Search

Between 1974 and 1980, 61 primary esophageal squamous cell carcinoma were treated by external irradiation combined with additional intracavitary radium therapy. The esophageal primary control rate was 36% (22/61) and the 5-year survival rate was 24.7%. We believe that external radiation therapy followed by additional intracavitary radium irradiation produces good results.

There were 256 cases of the early stomach cancer resected, from 1967 to '77 in National Hospital-Sapporo. First, 4 recurrent cases of these 256 cases (1.6%) are analyzed and concluded. 1) Common items of these recurrent cases were male and submucosal invasion in depth of cancer. 2) Modes of recurrence of the gastric remnant were shown in 3 of 4 recurrent cases. These 3 cases died within 6 months, on the average, from the diagnosis of recurrence. Therefore, earlier detection and operation of recurrent cancer is important. 3) There are some cases in which the possibility of multiple or double cancers exist, so careful examination before initial operation is most necessary. Second, the early stomach cancers with metastasis to the regional lymph nodes (n+ group) are analyzed. 1) There were 20 cases of n+ group (7.8%). 2) There were 12 cases of depressed type early cancers with metastasis to the regional nodes (depressed type n+ group), and 137 cases of the single depressed type early cancers without metastasis to the nodes (depressed type n- group). Statistical comparison between the depressed type n+ group and n- group disclosed that the maximum diameter of the lesion of the n+ group was longer than that of the n- group, and histological type of cancer of the n+ group was more undifferentiated than that of the n- group. Items of the depth of invasion and site of the lesion are not statistically significant at this time, however, close attention should be paid to these items.

Between 1966-1977, 250 patients with esophageal carcinoma were treated by radiotherapy alone. The 5-year survival rate was 10.4% (12 of 115) in the curative cases. 52 of 5-year survivors, including 40 cases from the literature, were analyzed according to age, sex and the extent, location and type of tumor. 37 patients (71.1%) were between 50 and 69 years of age. There were more female than male survivors. Patients whose esophagograms showed spiral-type tumor had a worse prognosis than other tumor types. 16 of the 52 (30.8%) patients had received intracavitary treatment. We posit that an additional boost dose by intracavitary techniques improves the local control of the primary lesion. Radiation-induced myelitis and carditis were noted in some patients.

Between 1974 and 1982, 78 primary esophageal squamous cell carcinomas were treated by external irradiation combined with additional intracavitary radium therapy. 50 to 60 Gy were given by external irradiation, and 5 to 20 Gy were delivered on the surface of the esophageal mucosa. The combined dose ranged from TDF 110 to 140 on the esophageal mucosa and TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa. The 5-year survival rate was 19.3% by this combined radiotherapy alone. We conclude that the optimal dose of the combined therapy for esophageal cancer ranges from TDF 95 to 120 at a depth of 5 mm from the esophageal mucosa.

In a recent phase II trial we have shown a favorable response rate for sequential methotrexate-5-fluorouracil (MF) in advanced gastric and colorectal cancer. We determined the therapeutic effect of sequential MF in patients with advanced gastric cancer by comparing it to 5-fluorouracil alone (F) in a randomized multicenter trial. Since February 1987 to July 1988, 133 patients with advanced gastric cancer have been prospectively randomized to receive either MF (methotrexate 100 mg/m2 i.v. push, 5-fluorouracil 600 mg/m2 i.v. drip over 15 minutes one hour after methotrexate and leucovorin 15 mg p.o. q 6 hrs x 2 beginning 24 hrs after methotrexate) of F (the same 5-fluorouracil as described for MF). Each treatment was repeated weekly x 5, then q 2 weeks. The two treatment arms were balanced for 17 clinical characteristics. The response rate was 17.9% (10 of 56 patients) in the MF arm and 1.9% (one of 53 patients) in the F arm (p less than 0.01). Median duration of response was 6.8 weeks (MF) and 6 weeks (F), respectively. Median survival time was 7.9 months (MF) and 7.3 months (F) on interim findings. Leukocytopenia and GI toxicity were significantly more common in patients receiving MF, but the degree was similar for both arms. Other side effects were minimal and no different. This schedule of MF is more effective than F in inducing remission for patients with advanced gastric cancer.

In treating advanced gastric cancer cases, 100 mg/m2 of cisplatin (CDDP) was given to such patients by means of a 24 hr continuous iv infusion once a month. This was in addition to daily UFT chemotherapy with an oral administration of UFT at a dose of 200 mg/m2 twice a day before meals. In this paper, two patients who achieved an objective tumor response to this UFT/CDDP chemotherapy are discussed. It was felt that this treatment was not likely to induce either leukocytopenia or thrombocytopenia. With regard to this drug combination, it has been reported that a remarkable, synergistic, antitumoral activity of combined 5-fluorouracil and cisplatin was demonstrated against L-1210 leukemia in BDF1 mice.

A Phase II Study of single oral administration of SF-SP containing sustained-release granules of tegafur was conducted in 37 cases of advanced cancers by 9 institutions in the Hokkaido area. Two capsules each containing 200 or 250 mg of SF-SP were orally administered twice daily for a total of either 800 or 1000 mg per day. The results were as follows: Of the 24 evaluable cases PR was observed in 4 cases. (16.7%) The observed efficacy rate by cancer type was 23.5% for gastric cancer and toxicity was observed in 10 (27.8%) of 35 subject cases. These results thus indicate SF-SP to be therapeutically effective for treatment of gastric cancers, with mild toxicity.