[Progress in targeting therapy for hepatic cancer]

Targeting therapy for hepatic cancer is divided into a method using Lipiodol as drug carrier and a method employing immunological responses of monoclonal antibodies to the tumor antigens. For the latter method, immuno-conjugates of antibodies and cytotoxic agents have been studied. Because of the lower response rates of conventional chemotherapy. Lipiodol as drug carrier provides the most effective targeting therapy on hepatic cancer at the present time. Immunotherapy using cytotoxic cells, however, did not result in sufficient clinical efficacy on the liver cancer. The system for accumulation of the effective and sufficient number of cytotoxic cells or immunoconjugates in the targeting tumor tissues are expected to be investigated.

Role of surgical treatment for recurrent hepatocellular carcinoma after hepatic resection

From 1978 to 1989, 164 patients underwent hepatic resection for hepatocellular carcinoma at our institution. The carcinoma was resected completely in 149 patients. Sixteen patients were excluded from this study because it was not known whether they were recurrent or disease free, or because death occurred as a result of surgical complications. Recurrent disease occurred in 48.1% of the remaining 133 patients. Fifty-seven patients had recurrent tumor only in the residual liver. A second hepatic resection was performed in 14 cases, 22 received intraarterial chemotherapy and/or arterial embolization without resection,a nd the remaining 21 received no anticancer therapy. The 5-year survival rate of patients who had a second resection was 92.0%. Recurrences in distant organs occurred in 14 patients, and the recurrent carcinoma was resected in five cases. Four of these 5 patients survived more than 3 years after the second surgery. Aggressive surgical resection of recurrent HCC, even for distant metastasis, is a viable approach, and may produce long-term survivors.

[Adjuvant hepatic arterial chemotherapy on hepatocellular carcinoma with THP-adriamycin and carboplatin]

We studied the effect of adjuvant hepatic arterial chemotherapy with THP-adriamycin (THP) and carboplatin (CBDCA) in patients with hepatocellular carcinoma (HCC). Fifteen patients were treated by intraarterial infusion of THP 30 mg on the second and third week after hepatectomy. CBDCA 450 mg was further injected on the fourth week (group A). Intrahepatic arterial administration of the drug was carried out through the subcutaneously implanted reservoir; one to five courses of the protocol were performed (average 2 times). Transient leukocytopenia occurred in six cases, liver dysfunction in one case, duodenal ulcer in one case and occlusion of the catheter connected reservoir in three cases. Forty-two patients not treated with this protocol postoperatively were employed as historical control (group B). There were no significant differences between group A and B in operative procedures, tumor stage, clinical stage, tumor size and other histopathological findings including nuclear DNA ploidy pattern. The two-year cumulative disease-free survival rate was 78% in group A, which was significantly better than the 55% of group B (p < 0.05). It may be concluded that intrahepatic arterial chemotherapy using THP and CBDCA plays an important role to prevent recurrences of the tumor after hepatectomy in patients with HCC.

[A simple method for estimation of liver volume using CT-scan after major hepatic resection]

We developed a new system to estimate liver volume using CT-scan images printed on the films. This device is composed of X-Plan360i (Ushikata Shokai, Tokyo) and personal computer. Thirty-five patients with hepatocellular carcinoma were estimated those liver volume before and 4 to 6 weeks after hepatic resection. The presumed liver volumes calculated preoperatively were significantly correlated with the weight of the resected specimen. The postoperative increasing rates of residual liver volume was regulated by resected liver volume ratio and severity of associated cirrhosis. Four cases which suffered from postoperative liver insufficiency showed the lower postoperative rates than the patients without liver insufficiency. Measurement of liver volume with this method is simple and promises to play an important role for evaluate hepatic reserve.

Postoperative chemoimmunotherapy for the treatment of liver cancer

A randomized study using spleen-derived lymphokine-activated killer (LAK) cells in hepatocellular carcinoma (HCC) is reported. We induced cytotoxic lymphocytes from resected spleen of HCC. The effect of recombinant interleukin-2 (rIL-2)-activated spleen cells for prevention of recurrence of HCC after hepatic resection was studied. Enough mononuclear cells could be harvested from the resected spleens. The induction of activated spleen cells was carried out by culture in fresh medium containing 1,500 JU/ml of IL-2. The cytotoxicity of the activated spleen cells maintained high levels during the culture period ranging from 3-30 days. These autologous activated spleen cells were administered to patients 2 days after the intra-arterial infusion of Adriamycin. A randomized study using these spleen LAK cells resulted in lower recurrence rates in the LAK IL-2-treated group. No severe side effects were observed. The lymphocytes derived from resected spleens were useful as the source of effector cells in clinical adoptive immunochemotherapy for HCC, because of their higher cytotoxicity and the simplicity of gaining a large amount of cells.

