ダイドウミャク サシュキカンシ ニ シンジュン シタ コウド シンコウ キョウブ ショクドウガン ニ タイシ weekly DOC＋ low-dose FP リョウホウ ガ ソウコウシ コンチ セツジョ シエタ イチレイ

A ７０s woman was pointed out lower thoracic advanced esophageal squamous cell carcinoma with a chief complaint of dysphagia by upper gastrointestinal endoscopy. Computed tomography （CT）revealed that original tumor invaded to aorta and left main bronchus. Weekly docetaxel plus low-dose ５-FU and cisplatin therapy decreased the tumor. The invasion to aorta and left main bronchus was disappeared. She underwent curative esophagectomy. Main tumor had wide adherence to left main bronchus and aorta but was able to be resected. She underwent subtotal esophagectomy and gastric tube reconstruction by retrosternal route. Pathological diagnosis revealed carcinoma invaded from submucosa to adventitia and deep margin was negative（pT３）. Advanced esophageal carcinoma with invasion to aorta and main bronchus is commonly treated by definitive chemoradiotherapy and hardly undergo curative resection. This case underwent curative resection after only chemotherapy. This case suggests excellent anticancer effect of the triple drug therapy

ニボルマブによる重症筋無力症

A ７０s female suffering from recurrent gastric cancer presented with ptosis, dysphagia and lower limb and neck muscles weakness with elevation of serum CK levels after second treatment with the immune checkpoint inhibitor nivolumab. The symptoms suggested myasthenia gravis （MG）, although anti-acetylcholine receptor antibody and muscle-specific receptor tyrosine kinase antibody were negative. Steroid treatment quickly normalized CK levels and relieved MG symptoms. Nivolumab-induced MG can rapidly become severe and potentially fatal, and a prompt and accurate response is desirable

A case of advanced breast cancer with spinal palsy due to cervical bone metastasis who was improved a quality of life by emergent multidisciplinary oncological salvage

A ６０s female complained of right thigh pain caused by bone metastasis from advanced breast cancer. She was introduced to our ward for systemic therapy with palliative radiation to painful osteolytic lesion in the right femur. She suddenly complained of serious pain and motility disturbance in the right upper-extremity two days after her admission. Magnetic resonance imaging（MRI）suggested bone metastasis in the ３rd cervical vertebra which compressed spinal cord. We discussed about an optimal treatment with the orthopedic surgeon and the radiation therapeutic physician, and laminectomy was scheduled promptly. She also had a right femur fracture a day before her planed laminectomy, so she underwent osteosynthesis of the femur together with laminectomy of the cervical vertebra. She also received the irradiation to the ３rd cervical vertebra and the shaft of right femur. She became able to eat with a spoon by herself and her activity of daily living（ADL）have fully recovered by daily rehabilitation. She is receiving chemotherapy in our out-patient clinic now. We recognized that an emergent oncological treatment for the spinal decompression by the bone metastasis could improve the patients’ quality of life（QOL）to avoid the permanent paralysis and also their prognoses

イデンセイ ニュウガン ニツイテ

Hereditary breast cancer and/or ovarian cancer （HBOC） has been closed up in Japan. But few were known about the disease. HBOC is known as a syndrome that causes breast and ovarian cancer at exceptionally high rate in patients who have genetic mutations in BRCA １ or ２. The population of the Genetic/familial high risk breast and/or ovarian cancer is not low rate even in Japan if compared with the Western population. Important thing is recognize the fact that HBOC is not rare in Japan and perform a screening detailed family history if the patient has family history. We can evaluate the risk by genetic test and offer the preventive strategies like an intensive screening with MRI, chemoprevention and prophylactic mastectomy before the occurrence of cancer for the carrier. Genetic counseling service by the authorized doctor and counselor has been started in our institute. Genetic screening of BRCA１/２ mutation can be taken in Tokushima University Hospital

遺伝性乳癌卵巣癌症候群

Hereditary breast and ovarian cancer（HBOC）syndrome is an autosomal dominant genetic disease, which represents about ５% of all breast cancers. The pathogenic mutations in the BRCA １／２genes involved in DNA repair pathway are known to be associated with an increased risk of not only breast cancer and ovarian cancer but also prostate cancer, pancreatic cancer and male breast cancer. The risk reduction management is required for BRCA mutation-positive patients. The surveillance using breast magnetic resonance imaging（MRI）is recommended for early detection of breast cancer in HBOC patients. Furthermore, it has been reported that risk reducing salpingooophorectomy（RRSO）reduces mortality caused by breast cancer and ovarian cancer, and contralateral risk-reducing mastectomy（CRRM）improves the overall survival in postoperative breast cancer patients

