1
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Finn R, Kudo M, Merle P, Meyer T, Qin S, Ikeda M, Xu R, Edeline J, Ryoo BY, Ren Z, Cheng AL, Galle P, Kaneko S, Kumada H, Wang A, Mody K, Dubrovsky L, Siegel A, Llovet J. LBA34 Primary results from the phase III LEAP-002 study: Lenvatinib plus pembrolizumab versus lenvatinib as first-line (1L) therapy for advanced hepatocellular carcinoma (aHCC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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2
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Kudo M, Finn R, Ikeda M, Zhu A, Sung M, Baron A, Okusaka T, Kobayashi M, Kumada H, Kaneko S, Pracht M, Meyer T, Nagao S, Saito K, Mody K, Dubrovsky L, Llovet J. 68P A phase Ib study of lenvatinib + pembrolizumab (LEN + PEMBRO) in patients (pts) with unresectable hepatocellular carcinoma (uHCC): Study 116 follow-up analysis. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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3
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Ikebe Y, Oshima M, Bamba S, Asai M, Tsukada K, Sato TK, Toyoshima A, Bi C, Seto H, Amano H, Kumada H, Morimoto T. Study of charged particle activation analysis (II): Determination of boron concentration in human blood samples. Appl Radiat Isot 2020; 164:109106. [PMID: 32819495 DOI: 10.1016/j.apradiso.2020.109106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/05/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Boron Neutron Capture Therapy (BNCT) is a radiotherapy for the treatment of intractable cancer. In BNCT precise determination of 10B concentration in whole blood sample before neutron irradiation of the patient, as well as accurate neutron dosimetry, is crucial for control of the neutron irradiation time. For this purpose ICP-AES and neutron induced prompt γ-ray analysis are generally used. In Ibaraki Neutron Medical Research Center (iNMRC), an intense proton beam will be accelerated up to 8 MeV, which can also be used for Charged Particle Activation Analysis (CPAA). Thus, in this study, we apply the CPAA utilizing the proton beam to non-destructive and accurate determination of 10B concentration in whole blood sample. A CPAA experiment is performed by utilizing an 8 MeV proton beam from the tandem accelerator of Nuclear Science Research Institute in Japan Atomic Energy Agency. The 478 keV γ-ray of 7Be produced by the 10B(p, α)7Be reaction is used to quantify the 10B in human blood. The 478 keV γ-ray intensity is normalized by the intensities of the 847 keV and 1238 keV γ-rays of 56Co originating from Fe in blood. The normalization methods were found to be linear in the range of 3.27 μg 10B/g to 322 μg 10B/g with correlation coefficients of better than 0.9999.
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Affiliation(s)
- Y Ikebe
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan.
| | - M Oshima
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan
| | - S Bamba
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan
| | - M Asai
- Japan Atomic Energy Agency, Shirakata 2-4, Tokai, Naka, Ibaraki, 319-1195, Japan
| | - K Tsukada
- Japan Atomic Energy Agency, Shirakata 2-4, Tokai, Naka, Ibaraki, 319-1195, Japan
| | - T K Sato
- Japan Atomic Energy Agency, Shirakata 2-4, Tokai, Naka, Ibaraki, 319-1195, Japan
| | - A Toyoshima
- Japan Atomic Energy Agency, Shirakata 2-4, Tokai, Naka, Ibaraki, 319-1195, Japan
| | - C Bi
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan
| | - H Seto
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan
| | - H Amano
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan
| | - H Kumada
- University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - T Morimoto
- Japan Chemical Analysis Center, Sanno 295-3, Inage, Chiba, 263-0002, Japan
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Llovet J, Shepard K, Finn R, Ikeda M, Sung M, Baron A, Kudo M, Okusaka T, Kobayashi M, Kumada H, Kaneko S, Pracht M, Mamontov K, Meyer T, Mody K, Kubota T, Saito K, Siegel A, Dubrovsky L, Zhu A. A phase Ib trial of lenvatinib (LEN) plus pembrolizumab (PEMBRO) in unresectable hepatocellular carcinoma (uHCC): Updated results. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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Aihara T, Hiratsuka J, Ishikawa H, Kumada H, Ohnishi K, Kamitani N, Suzuki M, Sakurai H, Harada T. Fatal carotid blowout syndrome after BNCT for head and neck cancers. Appl Radiat Isot 2015; 106:202-6. [PMID: 26282568 DOI: 10.1016/j.apradiso.2015.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 07/30/2015] [Accepted: 08/09/2015] [Indexed: 11/29/2022]
Abstract
Boron neutron capture therapy (BNCT) is high linear energy transfer (LET) radiation and tumor-selective radiation that does not cause serious damage to the surrounding normal tissues. BNCT might be effective and safe in patients with inoperable, locally advanced head and neck cancers, even those that recur at previously irradiated sites. However, carotid blowout syndrome (CBS) is a lethal complication resulting from malignant invasion of the carotid artery (CA); thus, the risk of CBS should be carefully assessed in patients with risk factors for CBS after BNCT. Thirty-three patients in our institution who underwent BNCT were analyzed. Two patients developed CBS and experienced widespread skin invasion and recurrence close to the carotid artery after irradiation. Careful attention should be paid to the occurrence of CBS if the tumor is located adjacent to the carotid artery. The presence of skin invasion from recurrent lesions after irradiation is an ominous sign of CBS onset and lethal consequences.
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Affiliation(s)
- T Aihara
- Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan; Otolaryngology Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan.
| | - J Hiratsuka
- Departments of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan
| | - H Ishikawa
- Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan
| | - H Kumada
- Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan
| | - K Ohnishi
- Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan
| | - N Kamitani
- Departments of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan
| | - M Suzuki
- Radiation Oncology Research Laboratory, Research Reactor Institute, Kyoto University, Osaka, Japan
| | - H Sakurai
- Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan
| | - T Harada
- Otolaryngology Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan
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6
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Hara T, Suzuki F, Kawamura Y, Sezaki H, Hosaka T, Akuta N, Kobayashi M, Suzuki Y, Saitoh S, Arase Y, Ikeda K, Kobayashi M, Watahiki S, Mineta R, Kumada H. Long-term entecavir therapy results in falls in serum hepatitis B surface antigen levels and seroclearance in nucleos(t)ide-naïve chronic hepatitis B patients. J Viral Hepat 2014; 21:802-8. [PMID: 25274427 DOI: 10.1111/jvh.12211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/08/2013] [Indexed: 12/12/2022]
Abstract
Entecavir (ETV) is reported to result in suppression of hepatitis B virus DNA (HBV DNA) replication with minimal drug resistance. However, information on the long-term effect of such therapy on serum hepatitis B surface antigen (HBsAg) level and elimination of HBsAg is not available. ETV therapy was started in 553 nucleos(t)ide-naïve patients with chronic hepatitis B infection (HBeAg positive: 45%) in our hospital. Serum HBsAg levels were measured serially by the Architect assay. The median baseline HBsAg was 2180 IU/mL (0.12-243 000 IU/mL), and median follow-up period was 3.0 years, with 529, 475, 355, 247 and 163 patients followed-up for 1, 2, 3, 4 and 5 years, respectively. At year 5, the mean log HBsAg decline from baseline was -0.48 log IU/mL, and the cumulative HBsAg clearance rate was 3.5%. Multivariate analysis identified HBV DNA level at baseline (<3.0 log copies IU/mL, odd ratio = 10.2; 95% confidence interval = 1.87-55.5, P = 0.007) and HBsAg level (<500 IU/mL, odd ratio = 29.4; 95% confidence interval = 2.80-333, P = 0.005) as independent predictors of HBsAg seroclearance. These results indicate that although serum HBsAg level declines gradually during ETV therapy, HBsAg seroclearance remains a rare event.