Chemohormonal therapy of unresectable hepatocellular carcinoma

This article reports a prospective randomized controlled study to investigate the effect of sex hormone therapy combined with intra-arterial chemotherapy for hepatocellular carcinoma (HCC). Thirty patients with unresectable HCC were randomly divided into two groups. A catheter was inserted into the hepatic artery of all patients. The first group (group A) was administered 60 mg/m2 of cisplatin (CDDP) on day 15 and 13 mg/m2 of Adriamycin (ADM) on day 1 and 8 postoperatively via the hepatic artery cannula; in addition, a daily dose of 150 mg 5-fluorouracil (5-FU) was administered orally. Tamoxifen (TAM) 25 mg/m2 daily and medroxyprogesterone acetate (MPA) 400 mg/m2 daily were also administered orally. TAM and MPA administration were alternated every 4 weeks. For the second group (group B) the same protocol of anticancer drugs administration, without the hormonal agents, was given. At least three courses of the treatments were carried out. Twelve patients in group A and 14 in group B were evaluated. Partial response of the hepatic tumor to the treatments was observed in 33.3% of group A patients and 21.4% of group B patients, a difference that was not statistically significant. The 1-year survival rate was 44.5% in group A and 33.0% in group B. The performance status of 25% of the patients in group A was significantly improved compared with 14.3% in group B (p < 0.05). TAM- and MPA-combined chemotherapy may not prolong the survival of patients with HCC, although it improves their quality of life.

Intra-arterial infusion chemotherapy on unresectable hepatocellular carcinoma under occlusion of hepatic arterial flow

Intra-arterial infusion chemotherapy (IAIC) by occluding hepatic arterial flow augments intrahepatic drug concentrations, resulting in response rates higher than those with conventional infusion methods. We recently developed an intra-hepatic artery catheter and device attached with an implantable double-lumen reservoir that can be used for repeated IAIC in outpatient clinics. Eight patients with unresectable hepatocellular carcinoma were treated by infusion of anticancer drugs using this method. The catheter was inserted into the hepatic artery under laparotomy. The occlusion balloon was attached to the common hepatic artery, and catheters were connected to the subcutaneous double-lumen reservoir. Approximately 0.5 ml of distilled water was injected through the one port of the double-lumen reservoir to inflate the balloon, which compressed the artery within the cylinder-like occluder. 4'-O-tetrahydropyranyladriamycin (THP-ADM) was used as the anticancer agent, and two patients received combined administration with carboplatin. Three to seven repeated infusions were possible without any severe side effects. This treatment was also easy to perform in the outpatient clinic. Six of the eight patients survived for more than 2 years, an improvement over the survival rates obtained in a previous conventional IAIC group. We conclude that IAIC with THP-ADM for unresectable hepatocellular carcinoma under occluding blood flow using our device is more convenient and more effective than other available methods.

[Statistical observations on the cases of unnatural deaths examined at our department during the past 10 years]

Medicolegal evaluation of 1495 cases of unnatural death of last 10 years was carried out in our department and the data so obtained were statistically analysed. The cases consisted of 260 inspections, 865 judicial autopsies and 370 administrative autopsies. The most frequent category was death from diseases followed by suicide, homicide, traffic accidents, other accidents and self originated accidents. In homicide cases, sharp objects were mainly used. Six cases of accident of scuba diving were included within the group of 28 cases of drowning of self originated variety. Although Okinawa is subtropical 12 cases of death by accidental hypothermia were found. Gangland fight using rifles cost 7 lives, 2 policemen, a high school student and 4 members of locally originated gangsters during last 18 months. Cardiac insufficiency was the most common of sudden unexpected death cases that complied with the data of Tokyo and Osaka. Death from alimentary disorder in Okinawa was 1.5 times more frequent than that in Tokyo and Osaka and liver disorder accounted for about 41%. The 68 cases of death from suckling contained 10 SIDS cases. Complication of medical treatment was encountered in 9 cases during the past 10 years.

Pituitary dependent hyperadrenocorticism in a cat

A cat that was suspected some insulin resistance was diagnosed as pituitary dependent hyperadrenocorticism from an adrenocorticotropic hormone (ACTH) stimulation test, dexamethasone suppression test and measure of endogenous plasma ACTH concentration. Histopathological examination revealed chromophobe adenoma in pituitary gland and hyperplasia in adrenal cortex.

Liver regeneration following portacaval shunt in rats: 3',5'-cyclic AMP changes in plasma and liver tissue

Hepatic regeneration following portacaval shunt was evaluated in the light of the changes of 3',5'-cyclic AMP (cAMP) levels in plasma and liver tissue, and also plasma cAMP levels after glucagon administration, using a 70% hepatectomy and portacaval shunt model in rats. Ratios of liver to body weight recovered to 60% of pre-operative ratios 2 weeks after the operation. Plasma cAMP level decreased slightly, but insignificantly, 1 day and 3 days after the operation, then recovered to the pre-operative level. Hepatic cAMP concentration increased for 2 weeks after the operation. Plasma cAMP levels induced after glucagon administration did not increase until 3 days after the operation and were only 50% of pre-operative levels 4 weeks after the operation. From these results, liver regeneration following the portacaval shunt was remarkably delayed, but continued until at least 2 weeks after the operation.

