ii) large tumor nest; (iii) severe inflammatory cell infiltration; (iv) mild stromal fibrosis; and (v) absence of lymph node metastasis. The mean value of blood vessels in the strongly positive group was significantly increased in the overall and the intermediate areas. The density of the vessels in the intermediate area was thus thought to be responsible for the tumor blushing.

A 56-year-old woman was referred to Shizuoka General Hospital on April 17, 1992, because of progressive jaundice and massive pleural effusion. A thorough work-up revealed the diagnosis of advanced left breast cancer complicated with direct invasion of the thoracic wall, pleural carcinomatosis, multiple liver and bone metastases and obstructive jaundice due to the hilar mass. From a prognostic point of view, we scheduled the treatment course as follows. First, we treated the chief complaints. After emergency drainage and chemo-adhesive therapy of the pleural lesion, percutaneous biliary drainage and radiotherapy were done for obstructive jaundice, followed by internal drainage with self-expandable metallic stents. For the primary cancer of the left breast, standard mastectomy was performed following 57 Gy of radiotherapy. MPA was also administered because estrogen-receptor was positive on the histological examination of the resected specimen. To complete the multi-disciplinary treatment, we implanted a vascular access percutaneously via the left femoral artery and started intermittent hepatic arterial infusion chemotherapy on an outpatient basis. The patient was discharged on the 123rd hospital day and is well and active without any symptom 9 months thereafter.