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Affiliation(s)
- T Hara
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
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7
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Kageji T, Mizobuchi Y, Nagahiro S, Nakagawa Y, Kumada H. Correlation between radiation dose and histopathological findings in patients with gliblastoma treated with boron neutron capture therapy (BNCT). Appl Radiat Isot 2013; 88:20-2. [PMID: 24480727 DOI: 10.1016/j.apradiso.2013.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 12/08/2013] [Accepted: 12/09/2013] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to clarify the correlation between the radiation dose and histopathological findings in patients with glioblastoma multiforme (GBM) treated with boron neutron capture therapy (BNCT). Histopathological studies were performed on specimens from 8 patients, 3 had undergone salvage surgery and 5 were autopsied. For histopathological cure of GBM at the primary site, the optimal minimal dose to the gross tumor volume (GTV) and the clinical target volume (CTV) were 68Gy(w) and 44Gy(w), respectively.
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Affiliation(s)
- T Kageji
- Department of Neurosurgery, The University of Tokushima, Tokushima 770-8503, Japan.
| | - Y Mizobuchi
- Department of Neurosurgery, The University of Tokushima, Tokushima 770-8503, Japan
| | - S Nagahiro
- Department of Neurosurgery, The University of Tokushima, Tokushima 770-8503, Japan
| | - Y Nakagawa
- Department of Neurosurgery, Kagawa National Children's Hospital, Kagawa, Japan
| | - H Kumada
- Department of Radiation Oncology, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaragi, Japan
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Toyota J, Ozeki I, Karino Y, Asahina Y, Izumi N, Takahashi S, Kawakami Y, Chayama K, Kamiya N, Aoki K, Yamada I, Suzuki Y, Suzuki F, Kumada H. Virological response and safety of 24-week telaprevir alone in Japanese patients infected with hepatitis C virus subtype 1b. J Viral Hepat 2013; 20:167-73. [PMID: 23383655 PMCID: PMC3592988 DOI: 10.1111/j.1365-2893.2012.01640.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hepatitis C virus (HCV) subtype 1b, which infects approximately 70% of Japanese carriers, is likely to be more eradicable by a telaprevir regimen than subtype 1a because of the higher genetic barrier of Val(36) and Arg(155) substitutions. The aims of this exploratory study were to evaluate the virological response and safety of 24-week oral administration of telaprevir alone in chronic HCV subtype 1b infection. Fifteen treatment-naïve patients were treated with telaprevir 750 mg every 8 h for 24 weeks. All patients were Japanese whose median age was 58.0 years (range: 45-68), and six patients (40%) were men. Median baseline HCV RNA level was 6.80 log(10) IU/mL (range: 3.55-7.10). The HCV RNA levels decreased to undetectable in five patients (33%) within 8 weeks. Three patients (20%) with negative HCV RNA by Week 4 achieved end of treatment response. One patient (7%) who achieved sustained virological response had a low baseline viraemia of 3.55 log(10) IU/mL. Most of the adverse events including anaemia and skin disorders were mild to moderate. Developed variants were T54A and A156V/T/F/Y with or without secondary substitutions rather than V36M ± R155K. Telaprevir alone for 24 weeks in Japanese patients with HCV subtype 1b resulted in an sustained viral response rate of 7% (1/15) and was well tolerated for 24 weeks. These results will support the implementation of further studies on oral combination of telaprevir with other direct-acting antiviral agents in patients infected with HCV subtype 1b.
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Affiliation(s)
- J Toyota
- Department of Gastroenterology, Sapporo Kosei General HospitalHokkaido, Japan
| | - I Ozeki
- Department of Gastroenterology, Sapporo Kosei General HospitalHokkaido, Japan
| | - Y Karino
- Department of Gastroenterology, Sapporo Kosei General HospitalHokkaido, Japan
| | - Y Asahina
- Division of Gastroenterology and Hepatology, Musashino Red Cross HospitalTokyo, Japan
| | - N Izumi
- Division of Gastroenterology and Hepatology, Musashino Red Cross HospitalTokyo, Japan
| | - S Takahashi
- Division of Frontier Medical Science, Department of Medical and Molecular Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima UniversityHiroshima, Japan
| | - Y Kawakami
- Division of Frontier Medical Science, Department of Medical and Molecular Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima UniversityHiroshima, Japan
| | - K Chayama
- Division of Frontier Medical Science, Department of Medical and Molecular Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima UniversityHiroshima, Japan
| | - N Kamiya
- Research and Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - K Aoki
- Research and Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - I Yamada
- Research and Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - Y Suzuki
- Department of Hepatology, Toranomon HospitalTokyo, Japan
| | - F Suzuki
- Department of Hepatology, Toranomon HospitalTokyo, Japan
| | - H Kumada
- Department of Hepatology, Toranomon HospitalTokyo, Japan
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9
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Yamada I, Suzuki F, Kamiya N, Aoki K, Sakurai Y, Kano M, Matsui H, Kumada H. Safety, pharmacokinetics and resistant variants of telaprevir alone for 12 weeks in hepatitis C virus genotype 1b infection. J Viral Hepat 2012; 19:e112-9. [PMID: 22239508 PMCID: PMC3584515 DOI: 10.1111/j.1365-2893.2011.01514.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Telaprevir in combination with peginterferon and ribavirin is a promising advancement in chronic hepatitis C treatment. However, the safety, tolerability, pharmacokinetics and antiviral profiles of telaprevir alone beyond 2 weeks have not been studied. METHODS In a phase 1b study in Japan, 10 treatment-naïve patients infected with hepatitis C virus genotype 1b with high viral load (>5 log(10) IU/mL) received telaprevir 750 mg every 8 h (q8h) for 12 weeks. We examined the safety, tolerability, pharmacokinetics, hepatitis C virus (HCV) RNA levels and resistant variants of telaprevir. RESULTS Neither serious adverse events nor discontinuations of study drug owing to an adverse event occurred. The most common adverse drug reactions were rash (80%) and anaemia (70%). Telaprevir concentration reached its steady state within 2 days after the first administration without abnormal accumulation. Telaprevir alone provided potent antiviral activity: a median log(10) decrease of 2.325 at 16 h and 5.175 on Day 14. During the treatment, HCV RNA levels at the nadir were below the limit of the quantification in seven patients and undetectable in three of 10 patients. Viral breakthrough associated with mainly Ala(156) -substituted variants occurred in eight patients, and only one patient showed end-of-treatment response. The selected variants reverted to the wild-type during the 24-week follow-up period. CONCLUSION Telaprevir alone was well tolerated at 750 mg q8h for up to 12 weeks. The safety profile and emergence of resistant variants of genotype 1b under telaprevir monotherapy for 12 weeks will become increasingly important in evaluating an oral combination of telaprevir with other direct-acting antiviral agents.