[Malignancy of hepatocellular carcinoma evaluated with nuclear DNA ploidy pattern]

Nucleus DNA ploidy analysis was performed by flow cytometry on 81 patients with hepatocellular carcinoma. DNA ploidy patterns were divided into two groups; diploid pattern and aneuploid pattern, which were estimated by the rate of the first peak channel on histograms. DNA aneuploidy significantly correlated with serum AFP level (p < 0.01), TNM stage (p < 0.01), and pathological findings: vp (p < 0.5), im (p < 0.01). The aneuploid cases showed better prognosis than the diploid cases (Generalized-Wilcoxon test, p < 0.01). In the diploid cases, recurrent tumors manifested almost solitary isolated. The disease free period after hepatectomy was longer in diploid cases (mean 24.2 months) than in aneuploid cases (mean 14.4 months). There was a higher frequency of aneuploid cases of recurrence within 2 years compared to diploid cases. Two and half year survival rates after recurrence of diploid cases (69.6%) was significantly better than those of aneuploid cases (38.2%) (p < 0.05). The DNA ploidy pattern of hepatocellular carcinoma plays an important role in predicting the malignant potentials of the disease.

[A clinical study of liver resections in patients with small hepatocellular carcinoma less than three centimeter in diameter]

Liver resections for 52 cases with small hepatocellular carcinoma (HCC) less than 3cm in diameter were clinically studied. The 5-year-survival rate was 57.1%, which was better than that of percutaneous ethanol injection (PEI) therapy. Histological study revealed infiltration to the capsule in 48.1%, of which 20% had extra-capsular invasion. This finding seemed to be an important problem in PEI therapy. The group in which resected area was much larger than the extent of tumors had a tendency having good cumulative survival and non-recurrence rates. It is thought that the curative resection should be intended for small HCC if the patient has enough hepatic reserve to undertake a curative operation.

Tumor-infiltrating lymphocytes and prognosis of hepatocellular carcinoma

Tumor-infiltrating lymphocytes (TIL) were isolated from 17 human hepatocellular carcinomas (HCC). The proliferation of TIL cultured with recombinant interleukin-2 (rIL-2) was evaluated. We also examined prognosis in relation to TIL. Successful expansion of TIL was achieved in 16 of the 17 lesions. In 10 of the 16, TIL increased more than 100-fold. Cytotoxicity to the allogeneic HCC cell line, HC-4, was demonstrated in all 13 TIL cultures tested. Maximum cytotoxicity was noted two to four weeks after culture. No statistical difference was observed either with respect to prognosis based upon growth rate or the cytotoxicity demonstrated in vitro. The initial number of TIL per unit weight of tumor was, however, significantly greater in the group for which the prognosis was good (19.0 +/- 5.1 x 10(6) vs. 5.6 +/- 1.6 x 10(6), P < 0.05). It would appear that greater lymphocytic tumor infiltration is a prognostic marker.

[Problem of the long-term arterial infusion therapy with implantable reservoir for unresectable hepatocellular carcinoma]

Arterial infusion therapy with implantable reservoir was performed for forty-seven cases with unresectable hepatocellular carcinoma since 1986-1991. The one-year survival rate of cases of arterial infusion therapy with implantable reservoir was 50.6% and the 2-year survival rate was 37.8%. The survival rate was 51.4% and 32.2%, respectively, in the TAE cases for the same period. Considering the kinds of reservoirs used for HCC, the survival curve of 23 cases with double lumen reservoir showed a significantly better pattern than that of 24 cases with the usual single lumen reservoir (p less than 0.05). Cumulative usable rate of reservoir was 78.6% at one year, and 42.4% at two years (Kaplan-Meier method). Therapy after the reservoir was unusable, particularly with arterial obstruction by catheter, was restricted because arterial infusion therapy was impossible. It is considered very important to retain the hepatic artery because arterial infusion therapy is mainly for unresectable hepatocellular carcinoma.

Changes in the plasma abnormal prothrombin level following treatment of hepatocellular carcinoma

The Hokkaido Liver Cancer Study Group focused on the changes in PIVKA-II levels observed in 61 HCC patients after several regimens of treatment in comparison with the AFP levels and the pathophysiological characteristics of HCC. The overall positivity rate for PIVKA-II was 47%, and there was no correlation between the PIVKA-II values and the AFP levels. Accordingly, the HCC detection rate was increased by about 20% by the measurement of both markers. In all, 13 patients underwent hepatic resection, and nonsurgical therapy was carried out in the other 48 subjects. Of the 6 surgically treated patients, 5 (83%) showed a fall in PIVKA-II levels to the normal range immediately after surgery, whereas 14/29 (48%) subjects receiving nonsurgical treatment showed a decrease in PIVKA-II values. Although inconsistency between these tumor markers was detected in four treated cases, we concluded that assay for both of these two parameters may expand their clinical utility for the diagnosis of HCC and monitoring of patients after treatment.

[Adopted immunochemotherapy using IL-2 and spleen LAK cell--randomized study]

Thirty patients with hepatocellular carcinoma who underwent hepatic resection during the recent 2 years in our department were randomized. We derived LAK cells from the autologous spleen removed during operation. The cultivation of LAK cells were done with IL-2. Adriamycin 20mg/body was injected into hepatic artery via subcutaneous implanted reservoir on the 8th postoperative day. In group A, 1.0-7.6 x 10(9) LAK cells were injected i.a on day, 10, 14, and 21 after operation. IL-2 of 5 x 10(5) JU were also injected i.a. during 3 weeks. Group B patients were treated only by adriamycin. High fever was seen in all patients belonged to group A. Twelve patients in each group were evaluable. Recurrence rate 8.3% in group A was significantly lower than 50% in group B. In experimental study, accumulation of 111In-oxine labelled LAK cells in mouse 3LL lung cancer was augmented in splenectomized ones. Adopted immunotherapy by spleen LAK-cells may be effective and safe treatment to preventing recurrence of hepatocellular carcinoma after hepatectomy.

