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Aim The aim of this study was to evaluate the efficacy and safety of the traditional herbal medicine kamikihito for bone marrow suppression, particularly thrombocytopenia, during cancer chemotherapy. Methods This retrospective pilot study investigated changes in hemoglobin (Hb) and neutrophil and platelet (Plt) count from before to after kamikihito treatment in nine patients with advanced recurrent ovarian cancer who developed grade ≥3 thrombocytopenia during chemotherapy (13 and 16 cycles before and after kamikihito use, respectively). Results Although the nadir Hb did not change significantly, the degree of change in Hb (baseline – nadir) during respective chemotherapy cycles (before vs after kamikihito use: 1.8 vs 1.0 g/dL), was significantly mitigated after kamikihito use. The nadir neutrophil count and degree of change in neutrophil count did not differ with kamikihito use. The nadir Plt count was slightly higher after kamikihito use (before, 2.9 × 104/μL; after, 3.4 × 104/μL), and the degree of change in Plt count (before, 12.7 × 104/μL vs after, 10.9 × 104/μL), was significantly mitigated after kamikihito use. Finally, significantly fewer days were required for Plt recovery from the nadir to a ≤grade 2 Plt count decrease after kamikihito use (before, 9.3 days; after, 5.8 days). Conclusion In patients undergoing chemotherapy for advanced recurrent ovarian cancer, kamikihito could alleviate anemia and thrombocytopenia and reduce the risk of requiring blood transfusion. Future prospective studies with larger sample sizes are warranted to accumulate further data.

The therapeutic value of para-aortic lymphadenectomy (PAL) in women with endometrial cancer (EC) remains uncertain. We retrospectively analysed 25 patients with stage IIIc EC (17 stage IIIC1; 8 IIIC2) who were treated in our institution. All subjects had undergone pelvic lymphadenectomies in which para-aortic nodes were sampled, or removed only when these nodes were enlarged. Sampling of para-aortic nodes or PAL was performed in all patients with stage IIIC2 disease and one of 17 with stage IIIC1 disease. Para-aortic lymph nodes were the most frequent site of recurrence in stage IIIC1 patients, but no such recurrences occurred in stage IIIC2 patients. Overall survival tended to be shorter in stage IIIC1 patients than stage IIIC2 patients. Our findings indicate that PAL improves the outcomes of patients with EC and high risk of para-aortic lymph node metastasis, such as those with positive pelvic lymph nodes or enlargement of para-aortic lymph nodes. Impact statement Para-aortic lymph node (PALN) metastases are important prognostic factors in endometrial cancer. Overall survival of patients with stage IIIC1 disease is generally longer than for those with stage IIIC2 disease. Retrospective studies - but no prospective studies - have suggested that para-aortic lymphadenectomy (PAL) provides a survival benefit. In our institution, we had performed PAL or para-aortic sampling for patients with enlarged PALNs; therefore, as most IIIC1 patients had no enlarged PALNs, they underwent pelvic lymphadenectomy only, whereas all IIIC2 patients had enlarged PALNs and underwent pelvic lymphadenectomy and PAL or PALN sampling in addition to pelvic lymphadenectomy. However, under this policy, survival of stage IIIC1 patients was not better than for stage IIIC2 patients. Our retrospective study indicates a survival benefit for PAL in patients with pelvic node-positive or enlarged PALN. PAL warrants a prospective randomised trial to see whether it should be a standard treatment in these patients.

Dear Editor, Systemic chemotherapy has not been established for metastatic brain tumors from primary ovarian cancer. Here, we report our experience with an important case in which the efficacy of systemic chemotherapy was enhanced and prolonged survival with a good quality of life (QOL) was achieved by using nifedipine to inhibit P-glycoprotein. The patient was a 53-year-old woman. In July 1998, she underwent an optimal surgery for stage IIIc ovarian cancer (serous adenocarcinoma). In August 2006, the disease recurred as metastasis in the para-aortic lymph nodes. Although these lesions disappeared after chemotherapy with paclitaxel plus carboplatin (CBDCA), four metastatic brain tumors were observed in July 2007: a lesion in the cerebellar vermis; an asymptomatic nodular lesion in the left basal ganglion; and an asymptomatic nodular lesion in the right and left cerebellar hemisphere, each. These lesions disappeared after Gamma Knife radiosurgery. In June 2008, yet another asymptomatic metastatic lesion was found in the cortex of the apical portion of the right temporal lobe, which disappeared after Gamma Knife radiosurgery. However, in March 2011, another asymptomatic metastatic lesion (8×5 mm) was observed in the medial portion of the sensory region of the right parietal lobe (Fig. 1a). We opted to administer systemic chemotherapy, anticipating that it would not only have therapeutic effects on brain metastases but also exert a preventive effect against both metastasis to other organs and recurrence. Pegylated liposomal doxorubicin (PLD) plus CBDCA, which has been shown to be effective for recurrent ovarian cancer, was selected. However, because of the previously reported poor outcomes for brain metastasis from primary ovarian cancer [3], we decided to combine PLD plus CBDCA with nifedipine in the hope of increasing the anti-cancer drug efficacy. The patient provided informed consent and was prescribed a sustained-release nifedipine tablet (20 mg) to be taken every morning and evening for 7 days, starting on day 1 of each cycle of chemotherapy. After two cycles, contrast-enhanced magnetic resonance imaging (MRI) showed a 75 % reduction in lesion size (Fig. 1b). After four cycles, the lesion was no longer visible on contrast-enhanced computed tomography (CT) (Fig. 1c). After five cycles, its disappearance was confirmed by contrast-enhanced MRI (Fig. 1d). The serum cancer antigen 125 level, which was 162.7 U/ml initially, normalized to 19.3 U/ml after three cycles. There were no variations in blood pressure during nifedipine treatment and no adverse events such as palpi tations, nausea, or facial f lushing. The chemotherapy-related adverse events were minor. Treatment was completed after seven cycles in November 2011. As of this writing, the patient is completely independent in her activities of daily living, with a performance status of 0. She has a good QOL and is under outpatient management. * Toru Yanase toyanase@gmail.com

trophoblastにはsyncytiotrophoblast (ST), cytotrophoblast (CT) の他, cellcolumnなどに存在するintermediate trophoblast (IT) がある. 流産の子宮内容物を用いた捺印細胞診に出現するtrophoblastを細胞形態学的に観察し, 捺印細胞診のもつ臨床的意義を検討した自然流産36例 (妊娠5-14週) の子宮内容物を捺印後, パパニコロー染色して形態学的観察を行い, 以下の結果を得た.(1) 細胞診に出現するのはSTとITであり, CTは観察されなかった.(2) 病理組織診で絨毛がみられた26例中25例の細胞診でSTが観察された.一方, 組織診で絨毛のみられない10例中1例でSTが観察された.他の9例中6例は完全流産, 3例は卵管妊娠であった.(3) ITは16例でみられ, 妊娠週数の若い症例で多数観察される傾向が認められた.(4) 26例中19例のSTに細胞質内空胞がみられ, 流産trophoblastの細胞学的特徴と思われた.流産例では子宮外妊娠の除外診断のため子宮内容物の病理組織検査が行われるが, 胎児成分であるtrophoblastの証明をするうえで, 捺印細胞診は組織診に優るとも劣らぬ成績を示した. 細胞診は簡便性, 迅速性, 経済性などに優れており, 流産における子宮外妊娠の除外診断にきわめて有用と思われた.