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Affiliation(s)
- I Yamada
- Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - F Suzuki
- Department of Hepatology, Toranomon HospitalTokyo, Japan
| | - N Kamiya
- Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - K Aoki
- Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - Y Sakurai
- Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - M Kano
- Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - H Matsui
- Development Division, Mitsubishi Tanabe Pharma CorporationTokyo, Japan
| | - H Kumada
- Department of Hepatology, Toranomon HospitalTokyo, Japan
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Hayashi N, Okanoue T, Tsubouchi H, Toyota J, Chayama K, Kumada H. Efficacy and safety of telaprevir, a new protease inhibitor, for difficult-to-treat patients with genotype 1 chronic hepatitis C. J Viral Hepat 2012; 19:e134-42. [PMID: 22239511 PMCID: PMC3489056 DOI: 10.1111/j.1365-2893.2011.01528.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aims of this phase III study were to assess the efficacy and safety of telaprevir in combination with peginterferon alfa-2b (PEG-IFN) and ribavirin (RBV) for difficult-to-treat patients who had not achieved sustained virological response (SVR) to prior regimens in Japan. The subjects were 109 relapsers (median age of 57.0 years) and 32 nonresponders (median age of 57.5 years) with hepatitis C virus genotype 1. Patients received telaprevir (750 mg every 8 h) for 12 weeks and PEG-IFN/RBV for 24 weeks. The SVR rates for relapsers and nonresponders were 88.1% (96/109) and 34.4% (11/32), respectively. Specified dose modifications of RBV that differed from that for the standard of care were introduced to alleviate anaemia. RBV dose reductions were used for 139 of the 141 patients. The SVR rates for relapsers did not depend on RBV dose reduction for 20-100% of the planned dose (SVR rates 87.5-100%, P < 0.05). Skin disorders were observed in 82.3% (116/141). Most of the skin disorders were controllable by anti-histamine and/or steroid ointments. The ratios of discontinuation of telaprevir only or of all the study drugs because of adverse events were 21.3% (30/141) and 16.3% (23/141), respectively. A frequent adverse event leading to discontinuation was anaemia. Telaprevir in combination with PEG-IFN/RBV led to a high SVR rate for relapsers and may offer a potential new therapy for nonresponders even with a shorter treatment period.
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Affiliation(s)
| | - T Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita HospitalOsaka, Japan
| | - H Tsubouchi
- Department of Digestive and Life-style Related Disease, Kagoshima University Graduate School of Medical and Dental SciencesKagoshima, Japan
| | - J Toyota
- Department of Gastroenterology, Sapporo Kosei General HospitalHokkaido, Japan
| | - K Chayama
- Department of Medical and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima UniversityHiroshima, Japan;
| | - H Kumada
- Department of Hepatology, Toranomon HospitalTokyo, Japan
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Kageji T, Mizobuchi Y, Nagahiro S, Nakagawa Y, Kumada H. Clinical results of boron neutron capture therapy (BNCT) for glioblastoma. Appl Radiat Isot 2011; 69:1823-5. [DOI: 10.1016/j.apradiso.2011.05.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 03/22/2011] [Accepted: 05/27/2011] [Indexed: 11/28/2022]
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Kumada H, Saito K, Nakamura T, Sakae T, Sakurai H, Matsumura A, Ono K. Multistep Lattice-Voxel method utilizing lattice function for Monte-Carlo treatment planning with pixel based voxel model. Appl Radiat Isot 2011; 69:1866-9. [DOI: 10.1016/j.apradiso.2011.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/04/2011] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
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Horiguchi H, Nakamura T, Kumada H, Yanagie H, Suzuki M, Sagawa H. Investigation of irradiation conditions for recurrent breast cancer in JRR-4. Appl Radiat Isot 2011; 69:1882-4. [DOI: 10.1016/j.apradiso.2011.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 03/22/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
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Aiyama H, Nakai K, Yamamoto T, Nariai T, Kumada H, Ishikawa E, Isobe T, Endo K, Takada T, Yoshida F, Shibata Y, Matsumura A. A clinical trial protocol for second line treatment of malignant brain tumors with BNCT at University of Tsukuba. Appl Radiat Isot 2011; 69:1819-22. [PMID: 21778066 DOI: 10.1016/j.apradiso.2011.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 03/14/2011] [Accepted: 04/07/2011] [Indexed: 11/24/2022]
Abstract
We have evaluated the efficacy and safety of boron neutron capture therapy (BNCT) for recurrent glioma and malignant brain tumor using a new protocol. One of the two patients enrolled in this trial is a man with recurrent glioblastoma and the other is a woman with anaplastic meningioma. Both are still alive and no severe adverse events have been observed. Our findings suggest that NCT will be safe as a palliative therapy for malignant brain tumors.
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Affiliation(s)
- H Aiyama
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba, Tennodai, Tsukuba, Japan
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Nakamura T, Horiguchi H, Kishi T, Motohashi J, Sasajima F, Kumada H. Resumption of JRR-4 and characteristics of neutron beam for BNCT. Appl Radiat Isot 2011; 69:1932-5. [PMID: 21621416 DOI: 10.1016/j.apradiso.2011.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 05/06/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
Abstract
The clinical trials of Boron Neutron Capture Therapy (BNCT) have been conducted using Japan Research Reactor No. 4 (JRR-4) at Japan Atomic Energy Agency (JAEA). On December 28th, 2007, a crack of a graphite reflector in the reactor core was found on the weld of the aluminum cladding. For this reason, specifications of graphite reflectors were renewed; dimensions of the graphite were reduced and gaps of water were increased. All existing graphite reflectors of JRR-4 were replaced by new graphite reflectors. In February 2010 the resumption of JRR-4 was carried out with new graphite reflectors. We measured the characteristics of neutron beam at the JRR-4 Neutron Beam Facility. A cylindrical water phantom of 18.6 cm diameter and 24 cm depth was set in front of the beam port with 1cm gap. TLDs and gold wires were inserted within the phantom when the phantom was irradiated. The results of the measured thermal neutron flux and the gamma dose in water were compared with that of MCNP calculation. The neutron energy spectrum of the calculation model with new reflector had little variation compared to that with old reflector, but intensities of the neutron flux and gamma dose with new reflector were rather smaller than those with old reflector. The calculated results showed the same tendency as that of the experimental results. Therefore, the clinical trials of BNCT in JRR-4 could be restarted.
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Affiliation(s)
- T Nakamura
- Department of Research Reactor and Tandem Accelerator, Japan Atomic Energy Agency, Tokai, Ibaraki, Japan.