[Intra-arterial infusion chemotherapy for unresectable hepatocellular carcinoma using an implantable reservoir]

Arterial infusion therapy using implantable reservoirs was used in 44 patients with hepatocellular carcinoma which was unresectable for severe liver dysfunction or advanced tumor. The prognosis for patients with whom the double lumen reservoir developed by our department which can occlude the hepatic artery, was compared with that of patients for whom the conventional reservoir was employed. We also evaluated the reduction surgery previous to infusion therapy for tumor-advanced unresectable HCC. The six-month survival rates (Kaplan-Meier method) of the double lumen reservoir cases were significantly higher than for conventional reservoir cases. The survival rates of the cases of reduction surgery and infusion therapy (within only one year) were higher than for infusion therapy cases. Not only the use of the double lumen reservoir but the reduction surgery for unresectable HCC increases the effectiveness of infusion therapy and improves the prognosis.

[Studies on postoperative arterial infusion chemotherapy using implanted reservoir for hepatocellular carcinoma]

The effect of postoperative arterial infusion therapy using implanted reservoir was evaluated in 28 cases of resected hepatocellular carcinoma which showed at least one of those findings as Vp (+), Vv (+), IM (+) and more than 5 cm in tumor diameter. Ten of them underwent arterial infusion therapy with combination ADM and CDDP after hepatic resection (IA group) and the rest underwent no regional chemotherapy (control group). The one-, two- and three-year cumulative disease-free survival rates between control group and IA group were 55.6% against 80.0%, 25.4% against 70.0%, and 16.9% against 37.3%, respectively. The one-, two- and three-year cumulative survival rates between control group and IA group were 71.8% against 90.0%, 51.8% against 70.0% and 41.5% against 56.0%, respectively, a difference that was not statistically significant. We suggest this therapy can prevent intrahepatic recurrence, although it does not improve prognosis. To achieve a better prognosis, a new arterial infusion chemotherapy more effective than this one must be developed.

[Intraportal vein infusion chemotherapy after hepatectomy for hepatocellular carcinoma--preliminary report]

Four cases of advanced hepatocellular carcinoma patients were treated by intra-portal infusion of 5-FU immediately after surgery. 5-FU at 120-250 mg daily was injected continuously via portal catheter from postoperative day 4 to 21. Two cases with short administration period of 4 days died of recurrence on the residual liver at 9 and 7 months after hepatic resection. Another 2 cases with a total amount of 5-FU at 2,165 mg and 2,250 mg, respectively, survived 4 years 3 months and 4 year 8 months each. Mild leukocytopenia and transient liver dysfunction were found as side effects. Intraportal infusion of anticancer drugs is a promising means to prevent intrahepatic micrometastasis after resection of hepatocellular carcinoma.

Spontaneous hepatic copper accumulation in Long-Evans Cinnamon rats with hereditary hepatitis. A model of Wilson's disease

Long-Evans Cinnamon (LEC) rats, an inbred strain of a mutant rat isolated from Long-Evans rats, develop hereditary hepatitis. To elucidate the role of copper metabolism in the development of the hepatitis in LEC rats, we examined the copper concentration in the tissues and serum levels of copper and ceruloplasmin. Copper concentration in the liver of LEC rats was over 40 times that of normal Long-Evans Agouti (LEA) rats, while the serum ceruloplasmin and copper concentrations in LEC rats decreased significantly. The hepatocytes of LEC rats show steatosis in cytoplasm and pleomorphism of mitochondria, resembling the histologic features of the liver in Wilson's disease. These findings suggest that the hereditary hepatitis in LEC rats is closely associated with copper toxicity, and may be dealing with a rat form of Wilson's disease. Thus the LEC rats will provide a unique and useful animal model for clarifying the mechanism and for developing treatment strategies for Wilson's disease and other abnormal copper metabolism in humans.

Abnormal copper accumulation in non-cancerous and cancerous liver tissues of LEC rats developing hereditary hepatitis and spontaneous hepatoma

We studied the copper concentrations in the non-cancerous and cancerous liver tissues of LEC rats with hereditary hepatitis and spontaneous hepatoma by atomic absorption spectrophotometry. Copper concentration in the non-cancerous livers of 29-month-old male LEC rats was comparable to that in the livers of LEC rats aged 2, 3 and 8 months whose hepatic copper concentrations were more than 40 times those of normal LEA rats. Copper concentration in spontaneously developed hepatocellular carcinomas of the 29-month-old male LEC rats was lower than that in the surrounding non-cancerous liver tissues, but was still more than 39 times that of 8-month-old male LEA rats. These findings suggest that in LEC rats an abnormal copper metabolism may be maintained during the process of hepatic carcinogenesis.

