1.Feasibility of metronomic chemotherapy with tegafur-uracil, cisplatin, and dexamethasone for docetaxel-refractory prostate cancer
Hiroki Kubota ; Katsuhiro Fukuta ; Kenji Yamada ; Masahito Hirose ; Hiromichi Naruyama ; Yoshimasa Yanai ; Yasuyuki Yamada ; Hideki Watase ; Noriyasu Kawai ; Keiichi Tozawa ; Takahiro Yasui
Journal of Rural Medicine 2017;12(2):112-119
Objectives: To evaluate the efficacy of tegafur–uracil (UFT), a prodrug of 5-fluorouracil, plus cisplatin and dexamethasone in patients with docetaxel-refractory prostate cancers.
Methods: Twenty-five patients with docetaxel-refractory prostate cancer were administered oral UFT plus intravenous cisplatin (UFT-P therapy) and dexamethasone. Treatment responses were assessed monthly via prostate-specific antigen (PSA) level measurements. Treatment-related adverse events and overall survival were also assessed.
Results: UFT-P therapy resulted in decreased PSA levels in 14 (56%) patients and increased PSA levels in 11 (44%). In patients with increased PSA levels, 7 (64%) of the 11 patients displayed decreased PSA doubling times. The UFT-P therapy response rate was 84% (21/25 patients). Imaging studies revealed that tumor shrinkage during UFT-P therapy occurred in 1 patient in whom bilateral hydronephrosis caused by lymph node metastasis improved. The median survival time from docetaxel initiation was 36 months. In UFT-P-treated patients, the median PSA progression and overall survival times were 6 and 14 months, respectively. UFT-P treatment-related adverse events were mild diarrhea, general fatigue, and anorexia. Treatment was not discontinued for any of the patients. UFT-P therapy did not cause serious hepatic or renal dysfunction or pancytopenia.
Conclusions: UFT-P therapy is a safe and effective treatment for patients with docetaxel-refractory prostate cancer, although large-scale, multicenter, prospective studies are needed to validate these findings.
2.Combined use of a two-channel endoscope and a flexible tip catheter for difficult biliary cannulation
Masaki KUWATANI ; Yoshimasa KUBOTA ; Shuhei KAWAHATA ; Kimitoshi KUBO ; Kazumichi KAWAKUBO ; Hiroshi KAWAKAMI ; Naoya SAKAMOTO
Gastrointestinal Intervention 2018;7(1):34-35
A 69-year-old woman with jaundice was referred to our hospital. After a final diagnosis of pancreatic cancer with liver metastasis, we performed transpapillary biliary drainage with a covered self-expandable metal stent (SEMS). Three months later, we also placed an uncovered duodenal stent for duodenal stricture in a side-to-end fashion. Another month later, for biliary SEMS obstruction, we attempted a transpapillary approach. A duodenoscope was advanced and a guidewire was passed through the mesh of the duodenal stent into the bile duct with a flexible tip catheter, but the catheter was not. Thus, we exchanged the duodenoscope for a forward-viewing two-channel endoscope and used the left working channel with a flexible tip catheter. By adjusting the axis, we finally succeeded biliary cannulation and accomplished balloon cleaning for recanalization of the SEMS. This is the first case with successful biliary cannulation by combined use of a two-channel endoscope and a flexible tip catheter.
Aged
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Bile Ducts
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Catheterization
;
Catheters
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Cholestasis
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Constriction, Pathologic
;
Diagnosis
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Drainage
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Duodenoscopes
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Endoscopes
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Female
;
Humans
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Jaundice
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Liver
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Neoplasm Metastasis
;
Pancreatic Neoplasms
;
Stents
3.A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents.
Kazumichi KAWAKUBO ; Kei YANE ; Kazunori ETO ; Hirotoshi ISHIWATARI ; Nobuyuki EHIRA ; Shin HABA ; Ryusuke MATSUMOTO ; Keisuke SHINADA ; Hiroaki YAMATO ; Taiki KUDO ; Manabu ONODERA ; Toshinori OKUDA ; Yoko TAYA-ABE ; Shuhei KAWAHATA ; Kimitoshi KUBO ; Yoshimasa KUBOTA ; Masaki KUWATANI ; Hiroshi KAWAKAMI ; Akio KATANUMA ; Michihiro ONO ; Tsuyoshi HAYASHI ; Minoru UEBAYASHI ; Naoya SAKAMOTO
Gut and Liver 2018;12(3):353-359
BACKGROUND/AIMS: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. METHODS: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. RESULTS: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. CONCLUSIONS: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abscess
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Asian Continental Ancestry Group
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Endoscopic Ultrasound-Guided Fine Needle Aspiration*
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Endoscopy, Gastrointestinal
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Erythrocyte Transfusion
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Fibrinolytic Agents*
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Hemorrhage*
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Hemothorax
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Humans
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Incidence
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Japan
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Male
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Melena
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Prospective Studies*