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16
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Nakai K, Yamamoto T, Aiyama H, Takada T, Yoshida F, Kageji T, Kumada H, Isobe T, Endo K, Matsuda M, Tsurubuchi T, Shibata Y, Takano S, Mizumoto M, Tsuboi K, Matsumura A. Boron neutron capture therapy combined with fractionated photon irradiation for glioblastoma: a recursive partitioning analysis of BNCT patients. Appl Radiat Isot 2011; 69:1790-2. [PMID: 21565517 DOI: 10.1016/j.apradiso.2011.03.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 02/21/2011] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
Abstract
Eight patients to received Boron Neuron Capture Therapy (BNCT) were selected from 33 newly diagnosed glioblastoma patients (NCT(+) group). Serial 42 glioblastoma patients (NCT(-) group) were treated without BNCT. The median OS of the NCT(+) group and NCT (-) group were 24.4 months and 14.9 months. In the high risk patients (RPA class V), the median OS of the NCT(+) group tended to be better than that of NCT(-) group. 50% of BNCT patients were RPA class V.
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Affiliation(s)
- K Nakai
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba, Tennodai, Tsukuba, Japan.
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Yamamoto T, Nakai K, Nariai T, Kumada H, Okumura T, Mizumoto M, Tsuboi K, Zaboronok A, Ishikawa E, Aiyama H, Endo K, Takada T, Yoshida F, Shibata Y, Matsumura A. The status of Tsukuba BNCT trial: BPA-based boron neutron capture therapy combined with X-ray irradiation. Appl Radiat Isot 2011; 69:1817-8. [PMID: 21393005 DOI: 10.1016/j.apradiso.2011.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 01/26/2011] [Accepted: 02/08/2011] [Indexed: 11/28/2022]
Abstract
The phase II trial has been prepared to assess the effectiveness of BPA (250 mg/kg)-based NCT combined with X-ray irradiation and temozolomide (75 mg/m(2)) for the treatment of newly diagnosed GBM. BPA uptake is determined by (18)F-BPA-PET and/or (11)C-MET-PET, and a tumor with the lesion to normal ratio of 2 or more is indicated for BNCT. The maximum normal brain point dose prescribed was limited to 13.0 Gy or less. Primary end point is overall survival.
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Affiliation(s)
- T Yamamoto
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba, Tennodai, Tsukuba, Japan.
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Okusaka T, Makuuchi M, Matsui O, Kumada H, Tanaka K, Kaneko S, Moriwaki H, Izumi N, Ohashi Y, Okita K. Clinical benefit of peretinoin for the suppression of hepatocellular carcinoma (HCC) recurrence in patients with Child-Pugh grade A (CP-A) and small tumor: A subgroup analysis in a phase II/III randomized, placebo-controlled trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
165 Background: HCC has a high recurrence rate and poor prognosis; however, no effective treatment has been established for preventing recurrence after resection or ablation. Peretinoin, an acyclic retinoid, of 600 mg/day reduced HCC recurrence and a strong effect after two years suggested that it mainly suppressed de novo carcinogenesis (ASCO2010). Liver impairment causes non- HCC-related deaths or adverse events, and can potentially mask drug efficacy. The size of the main HCC nodule associates vascular invasion and intrametastasis. To evaluate peretinoin efficacy and assess its mechanism of action, we performed subgroup analysis in CP-A patients who had undergone curative therapy for a small tumor. Methods: Eligibility criteria included HCV positive, CP-A or B, and prior curative resection or ablation for conventional HCC. The patients were randomized into groups to receive peretinoin 600 mg/day (high dose, H), peretinoin 300 mg/day (low dose, L), or placebo (P). The patients were grouped according to the CP grade and the size of the major tumor <20mm at the time of diagnosis. Cumulative recurrence-free survival rates were calculated. Hazard ratio (HR) was calculated using Cox regression analysis. Results: Of the 401 patients, 310 showed CP-A, and 144 showed CP-A and tumor size <20 mm. In the CP-A subgroup, the HR of H group (100) vs. P group (106) was 0.603 (95% CI, 0.408-0.891); in the CP-A and tumor size <20 mm subgroup, the HR of H group (49) vs. P group (49) was 0.376 (95% CI, 0.200-0.705). The common treatment-related adverse events in the CP-A subgroup were albuminuria, hypertension, and headache, which were tolerated. Conclusions: Subgroup analysis with CP-A reinforced the peretinoin efficacy in preventing HCC recurrence. In addition, the CP-A and tumor size <20mm subgroup results strongly suggested that peretinoin inhibited de novo carcinogenesis. The subgroup analyses results of our phase II/II study supported the efficacy and safety of peretinoin and showed that it has early benefits for patients with well-preserved liver function and undergone curative therapy for a small tumor. [Table: see text]
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Affiliation(s)
- T. Okusaka
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - M. Makuuchi
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - O. Matsui
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - H. Kumada
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - K. Tanaka
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - S. Kaneko
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - H. Moriwaki
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - N. Izumi
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - Y. Ohashi
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
| | - K. Okita
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan; Kanazawa University, Ishikawa, Japan; Toranomon Hospital, Tokyo, Japan; Yokohama City University Medical Center, Yokohama, Japan; Gifu University, Gifu, Japan; Musashino Red-Cross Hospital, Tokyo, Japan; Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan; Shimonoseki Kohsei Hospital, Yamaguchi, Japan
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Hirakawa M, Ikeda K, Akuta N, Kawamura Y, Hosaka T, Kobayashi M, Suzuki F, Suzuki Y, Arase Y, Kumada H. Effect of IFN therapy and amino acid substitutions in the hepatitis C virus (HCV) core region on hepatocarcinogenesis in HCV-related cirrhotic patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kawamura Y, Ikeda K, Hirakawa M, Hosaka T, Akuta N, Kobayashi M, Saitoh S, Suzuki F, Suzuki Y, Kumada H. A new classification of dynamic CT images predictive of malignant characteristics of hepatocellular carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Okita K, Matsui O, Kumada H, Tanaka K, Kaneko S, Moriwaki H, Izumi N, Okusaka T, Ohashi Y, Makuuchi M. Effect of peretinoin on recurrence of hepatocellular carcinoma (HCC): Results of a phase II/III randomized placebo-controlled trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ikeda K, Kobayashi M, Someya T, Saitoh S, Hosaka T, Akuta N, Suzuki F, Suzuki Y, Arase Y, Kumada H. Occult hepatitis B virus infection increases hepatocellular carcinogenesis by eight times in patients with non-B, non-C liver cirrhosis: a cohort study. J Viral Hepat 2009; 16:437-43. [PMID: 19226331 DOI: 10.1111/j.1365-2893.2009.01085.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
An impact of serum hepatitis B virus (HBV) DNA on hepatocarcinogenesis has not been investigated in a cohort of patients with non-B, non-C cirrhosis. Eighty-two consecutive Japanese patients with cirrhosis, who showed negative hepatitis B surface antigen and negative anti-hepatitis C virus, were observed for a median of 5.8 years. Hepatitis B virus core (HBc) region and HBx region were assayed with nested polymerase chain reaction. Both of HBc and HBx DNA were positive in 9 patients (11.0%) and both were negative in 73. Carcinogenesis rates in the whole patients were 13.5% at the end of the 5th year and 24.6% at the 10th year. The carcinogenesis rates in the patients with positive DNA group and negative DNA group were 27.0% and 11.8% at the end of the 5th year, and 100% and 17.6% at the 10th year, respectively (P = 0.0078). Multivariate analysis showed that men (P = 0.04), presence of HBc and HBx DNA (hazard ratio: 8.25, P = 0.003), less total alcohol intake (P = 0.010), older age (P = 0.010), and association of diabetes (P = 0.005) were independently associated with hepatocellular carcinogenesis. Existence of serum HBV DNA predicted a high hepatocellular carcinogenesis rate in a cohort of patients with non-B, non-C cirrhosis.