Modification of lymphokine-activated killer cell accumulation into tumor sites by chemotherapy, local irradiation, or splenectomy

The effects of chemotherapy or local irradiation on lymphokine-activated killer (LAK) cell accumulation into tumor sites were investigated. Lymphokine-activated killer cells labeled with 111In-oxine were injected into the caudal vein of C57BL/6 mice that had been previously transplanted with 3LL cancer. An adoptive transfer of LAK cells was carried out 4 days after treatments. Twenty-four hours after the transfer, tumor tissues were excised, and the accumulation of labeled LAK cells in the tumor was measured. In two different experiments, LAK cell accumulation in tumor in the nontreated group was 2.15% and 1.58% of the administered dose per gram of tissue. The accumulation in the groups of mice treated with cyclophosphamide, nimustine hydrochloride, or Adriamycin increased fourfold (7.38% dose/g, 6.61% dose/g), threefold (6.47% dose/g) and twofold (4.46% dose/g), respectively, as compared with the nontreated group. These agents induced significant tumor regression. In the group treated with bleomycin, which showed no significant effect on tumor growth, LAK cell accumulation in tumor remained unaltered (1.57% dose/g). However, the group treated with local irradiation, which induced significant tumor reduction, showed no increase in LAK cell accumulation into tumors. These results suggest that some antitumor drugs enhance LAK cell accumulation into tumor sites and that this increase is due to tumor modification by antitumor drugs.

Mammary carcinoma with pulmonary metastasis in a sow

Mammary adenocarcinoma was diagnosed in a 3-year-old Landrace sow with prolonged infertility, anorexia and progressive emaciation after parturition. Gross examination confirmed a large tumour in the left anterior mammary gland with metastatic nodules on the pleura and in the parenchyma of lung. Microscopically, the tumour consisted mainly of solid adenomatous proliferations with numerous mitotic figures. Irregular glandular structures, solid nests of polygonal tumour cells without polarity and nests consisting of glandular, cribriform and solid portions were evident in dense fibrous stroma. Immunostaining revealed keratin in the tumour cells.

[A case of double cancer of gastric and hepatocellular carcinoma associated with cirrhosis treated by hepatic resection after intra-hepatic arterial infusion chemotherapy]

A case of double cancer, early gastric cancer and hepatocellular carcinoma, was reported. The patient was diabetic and had liver cirrhosis. After gastrectomy for gastric cancer which was hemorrhagic, he was treated by intra-hepatic arterial infusion chemotherapy followed by hepatic resection. Histopathologically, about half of the main tumor showed necrosis, but very viable new cancer cell nests were seen around the main nodule. The patient is in good condition without recurrence of hepatic lesion 1 year after resection. The usefulness of arterial infusion chemotherapy was demonstrated in the case of double cancer, in which it is difficult to resect both cancers simultaneously.

[A case of non-functioning adrenocortical tumor]

A resected case of a non-functioning adrenocortical tumor is reported. The patient's chief complaint was fever and general fatigue. Computed tomography and ultrasonography revealed the suspected presence of a tumor on the right lobe of the liver, though a definite diagnosis of a right adrenal tumor was reached after hepatic angiography. An endocrinal examination, however, showed no abnormality. The tumor was dissected sharply from the right hepatic lobe and completely removed with a part of the diaphragm. It measured 10 x 12 x 18 cm and weighed 1,280 g. Hemorrhagic and necrotic changes were noted in the cut section, and a subsequent pathological examination revealed an adenocarcinoma of the adrenal cortex. An administration of 5-FU was given orally and the patient's progress has gone well without a recurrence or a metastasis for 4 years and a month since the surgery.

Surgical aspects of hepatic segmentation based on hepatic venographies

Hepatic venographies were performed selectively in 42 patients with hepatocarcinoma. The findings were evaluated from anterior and lateral views. Thirty-nine right hepatic v. could be identified and the existence of one branch as the first ramification was found in 36 cases (92.3%). The first branches of the right hepatic v. could be classified into veins (V7) running from segment VII and those (V8) running from segment VIII. A V7 was identified in 26 cases (72.8%) and a V8 was identified in 10 cases (27.8%). The vena hepatica dorsalis (V8) running from segment VIII was recognised in 10 cases. The middle and left hepatic v. were identified in 31 cases and 33 cases respectively. Two main types of middle vein (one with no principal branching and the other with branching) were found in 11 cases (37.9%) and 12 cases (41.4%) respectively. The first branch of the middle hepatic v. (V8) running from segment VIII was identified in 10 cases (32.3%). These results indicate that anatomical consideration of the hepatic v. in each patient is necessary when performing hepatic resection.

[Study on the pharmacokinetics of UFT in patients with hepatocellular carcinoma associated with cirrhosis]

UFT was administered preoperatively in 20 cases of primary hepatocellular carcinoma, and tegafur, 5-fluorouracil (5-FU), uracil, total thymidylate synthase (TS) and free TS in blood and liver tissue were determined. The results were as follows. 1. Tegafur level was significantly high in blood, while the levels of 5-FU and uracil were high in the liver tissue. The 5-FU level in the cancerous area was 0.099 micrograms/g, higher than the effective level regardless of the presence or not of complication with liver cirrhosis. 2. Total TS, FdUMP (computed as total TS-free TS) and TS inhibition rate [(computed as (TS-free TS)/TS x 100 (%)] were significantly higher in the cancerous liver tissue than in the non-cancerous area. In the cases where determination was made simultaneously for the cancerous liver and non-cancerous liver tissues, the FdUMP level and TS inhibition rate in the cancerous liver tissue were high in 14 out of 17 cases (82.4%) and 13 out of 17 cases (76.5%) respectively. Therefore, UFT seems to have selective toxicity. 3. No correlation was found between 5-FU level, total TS, FdUMP in the liver tissue on the one hand and TS inhibition rate on the other. 4. UFT yielded sufficient 5-FU levels in the cancerous area regardless of the presence or not of complication with cirrhosis and therefore is expected to inhibit DNA synthesis selectively in the cancerous tissue.

