80歳以上の高齢者膵癌に対する膵切除の意義

Background: There is increasing need to evaluate the surgical indication of pancreatic cancer in very elderly patients. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of pancreatic resection in pancreatic cancer patients over the age of 80. Methods: Between 2005 and 2012, 26 octogenarian patients who received pancreatic resection and 20 who received chemotherapy for pancreatic cancer were retrospectively reviewed. Clinicopathological factors, chemotherapy administration status, and survival were compared. Univariate and multivariate analysis of prognostic factors for survival was performed. Results: Postoperative major complication rate was 8%, with no mortality. The one-year survival rate and median survival time of the surgery and chemotherapy groups were 50% and 45%, and 12.4 months and 11.7 months, respectively (P = 0.263). Of the 26 resected cases, 6 completed the planned adjuvant chemotherapy treatment course. The median survival time of those 6 completed cases was significantly longer than that of the 20 not completed cases (23.4 versus 10.0 months, P = 0.034). Furthermore, a multivariate analysis of the 26 resected cases showed that distant metastasis (HR 3.206, 95%CI 1.005-10.22, P = 0.049) and completion of the planned adjuvant therapy (HR 4.078, 95%CI 1.162-14.30, P = 0.028) were independent prognostic factors of surgical resection. Conclusions: Surgical resection was safe, but not superior to chemotherapy for pancreatic cancer in octogenarians. In the very elderly, only selected patients may benefit from pancreatic resection.博士（医学）・乙第1513号・令和3年12月21日Copyright © 2015 IAP and EPC. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved

Multicenter Phase II Study of Intravenous and Intraperitoneal Paclitaxel With S-1 for Pancreatic Ductal Adenocarcinoma Patients With Peritoneal Metastasis

OBJECTIVE:To evaluate the clinical efficacy and tolerability of intravenous (i.v.) and intraperitoneal (i.p.) paclitaxel combined with S-1, "an oral fluoropyrimidine derivative containing tegafur, gimestat, and otastat potassium" in chemotherapy-naive pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal metastasis.BACKGROUND:PDAC patients with peritoneal metastasis (peritoneal deposits and/or positive peritoneal cytology) have an extremely poor prognosis. An effective treatment strategy remains elusive.METHODS:Paclitaxel was administered i.v. at 50 mg/m and i.p. at 20 mg/m on days 1 and 8. S-1 was administered at 80 mg/m/d for 14 consecutive days, followed by 7 days of rest. The primary endpoint was 1-year overall survival (OS) rate. The secondary endpoints were antitumor effect and safety (UMIN000009446).RESULTS:Thirty-three patients who were pathologically diagnosed with the presence of peritoneal dissemination (n = 22) and/or positive peritoneal cytology (n = 11) without other organ metastasis were enrolled. The tumor was located at the pancreatic head in 7 patients and the body/tail in 26 patients. The median survival time was 16.3 (11.47-22.57) months, and the 1-year survival rate was 62%. The response rate and disease control rate in assessable patients were 36% and 82%, respectively. OS in 8 patients who underwent conversion surgery was significantly higher than that of nonsurgical patients (n = 25, P = 0.0062). Grade 3/4 hematologic toxicities occurred in 42% of the patients and nonhematologic adverse events in 18%. One patient died of thrombosis in the superior mesenteric artery.CONCLUSIONS:This regimen has shown promising clinical efficacy with acceptable tolerability in chemotherapy-naive PDAC patients with peritoneal metastasis

Comparative Studies of Values of Bone Mineral Density Measured with Different Photon Absorptiometries : A Preliminary Report

In order to compare values of bone mineral density measured with various photon absorptiometries, fundamental studies, using four different types of phantoms were performed in four instruments. The QDR-1000 (dual energy X-ray absorptiometry, DEXA) and Dualomex HC-1 (dual photon absorptiometry) were employed for the determination of bone mineral of a lumbar phantom and a cylindrical phantom, and the DCS-600 (DEXA) and Bone Densitometer (single photon absorptiometry) were used for the determination of bone mineral of a rectangular phantom and a ring phantom. The results indicate that the methodology for identification of the bone edge, which is necessary to calculate bone area or bone width, and the bone mineral per unit volume, which is defined as the line bone mineral content per cross-secional area, differ with the instruments used. Furthermore, the bone mineral per unit volume depends on the bone shape of the measured objects. Therefore, it seems taht the cross calibration of bone mineral density between instruments using phantoms is limited and in vivo investigation will be required in the future

Retrospective Study of the Correlation Between Pathological Tumor Size and Survival After Curative Resection of T3 Pancreatic Adenocarcinoma: Proposal for Reclassification of the Tumor Extending Beyond the Pancreas Based on Tumor Size

BackgroundEven though most patients who undergo resection of pancreatic adenocarcinoma have T3 disease with extra-pancreatic tumor extension, T3 disease is not currently classified by tumor size. The aim of this study was to modify the current TNM classification of pancreatic adenocarcinoma to reflect the influence of tumor size.MethodsA total of 847 consecutive pancreatectomy patients were recruited from multiple centers. Optimum tumor size cutoff values were calculated by receiver operating characteristics analysis for tumors limited to the pancreas (T1/2) and for T3 tumors. In our modified TNM classification, stage II was divided into stages IIA (T3aN0M0), IIB (T3bN0M0), and IIC (T1-3bN1M0) using tumor size cutoff values. The usefulness of the new classification was compared with that of the current classification using Akaike’s information criterion (AIC).ResultsThe optimum tumor size cutoff value distinguishing T1 and T2 was 2 cm, while T3 was divided into T3a and T3b at a tumor size of 3 cm. The median survival time of the stages IIA, IIB, and IIC were 44.7, 27.6, and 20.3 months, respectively. There were significant differences of survival between stages IIA and IIB (P = 0.02) and between stages IIB and IIC (P = 0.03). The new classification showed better performance compared with the current classification based on the AIC value.ConclusionsThis proposed new TNM classification reflects the influence of tumor size in patients with extra-pancreatic tumor extension (T3 disease), and the classification is useful for predicting mortality

A Study of Cases with Rib Metastasis Difficult to Distinguish from Microfractures on Bone Scintigraphy

A retrospective study of about 10,000 cases at Kawasaki Medical School Hospital on whom bone scans were performed over a six year period revealed five cases in which metastasis was mistaken for a benign rib lesion. This mistake occurred because the accumulation pattern of the radionuclide in the rib region on the bone scan indicated a so-called "hot spot" observed with microfractures rather than the rod-like increased accumulation along costal bones that is coincident with the finding of bone metastasis. This experience suggests that solitary hot spots in the rib region on bone scans should be diagnosed carefully, as such an accumulation is most frequently associated with a benign etiology but rarely may be a malignant lesion

Serial Cerebral Perfusion Imaging in a Case with Herpes Simplex Encephalitis

To evaluate cerebral blood flow, single photon emission computed tomographies (SPECTs) were serially performed in a case with herpes simplex encephalitis (HSE). Increased accumulation of N-ispropyl-I-123-p-iodoamphetamine (I-123-IMP) and Tc - 99m - hexamethylpropyleneamine oxime (Tc - 99m - HM - PAO) were noticed in the acute phase, and continued for seven weeks after the onset of the disease. In the third week, regional cerebral blood flow (rCBF) was estimated with I-123-IMP SPECT, and rCBF showed a high value in the affected temporal and occipital lobes of 60 to 70 ml/100 g/min (normal value; 40-50 ml/100 g/min), reflecting high accumulation of the tracer. After the twelfth week, when chinical symptoms and laboratory data had improved, the increased accumulation of these tracers was converted to a decreased accumulation