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Affiliation(s)
- K Ikeda
- Department of Hepatology, Toranomon Hospital, Minato-ku, Tokyo, Japan.
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Komeda M, Kumada H, Ishikawa M, Nakamura T, Yamamoto K, Matsumura A. Performance measurement of the scintillator with optical fiber detector for boron neutron capture therapy. Appl Radiat Isot 2009; 67:S254-7. [PMID: 19398347 DOI: 10.1016/j.apradiso.2009.03.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The thermal neutron flux can be easily measured in real time by using the scintillator with optical fiber (SOF) detector. However the irradiation damage under high-intensity neutron flux causes deterioration of the SOF detector due to radiation damage to the plastic scintillator in which (6)LiF is blended. After irradiating the SOF detector for 4 h (thermal neutron fluence is approximately 2.0 x 10(13)neutrons/cm(2)), the sensitivity of the SOF detector decreased by 3.0%. After irradiating the SOF detector for 2 months (thermal neutron fluence approximately 6.4 x 10(14)neutrons/cm(2)), the sensitivity was reduced to 42% of baseline. Supposing that the thermal neutron fluence is 2 x 10(12)neutrons/cm(2) on the surface of a patient in a BNCT treatment, the sensitivity of the SOF detector is reduced by approximately 0.3%. This report presents investigations on the deterioration of the SOF detector in irradiation experiments.
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Affiliation(s)
- M Komeda
- Department of Research Reactor and Tandem Accelerator, Japan Atomic Energy Agency, Japan.
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Yanagie H, Kumada H, Sakurai Y, Nakamura T, Furuya Y, Sugiyama H, Ono K, Takamoto S, Eriguchi M, Takahashi H. Dosimetric evaluation of neutron capture therapy for local advanced breast cancer. Appl Radiat Isot 2009; 67:S63-6. [PMID: 19427224 DOI: 10.1016/j.apradiso.2009.03.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Local recurrence breast cancer is one of the most difficult conditions to cure and there is a need for new therapy. If sufficient boron compound can be targeted to the tumor, boron neutron capture therapy (BNCT) can be applied to local recurrent breast cancer. In this study, we performed a preliminary dosimetry with a phantom model of the mammary gland at Kyoto University Research Reactor (KUR), and a feasibility dosimetry with JAERI Computational Dosimetry System (JCDS) at JRR4 reactor of Japan Atomic Research Institute. We performed preliminary dosimetry of a phantom model of the mammary gland with thermal neutron irradiation (OO-0011 mode) on LiF collimation at KUR. The thermal neutron flux was 5.16 E+08 cm(-2)s(-1) at the surface of phantom. The blood boron concentration is estimated to be 30 ppm; tumor boron concentration is also estimated to be 90 ppm according to tumor/blood ratio 3 and skin/blood ratio 1.2. Tumor RBE dose is estimated to be 47 Gy/h, and skin RBE dose is 12.4 Gy/h. In case of advanced breast cancer, we performed the feasibility estimation of 3D construction of tumor according to the MRI imaging of a patient with epithermal neutron mode at JRR4. The blood boron concentration (ppm) and tumor/normal tissue ratio are estimated to be 24 and 3.5, respectively. Skin RBE dose is restricted to 10 Gy/h, the maximum tumor RBE dose, minimum tumor RBE dose, and mean tumor RBE dose are 42.2, 11.3, and 28.9 Gy-Eq, respectively, in half hour irradiation. In this study, we showed the possibility to apply BNCT to local recurrent breast cancer. We can irradiate tumors selectively and as safely as possible, reducing the effects on neighboring healthy tissues.
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Affiliation(s)
- H Yanagie
- Department of Nuclear Engineering and Management, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.
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Matsuda M, Yamamoto T, Kumada H, Nakai K, Shirakawa M, Tsurubuchi T, Matsumura A. Dose distribution and clinical response of glioblastoma treated with boron neutron capture therapy. Appl Radiat Isot 2009; 67:S19-21. [PMID: 19375933 DOI: 10.1016/j.apradiso.2009.03.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The dose distribution and failure pattern after treatment with the external beam boron neutron capture therapy (BNCT) protocol were retrospectively analyzed. BSH (5 g/body) and BPA (250 mg/kg) based BNCT was performed in eight patients with newly diagnosed glioblastoma. The gross tumor volume (GTV) and clinical target volume (CTV)-1 were defined as the residual gadolinium-enhancing volume. CTV-2 and CTV-3 were defined as GTV plus a margin of 2 and 3 cm, respectively. As additional photon irradiation, a total X-ray dose of 30 Gy was given to the T2 high intensity area on MRI. Five of the eight patients were alive at analysis for a mean follow-up time of 20.3 months. The post-operative median survival time of the eight patients was 27.9 months (95% CI=21.0-34.8). The minimum tumor dose of GTV, CTV-2, and CTV-3 averaged 29.8+/-9.9, 15.1+/-5.4, and 12.4+/-2.9 Gy, respectively. The minimum tumor non-boron dose of GTV, CTV-2, and CTV-3 averaged 2.0+/-0.5, 1.3+/-0.3, and 1.1+/-0.2 Gy, respectively. The maximum normal brain dose, skin dose, and average brain dose were 11.4+/-1.5, 9.6+/-1.4, and 3.1+/-0.4 Gy, respectively. The mean minimum dose at the failure site in cases of in-field recurrence (IR) and out-field recurrence (OR) was 26.3+/-16.7 and 14.9 GyEq, respectively. The calculated doses at the failure site were at least equal to the tumor control doses which were previously reported. We speculate that the failure pattern was related to an inadequate distribution of boron-10. Further improvement of the microdistribution of boron compounds is expected, and may improve the tumor control by BNCT.
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Affiliation(s)
- M Matsuda
- Department of Neurosurgery, Graduate School of Comprehensive Human Science, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Japan.
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Abstract
A new multi-modal Monte-Carlo radiotherapy planning system (developing code: JCDS-FX) is under development at Japan Atomic Energy Agency. This system builds on fundamental technologies of JCDS applied to actual boron neutron capture therapy (BNCT) trials in JRR-4. One of features of the JCDS-FX is that PHITS has been applied to particle transport calculation. PHITS is a multi-purpose particle Monte-Carlo transport code. Hence application of PHITS enables to evaluate total doses given to a patient by a combined modality therapy. Moreover, JCDS-FX with PHITS can be used for the study of accelerator based BNCT. To verify calculation accuracy of the JCDS-FX, dose evaluations for neutron irradiation of a cylindrical water phantom and for an actual clinical trial were performed, then the results were compared with calculations by JCDS with MCNP. The verification results demonstrated that JCDS-FX is applicable to BNCT treatment planning in practical use.