[Clinical study of intrahepatic arterial infusion of unresectable hepatoblastoma and hepatocarcinoma in children]

Six cases of unresectable hepatic cancer in infant were treated with intra-arterial infusion therapy. The histological types were hepatoblastoma and hepatocellular carcinoma, 3 cases respectively. The clinical stages were 1 recurrent case in I, 1 in IIIA, 2 in IIIB and 2 in IV. Seldinger method and cannulation at laparotomy were employed in 4 cases and 2 cases, respectively. In the eldest case, a catheter with dual lumen reservoir developed in our department was inserted, making it possible to infuse drugs into hepatic artery and cutting off hepatic arterial blood flow temporarily. The anticancer drug used was ADM, CDDP, 5-FU, THP-ADM, and MMC; antiAFP-anticancer drug conjugate missile therapy was employed in 4 cases. According to image diagnosis, reduction or necrosis of tumor was observed in 5 cases. In all cases, AFP scores decreased. In 5 dead cases, 4 cases died of tumor enlargement (average survival time 16.3 months); 1 case died of DIC during chemotherapy. The other case could eventually undergo complete resection and is now alive. Intra-arterial infusion therapy seemed to be useful for patients of infant unresectable hepatic cancer.

[Intra-arterial infusion chemotherapy under flow occlusion using a double lumen reservoir]

Recently, we developed an intrahepatic artery catheter and a device attached with an implantable double lumen reservoir. In this paper, we present clinical experience with this device in 15 cases of hepatocellular carcinoma and the results of an experimental study using canine regarding the significance of arterial infusion therapy with occlusion of hepatic arterial flow. Adriamycin and CDDP were used as anticancer agents, and in 3 out of 15 cases IL-2 and LAK cell were used as chemoimmunotherapy. Twenty-one infusions were possible without any severe side effects. This treatment was also safely done even in the out-patient clinic. In one case extravasation of drug and another case of fever caused by catheter were seen, which was easily diminished by conservative treatment. Ten cases were estimated for antitumor effects and 5 showed partial remission. In experimental study, augmentation of the intrahepatic tissue level of adriamycin was found with occlusion of arterial flow. Intra-arterial infusion therapy using this device promises to be a most useful routine method for cancer control in the outpatient clinic.

[Reservoir implanted arterial infusion therapy in liver cancer with replaced right hepatic artery]

Seven cases of liver cancer with replaced right hepatic artery were treated with arterial infusion therapy using implanted reservoir. The reservoir was surgically implanted in all cases. In 5 cases, right hepatic artery ligation was done simultaneously. TAE via right hepatic artery and ligation of middle and left hepatic artery was done in 2 other cases. ADM, CDDP, MMC, 5-FU and Lentinan were used. As the result, decrease in tumor size or necrosis of tumor was found in 3 cases of hepatomas, necrosis of tumor was found in 1 of three cases of metastatic liver cancer and remarkable decrease in tumor size and normalization of CEA level were found in another case. Arterial infusion therapy using implanted reservoir for the cases with variation would be effective with the combination of hepatic ligation or TAE.

[Development of a new therapeutic method in hepatocellular carcinoma using a culture system--the intensifying effect of human epidermal growth factor (hEGF) on the antitumor action of antitumor agents]

The culture system of hepatocellular carcinoma (HCC) has been established and the effect of hepatotrophic factors on these cell lines have been studied. During this study the effect of the human epidermal growth factor intensifying anti-tumor action of anti-tumor agents will be evaluated. HCC cell lines (C-HC-4, C-HC-20) show logarithmic growth in the serum-free medium. These growth curves after administration of 1 x 10(-12- -8) M of hEGF were measured, and the existence of the hEGF receptors was evaluated using the ABC method. The growth curve of HC-4 transplanted into nude mice was measured in 4 groups; the control group, the hEGF group, the gamma Interferon (gamma IFN) group, and the hEGF + gamma IFN group. The hEGF enhanced the cell growth of C-HC-4 and C-HC-20, and EGF receptors were confirmed immunohistologically. In the hEGF+ gamma IFN group, growth inhibition seems to be most important. The hEGF may intensify the anti-tumor action of the anti-tumor agents.