ゴウセイ キュウシュウセイ ユチャク ボウシザイ オ シヨウシタ イ ゼンテキ ジュツゴ ニ ハッショウシタ コウヤクセイ イレウス ノ イチレイ

The patient was a 50-year-old male. He underwent total gastrectomy with complication ablationof the greater omentum for gastric cancer. We used composition absorbent materials toprevent adhesion（seprafilm_）at closing of the abdominal wall. When he consulted our hospital forabdominal pain after 7 months later, we diagnosed the patient as having adhesive ileus. Severalhours later, he demonstrated abdominal swelling and fell into shock. Therefore, we performedurgent abdominal surgery. There were large quantities of cacosmia ascites and no adhesion exceptat only one point between the bottom of the previous wound and the small intestine. Weconfirmed strangulation ileus that had turned the small intestine with 360°dextroversion centeringon the adhesion point and the superior mesenteric artery root. Because most of small intestinehad become swollen and necrotized, we performed wide small intestinal resection with about 60cmsmall intestines survived. Currently we are following the patient with at-home intravenous hyperalimentationafter two further reoperations. At the time of the first operation, we had applied　seprafilm. This patient had a very late case of strangulation ileus, because there was almost noadhesion. This case represents a rare r side effect reports, involving shock, infection developingafter the use of seprafilm

A multidisciplinary approach in palliative care for the patient with advanced phyllodes tumor

The case subject was a woman in her５０s who consulted her local clinic for the chief complaint of pain extending from the left buttock to the lower leg. A sacral lesion and giant mass in the right breast were observed, and thus on suspicion of breast cancer the subject was referred to our department. The results of needle biopsy led to the definite diagnosis of malignant phyllodes tumor. At the start of treatment the subject presented markedly reduced activities of daily living due to the pain, and upon the introduction of opioids, and performing palliative irradiation for the sacral metastasis, the pain was successfully alleviated relatively quickly. During this period, the primary lesion became ulcerated and progression of anemia was also observed, and therefore upon applying metronidazole ointment and commencing irradiation for the right breast, therapeutic effects such as tumor regression and control of anemia progression were observed. After the initial consultation the subject expressed severe anxiety, and thus intervention was requested from a nurse specialist in cancer care, who sat with the patient when her condition was explained, and listened closely to her anxiety. Thereafter, ２ courses of epirubicin and cyclophosphamide therapy as systemic chemotherapy were administered, however the disease progressed. The subject desired to receive care at a local medical institution, and thus it was decided with the help of a social worker that she be transferred to a hospice in the short-term

ショウチョウカンマク デスモイド シュヨウ ノ 1レイ

A 51-year-old man was referred to our hospital in 2005, because of an abdominal mass in thehypogastrium. There was no tenderness, and the tumor moved to epigastric resion easily. Therewere no important findings in a physical examination, except the mass. Enhanced CT showed themass with clear boundaries of 8cm size that the inside was contrasted heterogeneously in pelviccavity, and the internal was able to confirm tessellated mass by a supersonic wave. We doubtedintestinal GIST and performed an operation. We showed mass of mesoileum origin, in 15cm oralside from terminal ileum, there was no adhesion and invasion to circumference, so we underwent apartial resection of the terminal ileum. It was diagnosed as desmoid of a mesoileum origin by apostoperative histopathology diagnosis. There has been no recurrence for postoperative threeyears. Intraabdominal desmoid is relatively rare, and often noted a history of the laparotomy orestrogenic intervention, and combined with Gardner’s syndrome. In addition, it is assumed that itusually grows infiltrative, and easy to develop local recurrence. We experienced a rare case fallingunder neither, so we report it

がん地域連携における役割分担に関するアンケート調査

It was suggested long ago that regional cooperation is necessary for cancer patients. Both doctors in base hospitals and community doctors understand the importance of such cooperation. Here we report the results of our widely distributed questionnaire designed to clarify the division of physicians' roles and to strengthen the relationships between base hospital and community doctors. The questionnaire asks whether community doctors can accept cancer patients and what types of medical treatment the doctors can provide for patients with esophageal cancer, lung cancer, breast cancer, and thyroid cancer. The doctors in 289 of 550 (53%) facilities completed and returned the questionnaire. About half of the community doctors responded that they can accept patients with any of the four cancers and can provide most types of the necessary medical examinations and treatments in their daily practices. Most of the community doctors indicated that they could not provide some anti-cancer drugs and supportive drug therapies for breast cancer patients. The development and implementation of a clinical pathway system could enable the participation of more community doctors and base hospital doctors. Although our findings are preliminary, they will contribute to a foundation for building better regional corporative relationships with community doctors who treat cancer patients

Efficacy of PEG on head and neck cancer

Objective : Efficacy of percutaneous endoscopic gastrostomy (PEG) on unplanned treatment interruption and nutritional status was examined in patients undergoing chemoradiotherapy (CRT) for advanced head and neck cancer. Methods :We retrospectively reviewed hospital charts of 44 patients with advanced head and neck cancer who were treated with CRT. Results : CRT-induced mucositis of grade 3 or worse and inadequate oral intake of less than one third of their usual intake developed in 33 patients who were recommended PEG placement, but not in 11 patients. Thirteen patients accepted PEG placement and then completed CRT (compliant group). However, among 20 patients who refused both PEG and nasogastoric tube (NGT) placements (non-compliant group), 10 required unplanned interruptions of CRT at a radiation dose around 30-40 Gy (UI-CRT group) while 10 others could complete CRT without interruption (C-CRT group) CRT. Total serum protein levels were significantly decreased after CRT in all patients. Discussion : It is suggested that therapeutic PEG placement is useful for preventing unplanned interruption of CRT in patients with advanced head and neck cancer. After severe mucositis and inadequate oral intake have developed during CRT, PEG placement should be considered before the radiation therapy dose of 30 Gy