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Affiliation(s)
- H Kumada
- Department of Research Reactor and Tandem Accelerator, Japan Atomic Energy Agency, Tokai, Ibaraki, Japan.
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Sakamoto M, Kumada H, Hamada N, Takahashi Y, Okamoto M, Bakir MA, Benno Y. Prevotella falsenii sp. nov., a Prevotella intermedia-like organism isolated from monkey dental plaque. Int J Syst Evol Microbiol 2009; 59:319-22. [DOI: 10.1099/ijs.0.002626-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kumada H, Haishima Y, Watanabe K, Hasegawa C, Tsuchiya T, Tanamoto K, Umemoto T. Biological properties of the native and synthetic lipid A of Porphyromonas gingivalis lipopolysaccharide. ACTA ACUST UNITED AC 2008; 23:60-9. [PMID: 18173800 DOI: 10.1111/j.1399-302x.2007.00392.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND METHODS A pentaacyl and diphosphoryl lipid A molecule found in the lipid A isolated from Porphyromonas gingivalis lipopolysaccharide (LPS) was chemically synthesized, and its characteristics were evaluated to reconfirm its interesting bioactivities including low endotoxicity and activity against LPS-unresponsive C3H/HeJ mouse cells. RESULTS The synthesized P. gingivalis lipid A (synthetic Pg-LA) exhibited strong activities almost equivalent to those of Escherichia coli-type synthetic lipid A (compound 506) in all assays on LPS-responsive mice, and cells. LPS and native lipid A of P. gingivalis displayed overall endotoxic activities, but its potency was reduced in comparison to the synthetic analogs. In the assays using C3H/HeJ mouse cells, the LPS and native lipid A significantly stimulated splenocytes to cause mitosis, and peritoneal macrophages to induce tumor necrosis factor-alpha and interleukin-6 production. However, synthetic Pg-LA and compound 506 showed no activity on the LPS-unresponsive cells. Inhibition assays using some inhibitors including anti-human Toll-like receptor 2 (TLR2) and TLR4/MD-2 complex monoclonal antibodies showed that the biological activity of synthetic Pg-LA was mediated only through the TLR4 signaling pathway, which might act as a receptor for LPS, whereas TLR2, possibly together with CD14, was associated with the signaling cascade for LPS and native lipid A of P. gingivalis, in addition to the TLR4 pathway. CONCLUSION These results suggested that the moderated and reduced biological activity of P. gingivalis LPS and native lipid A, including their activity on C3H/HeJ mouse cells via the TLR2-mediated pathway, may be mediated by bioactive contaminants or low acylated molecules present in the native preparations having multiple lipid A moieties.
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Affiliation(s)
- H Kumada
- Department of Oral Microbiology, Kanagawa Dental College, Yokosuka, Kanagawa, Japan.
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Takahashi Y, Kumada H, Hamada N, Haishima Y, Ozono S, Isaka M, Yasuda Y, Tochikubo K, Umemoto T. Induction of immune responses and prevention of alveolar bone loss by intranasal administration of mice with Porphyromonas gingivalis fimbriae and recombinant cholera toxin B subunit. ACTA ACUST UNITED AC 2007; 22:374-80. [PMID: 17949339 DOI: 10.1111/j.1399-302x.2007.00373.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adult periodontitis is initiated by specific periodontal pathogens represented by Porphyromonas gingivalis; however, an effective measure for preventing the disease has not yet been established. In this study, the effectiveness of a vaccine composed of fimbriae of P. gingivalis and recombinant cholera toxin B subunit (rCTB) was evaluated using BALB/c mice. METHODS Fimbriae and rCTB were co-administered intranasally to BALB/c mice on days 0, 14, 21, and 28. On day 35, mice were sacrificed to determine immunoglobulin levels in serum, saliva, and nasal and lung extracts by enzyme-linked immunosorbent assay. The prevention effect of the vaccine on P. gingivalis-induced periodontitis in mice was evaluated by measuring alveolar bone loss. RESULTS The rCTB significantly increased serum immunoglobulin (Ig)A levels when mice were administered with a minimal amount (0.5 microg) of the fimbrial antigen. The adjuvant effect on serum IgG production was indistinct because the minimal amount of the antigen still induced a large amount of IgG. In contrast to systemic responses, a fimbria-specific secretory IgA response was strongly induced by co-administration of rCTB and 0.5 microg fimbriae; the same amount of the antigen alone scarcely induced a response. Histopathological examination revealed IgA-positive plasma cells in the nasal mucosal tissue but no observable mast cells in the area. In addition, nasal administration of the fimbrial vaccine significantly protected the mice from P. gingivalis-mediated alveolar bone loss. CONCLUSION Nasal vaccination with a combination of fimbriae and rCTB can be an effective means of preventing P. gingivalis-mediated periodontitis.
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Affiliation(s)
- Y Takahashi
- Department of Oral Microbiology, Kanagawa Dental College, Yokosuka, Kanagawa, Japan
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Iida K, Kawabata S, Miyatake S, Miyata S, Kuroiwa T, Kirihata M, Ono K, Kumada H. BNCT Displays Growth-inhibitory Effect on Malignant Meningioma Cell In Vivo. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Iida K, Kawabata S, Miyatake S, Miyata S, Kuroiwa T, Kirihata M, Ono K, Kumada H. 947 POSTER Target volume reduction in the treatment of malignant meningioma by boron neutron capture therapy. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70586-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kumada H, Yamamoto K, Matsumura A, Yamamoto T, Nakagawa Y. Development of JCDS, a computational dosimetry system at JAEA for boron neutron capture therapy. ACTA ACUST UNITED AC 2007. [DOI: 10.1088/1742-6596/74/1/021010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Endo K, Yamamoto T, Shibata Y, Tsuboi K, Matsumura A, Kumada H, Yamamoto K, Sakai T, Sato T, Oikawa M, Ohara Y, Ishii K. Demonstration of Inter- and Intracellular Distribution of Boron and Gadolinium Using Micro-Proton-Induced X-Ray Emission (Micro-PIXE). Oncol Res 2006; 16:57-65. [PMID: 16898266 DOI: 10.3727/000000006783981198] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Micro-proton-induced X-ray emission (Micro-PIXE) was applied to determine inter- and intracellular distribution of boron (10B) and gadolinium (157Gd), the capture atoms used to kill tumor cells in neutron capture therapy (NCT). Cultured 9L gliosarcoma cells on Mylar film were exposed to sodium borocaptate (BSH) and gadobenate dimeglumine (Gd-BOPTA). To analyze the inter- and intracellular distribution of 10B and 157Gd in 9L gliosarcoma cells, the cells were irradiated using a proton beam of 1.7 or 3 MeV energy collimated to 1 microm diameter and emission X-ray was detected. The distribution of 10B and 157Gd in 9L gliosarcoma cells was then examined. In this study, we could directly analyze the inter- and intracellular distribution of 10B and 157Gd elements in 9L gliosarcoma cells directly using Micro-PIXE. This is the first report on the distribution of 10B employing a method to detect gamma-rays resulting from the nuclear reaction of 10B using particle-induced gamma-ray emission (PIGE). These results show that the distribution of 157Gd elements was correctly measured using micro-PIXE. 157Gd should have the same tendency as 10B in cultured 9L gliosarcoma cells and agree with the distribution in 9L gliosarcoma cells. Further investigation is necessary for a higher spatial resolution and optimization of the measurement time or improvement of the sampling method. In the future, it will be possible to employ this method to analyze the intracellular microdistribution of the capture element and in the development of new drugs for NCT.