Reduction in the stability of the Gs-catalytic unit complex of adenylate cyclase in isoproterenol-induced heterologous desensitization

Treatment of rat reticulocytes with isoproterenol resulted in the heterologous desensitization of adenylate cyclase, causing a reduction in NaF/AlCl3- and guanylyl 5'-imidodiphosphate (Gpp(NH)p)-stimulated activities as well as in activity stimulated by beta-adrenoceptor agonists. Desensitization was also induced by dibutyryl cyclic AMP and 1-(5-isoquinolinylsulfonyl)-2-methylpiperazine (H-7), an inhibitor of cyclic AMP-dependent protein kinase (protein kinase A), prevented the isoproterenol-induced desensitization, suggesting the involvement of protein kinase A in the desensitization. Gs in the desensitized cell membrane was activated by treatment with Gpp(NH)p or NaF/AlCl3 in the presence of Mg2+. The activated state, the Gs-C complex, was gradually shifted to the basal state, i.e. the Gs-C complex was dissociated by removal of Mg2+. The rate constant of the dissociation was increased in the desensitized cell membranes (0.074 min-1) as compared with that in the control cell membranes (0.022 min-1). The half life of the Gs-C complex, calculated from the rate constant, was decreased during the process of desensitization. The results indicate that reduction in the stability of the Gs-C complex is related to heterologous desensitization. Agents which increase the level of cyclic AMP in the cell also reduced the stability of the complex. The potency of such an effect was in the following order; isoproterenol approximately NaF/AlCl3 (k = 0.071 min-1) greater than forskolin (0.039 min-1) greater than Mn2+ approximately dibutyryl cyclic AMP (0.030 min-1). The former two activate Gs and form Gs-C complex, while the latter two cause intracellular cyclic AMP accumulation without activation of Gs. It may be deduced from this order that the reduction of the stability depends not only on the increase in the cyclic AMP level but also on the level of Gs-C complex formed.

Cooperative study on arterial regional chemotherapy for primary liver cancer in Hokkaido

The Liver Study Group of Hokkaido analyzed a total of 57 patients with non-resectable primary liver cancers, which were treated by intra-arterial adriamycin infusion chemotherapy combined with lipiodol and/or the Gelform embolization of the hepatic arteries. Of the ten patients considered clinical responders, three complete response patients and seven partial response cases were obtained. The overall response rate was 17.5%. The median survival period at each clinical stage was as follows: stage I: 13.0 months, stage II: 16.0 months, stage III: 11.5 months and stage IV: 4.7 months. The common side-effects of this treatment were nausea, vomiting and anorexia. Hematological toxicities were also found, but there was no patient who suffered from severe complications.

Liver resection using a water jet

The water-jet method has been used during hepatic resection. The instrument cuts the hepatic tissue with the high pressure of the fine water flow, while the exposed elastic intrahepatic vessels are spared injury. A comparative study on the water-jet method with the previously employed conventional methods was undertaken. Hepatic resections were performed on 35 patients using the water-jet method. Cirrhosis of the liver was associated with 10 of the 24 patients with hepatocellular carcinoma. An ordinary saline solution was used as the jet, which was projected at a pressure of between 12 kg/cm2 and 20 kg/cm2 through a 0.15/mm-diameter nozzle. A higher jet pressure was needed to cut the fibrotic hepatic parenchyma. In the case of normal liver, the intrahepatic vessels of more than 0.2 mm were well preserved. In most of the cases, the loss of blood when cutting the hepatic parenchyma can be easily reduced with a jet pressure of 15-16 kg/cm2, thus preserving the fine vessels more than 0.2 mm in diameter without injury. When the same pressure was applied in the cutting of a cirrhotic liver, it took much longer time compared to that of a non-cirrhotic normal liver parenchyma. The cut surface was smooth compared to that after using CUSA, although its disadvantages lie in the formation of air bubbles, which obscure the operative field. The controlled projection of a jet of water under optimal pressure may ensure a safe hepatic resection of both normal and cirrhotic livers. Furthermore, because of its uncomplicated form, a wide range of applications can be expected, while the lower cost will also expedite its large-scale use for economic reasons.

[Repeated arterial infusion therapy with ADM and CDDP in liver cancer using implanted reservoir]

Between January 1986 and March 1988, 35 cases with primary liver cancer were treated by arterial infusion therapy using implanted reservoir. Twenty-one of these cases were treated by the repeated infusion of ADM and CDDP. Results were as follows. 1) Three of 7 non-curatively resected cases died, with a mean survival time of 11 months. Four cases survival for at most 14 months. 2) The response rate (PR) of whole unresectable cases was 29.2%. The cumulative survival rate after treatment was 52.5% at one year. 3) The response rate (PR) of the unresectable cases which were treated with ADM CDDP intraarterial infusion was 33.3%. The cumulative survival rate after treatment was 63.5% at one year. 4) Severe side effects and complications were not seen. We suggested that this form of therapy could prolong the survival time of unresectable hepatoma.

[Fabrication and clinical application of intrahepatic arterial catheter facilitating repeated infusion therapy and experience]

Balloon occluded arterial infusion (BOAI) is an ideal and widely accepted method for augmentation of the intrahepatic tissue level of anticancer drugs. But this method nakes repeated infusion very difficult because the Seldinger method is needed to cannulate into the hepatic artery. Recently, we made an intrahepatic artery catheter attached with an implantable reservoir, consisting of an intra-arterial catheter, reservoir and cylinder-like device which has a small balloon on its inner part. The cannulation is done at laparotomy. With this method, five cases of nonresectable hepatocellular carcinoma, one metastatic liver cancer and one noncurative hepatocellular carcinoma were treated. Intrahepatic vessels were quite visible by DSA using CO2 gas. Serum concentration level of adriamycin was lower and undetectable at 120 minutes after infusion. No side effects nor catheter complications were observed. Intra-arterial infusion therapy using this device will be a most useful routine method for cancer control in the outpatient clinic.