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Affiliation(s)
- K Endo
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
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Iino S, Toyota J, Kumada H, Kiyosawa K, Kakumu S, Sata M, Suzuki H, Martins EB. The efficacy and safety of thymosin alpha-1 in Japanese patients with chronic hepatitis B; results from a randomized clinical trial. J Viral Hepat 2005; 12:300-6. [PMID: 15850471 DOI: 10.1111/j.1365-2893.2005.00633.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thymalfasin (thymosin alpha-1; Talpha1) is a 28-amino acid polypeptide that has shown efficacy in the treatment of chronic hepatitis B virus (HBV) infection. The objective of this study was to evaluate the long-term, dose-related efficacy and safety of Talpha1 treatment in chronic hepatitis B patients with positive HBV-DNA and abnormally high alanine aminotransferase (ALT) levels. A total of 316 patients were randomized to receive either 0.8 or 1.6 mg of Talpha1 monotherapy for 24 weeks. At the end of the 72-week observation period (12 months after cessation of therapy), 36.4% of patients in the 1.6-mg treatment group achieved normalization of ALT, 30% achieved clearance of HBV-DNA by branched DNA vs 15% by transcription-mediated amplification, and 22.8% achieved clearance of HBe-antigen. Patients in the 0.8-mg treatment group achieved similar efficacy rates, although patients with advanced fibrosis demonstrated a significantly better response rate when treated with 1.6 mg of Talpha1 monotherapy vs 0.8 mg (as determined by intragroup analysis; patients were not stratified by liver biopsy). All adverse drug reactions were mild and most involved the fluctuation of liver enzymes, which was most likely related to the positive immune effects caused by the response to Talpha1 treatment. Adverse event incidence was similar in the 1.6- and 0.8-mg treatment groups. In conclusion, Talpha1 at doses of 0.8 and 1.6 mg exhibits long-term efficacy against hepatitis B with a good safety profile.
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Affiliation(s)
- S Iino
- Department of Gastroenterology, St Marianna University, School of Medicine, Kawasaki, Kanagawa, Japan
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Matsumura A, Zhang T, Nakai K, Endo K, Kumada H, Yamamoto T, Yoshida F, Sakurai Y, Yamamoto K, Nose T. Combination of boron and gadolinium compounds for neutron capture therapy. An in vitro study. J Exp Clin Cancer Res 2005; 24:93-8. [PMID: 15943038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In neutron capture therapy, the therapeutic effect of the boron compound is based on alpha particles produced by the B(n, alpha) reaction while with the gadolinium compound the main radiation effect is from gamma rays derived from the Gd(n, gamma) reaction. The uptake and distribution within the tumor may be different among these compounds. Thus, the combination of the boron and gadolinium compounds may be beneficial for enhancing the radiation dose to the tumor. Chinese hamster fibroblast V79 cells were used. For the neutron targeting compounds, 10B (BSH) at 0, 5, 10, and 15 ppm, and 157Gd (Gd-BOPTA) at 0, 800, 1600, 2400, 3200, and 4800 ppm, were combined. The neutron irradiation was performed with thermal neutrons for 30 min. (neutron flux: 0.84 x 10(8) n/cm2/s in free air). The combination of the boron and gadolinium compounds showed an additive effect when the gadolinium concentration was lower than 1600 ppm. This additive effect decreased as a function of gadolinium concentration at 2400 ppm and resulted in no additive effect at more than 3200 ppm of gadolinium. In conclusion, the combination of the boron and gadolinium compounds can enhance the therapeutic effect with an optimum concentration ratio. When the gadolinium concentration is too high, it may weaken the boron neutron capture reaction due to the high cross-section of gadolinium compound against neutrons.
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Affiliation(s)
- A Matsumura
- Dept. of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Japan.
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Kageji T, Nagahiro S, Mizobuchi Y, Toi H, Nakagawa Y, Kumada H. Radiation injury of boron neutron capture therapy using mixed epithermal- and thermal neutron beams in patients with malignant glioma. Appl Radiat Isot 2004; 61:1063-7. [PMID: 15308193 DOI: 10.1016/j.apradiso.2004.05.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to clarify the radiation injury in acute or delayed stage after boron neutron capture therapy (BNCT) using mixed epithermal- and thermal neutron beams in patients with malignant glioma. Eighteen patients with malignant glioma underwent mixed epithermal- and thermal neutron beam and sodium borocaptate between 1998 and 2004. The radiation dose (i.e. physical dose of boron n-alpha reaction) in the protocol used between 1998 and 2000 (Protocol A, n = 8) prescribed a maximum tumor volume dose of 15 Gy. In 2001, a new dose-escalated protocol was introduced (Protocol B, n = 4); it prescribes a minimum tumor volume dose of 18 Gy or, alternatively, a minimum target volume dose of 15 Gy. Since 2002, the radiation dose was reduced to 80-90% dose of Protocol B because of acute radiation injury. A new Protocol was applied to 6 glioblastoma patients (Protocol C, n = 6). The average values of the maximum vascular dose of brain surface in Protocol A, B and C were 11.4+/-4.2 Gy, 15.7+/-1.2 and 13.9+/-3.6 Gy, respectively. Acute radiation injury such as a generalized convulsion within 1 week after BNCT was recognized in three patients of Protocol B. Delayed radiation injury such as a neurological deterioration appeared 3-6 months after BNCT, and it was recognized in 1 patient in Protocol A, 5 patients in Protocol B. According to acute radiation injury, the maximum vascular dose was 15.8+/-1.3 Gy in positive and was 12.6+/-4.3 Gy in negative. There was no significant difference between them. According to the delayed radiation injury, the maximum vascular dose was 13.8+/-3.8 Gy in positive and was 13.6+/-4.9 Gy in negative. There was no significant difference between them. The dose escalation is limited because most patients in Protocol B suffered from acute radiation injury. We conclude that the maximum vascular dose does not exceed over 12 Gy to avoid the delayed radiation injury, especially, it should be limited under 10 Gy in the case that tumor exists in speech center.
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Affiliation(s)
- T Kageji
- Department of Neurosurgery, School of Medicine, University of Tokushima, Kuramoto-cho 3-18-15, 770, Tokushima, Japan.