Phorbol ester regulates stimulatory and inhibitory pathways of the hormone-sensitive adenylate cyclase system in rat reticulocytes

Treatment of rat reticulocytes with tetradecanoyl phorbol acetate (TPA), a tumor-promoting phorbol ester which activates protein kinase C, resulted in an about 50% decrease in the stimulation of adenylate cyclase activity by a subsequent challenge with a beta-adrenoceptor agonist. This phenomenon mimics agonist-induced desensitization. This decline is due to a reduction in the Vmax of the adenylate cyclase system rather than to a change in affinity to the agonist. The beta-adrenoceptor number was not changed while the KD for an agonist but not for an antagonist was increased by TPA treatment. Prostaglandin E1 (PGE1) plus GTP, NaF plus AlCl3, and guanylyl-5'-imidodiphosphate (GppNHp) regulated adenylate cyclase activity in a biphasic manner, i.e. stimulation at lower concentrations and inhibition at higher concentrations. The same treatment also caused a dose- and time-dependent reduction of the inhibitory phase of the PGE1/GTP action but did not affect the inhibitory phase of GppNHp and NaF/AlCl3 actions. Pertussis toxin (IAP) treatment caused a reduction of the inhibitory phase of PGE1/GTP action similar to that caused by TPA treatment. No synergistic effect was observed when the cells were treated with TPA and IAP simultaneously. These results suggest that TPA treatment impairs the coupling between PGE1 receptor and Gi rather than enhances that between PGE1 receptor and Gs. Protein kinase C was involved in the regulation of hormone-sensitive adenylate cyclase, the beta-agonist-induced stimulatory pathway and the PGE1-induced inhibitory pathway in rat reticulocytes, since other phorbol esters and diacylglycerol, which activate this kinase, caused the same response.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of the inhibitory GTP-binding regulatory protein and a low-affinity benzodiazepine receptor in the inhibitory effect of diazepam on rat brain adenylate cyclase system

The effect of diazepam on the adenylate cyclase system was studied in rat synaptosomal membranes. Micromolar concentrations of diazepam inhibited the cyclase activities in the presence or absence of guanylyl-5'-imidodiphosphate (GppNHp). The inhibitory effect of diazepam was greater on the cyclase activity in the presence of GppNHp than on that in the basal state. This effect of diazepam was not antagonized by Ro15-1788, an antagonist of a high affinity benzodiazepine receptor in the central nervous system. Furthermore, micromolar concentrations of Ro15-1788 had no inhibitory effect on cyclase activities in the presence or absence of GppNHp. In addition, the bromide ion enhanced the inhibition by diazepam of the cyclase activity in the presence of GppNHp, but not the basal activity, although the bromide ion had no effect on both activities in the absence of diazepam. On the other hand, the pretreatment of synaptosomal membranes with GppNHp increased the KD value for [3H]diazepam binding from 98 microM to 198 microM. These data led us to conclude that diazepam inhibits rat brain adenylate cyclase through the effects on both a low affinity benzodiazepine receptor coupled with the inhibitory GTP-binding regulatory protein (Gi) and the catalytic protein.

Significant reduction of the echogenicity of the compressed cavernous hemangioma

Eleven hyperreflective hepatic nodules in eight patients were examined by means of intraoperative ultrasonography (US) with the transducer placed on the liver surface. The nodules included four cavernous hemangiomas, four hepatocellular carcinomas, one metastatic tumor, and two regenerative nodules in cirrhotic livers. When the relevant part of the liver was compressed during US observation, the echogenicity was reduced only in the case of cavernous hemangioma. This phenomenon is considered to be unique to cavernous hemangioma.

[Study on the chemosensitivity of liver cell carcinoma by subrenal capsule assay]

Chemosensitivity of liver cell carcinoma was studied by subrenal capsule assay. The method of assay was based on Bogden's one, but the antitumor activity was evaluated by tumor growth inhibition rate (TG-IR). The anticancer agent with more than 50% TG-IR was judged as positive in the chemosensitivity test. Of 3 human hepatoma cell lines transplanted in the subcutaneous space of nude mice, all of 3 were evaluable. The positive rates of ADR, MMC, CDDP, 5-FU and CPA were 66.7%, 100%, 66.7%, 100% and 0%, respectively. Of 24 patients who provided fresh tumor specimens for the assay, 12 (50%) were evaluable. The positive rates of ADR, MMC, CDDP, 5-FU and CPA were 25%, 16.7%, 16.7%, 33.3% and 8.3%, respectively. Our study suggested that 5-FU, MMC and ADR were comparatively active against the hepatoma cell, CDDP was less active than these 3 agents, CPA was inactive. These results seem to justify the use of current anticancer agents against hepatic cell carcinoma and indicate the usefulness of SRC assay for selecting chemotherapeutic agents against liver cell carcinoma.