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Kumada H, Yamamoto K, Yamamoto T, Nakai K, Nakagawa Y, Kageji T, Matsumura A. Improvement of dose calculation accuracy for BNCT dosimetry by the multi-voxel method in JCDS. Appl Radiat Isot 2004; 61:1045-50. [PMID: 15308190 DOI: 10.1016/j.apradiso.2004.05.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To carry out boron neutron capture therapy (BNCT) clinical trials based on accurate dosimetry of several dose components given to a patient, we had developed the JAERI computational dosimetry system (JCDS), which can determine the absorbed doses by numerical simulation. The verification results of initial version of JCDS indicated that JCDS causes characteristic discrepancy, when JCDS estimates a sharp change arising such as near the surface. The aim of this study is to improve the accuracy of the BNCT dosimetry efficiently. The multi-voxel calculation method that reconstructs the original voxel model by combining several voxel cell sizes such as 0.125, 1 and 8 cm(3) has been developed. To verify the accuracy of the method, the calculation results were compared with the phantom experimental data. Furthermore, to verify its practicality to BNCT, retrospective evaluation of an actual BNCT in JRR-4 was performed by the multi-voxel method. The results of the comparison with the phantom experiments demonstrated that the calculation accuracy for the distributions of the thermal neutron flux was improved by employing the multi-voxel method. The computing time using the multi-voxel method increased only approximately 33% compared to the conventional uniform 1cm(3) voxel method. These results proved that the multi-voxel calculation enables JCDS to more accurately estimate the absorbed doses to a patient by efficient calculations.
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Affiliation(s)
- H Kumada
- Department of Research Reactor, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki, Japan.
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Yamamoto T, Matsumura A, Nakai K, Shibata Y, Endo K, Sakurai F, Kishi T, Kumada H, Yamamoto K, Torii Y. Current clinical results of the Tsukuba BNCT trial. Appl Radiat Isot 2004; 61:1089-93. [PMID: 15308197 DOI: 10.1016/j.apradiso.2004.05.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nine high grade gliomas (5 glioblastomas and 4 anaplastic astrocytomas) were treated with BSH-based intaoperative boron neutron capture therapy (IOBNCT). BSH (100 mg/kg body weight) was intravenously injected, followed by single fraction irradiation using the mixed thermal/epithermal beam of Japan Research Reactor 4. The blood boron level at the time of irradiation averaged 29.9 (18.8-39.5)microg/g. The peak thermal neutron flux as determined by post-irradiation measurements varied from 1.99 to 2.77x10(9) n cm(-2)s(-1). No serious BSH-related toxicity was observed in this series. The interim survival data in this study showed median survival times of 23.2 months for glioblastoma and 25.9 months for anaplastic astrocytoma, results which are consistent with the current conventional radiotherapy with/without boost radiation. Of the 4 residual tumors, 2 showed complete response (CR) and 2 showed partial response (PR) within 6 months following BNCT. No linear correlation was proved between the dose and the occurrence of early neurological events. The maximum boron dose of 11.7-12.2 Gy in the brain related to the occurrence of radiation necrosis. The clinical application of a mixed thermal/epithermal beam and JRR-4 facilities on BSH-based IOBNCT proved to be safe and effective in this series.
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Affiliation(s)
- T Yamamoto
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tenno-dai 1-1-1, Tsukuba City, Ibaraki 305-8575, Japan
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Kumada H, Yamamoto K, Matsumura A, Yamamoto T, Nakagawa Y, Nakai K, Kageji T. Verification of the computational dosimetry system in JAERI (JCDS) for boron neutron capture therapy. Phys Med Biol 2004; 49:3353-65. [PMID: 15379018 DOI: 10.1088/0031-9155/49/15/003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Clinical trials for boron neutron capture therapy (BNCT) by using the medical irradiation facility installed in Japan Research Reactor No. 4 (JRR-4) at Japan Atomic Energy Research Institute (JAERI) have been performed since 1999. To carry out the BNCT procedure based on proper treatment planning and its precise implementation, the JAERI computational dosimetry system (JCDS) which is applicable to dose planning has been developed in JAERI. The aim of this study was to verify the performance of JCDS. The experimental data with a cylindrical water phantom were compared with the calculation results using JCDS. Data of measurements obtained from IOBNCT cases at JRR-4 were also compared with retrospective evaluation data with JCDS. In comparison with phantom experiments, the calculations and the measurements for thermal neutron flux and gamma-ray dose were in a good agreement, except at the surface of the phantom. Against the measurements of clinical cases, the discrepancy of JCDS's calculations was approximately 10%. These basic and clinical verifications demonstrated that JCDS has enough performance for the BNCT dosimetry. Further investigations are recommended for precise dose distribution and faster calculation environment.
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Affiliation(s)
- H Kumada
- Department of Research Reactor, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki, Japan.
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Suzuki F, Arase Y, Suzuki Y, Tsubota A, Akuta N, Hosaka T, Someya T, Kobayashi M, Saitoh S, Ikeda K, Kobayashi M, Matsuda M, Takagi K, Satoh J, Kumada H. Single nucleotide polymorphism of the MxA gene promoter influences the response to interferon monotherapy in patients with hepatitis C viral infection. J Viral Hepat 2004; 11:271-6. [PMID: 15117331 DOI: 10.1111/j.1365-2893.2004.00509.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The biological activity of interferon (IFN) is mediated by the induction of intracellular antiviral proteins, such as 2'-5' oligoadenylate synthetase, dsRNA-activated protein kinase and MxA protein. Among these, MxA protein is assumed to be the most specific surrogate parameter for IFN action. This study was performed to elucidate whether a single nucleotide polymorphism (SNP) (G/T at nt-88) in the promoter region of the MxA gene influences the response to IFN therapy in patients with chronic hepatitis C virus (HCV) infection. Polymorphisms of the MxA gene in 235 HCV patients were determined by polymerase chain reaction-restriction fragment length polymorphism. The frequency of SNP was compared between sustained-responders (n = 78) and nonresponders (n = 157), as determined by biochemical and virological responses to IFN. Multivariate analysis showed that among all patients, HCV genotype, HCV RNA level and the SNP of the MxA gene were independent and significant determinants of the outcome of IFN therapy [odds ratio 3.8 (95% confidence interval 2.0-7.0), P < 0.0001; 0.27 (0.15-0.50), P < 0.0001; 1.8 (1.0-3.4), P = 0.0464, respectively]. Furthermore, among patients with a low viral load (< or =2.0 Meq/mL), MxA-T-positive patients were more likely to show a sustained response compared with MxA-T-negative patients [2.87 (1.3-6.3); 62%vs 36%; P = 0.0075]. Our findings suggested that the SNP of the MxA gene is one of the important host factors that independently influences the response to IFN in patients with chronic HCV infection, especially those with a low viral load.
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Affiliation(s)
- F Suzuki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
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Kobayashi M, Arase Y, Ikeda K, Tsubota A, Suzuki Y, Saitoh S, Kobayashi M, Suzuki F, Akuta N, Hosaka T, Someya T, Matsuda M, Sato J, Miyakawa Y, Kumada H. Wild-type precore and core promoter sequences in patients with acute self-limited or chronic hepatitis B. Scand J Gastroenterol 2004; 39:53-9. [PMID: 14992562 DOI: 10.1080/00365520310007684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mutations in the precore region and core promoter were compared between patients with acute and chronic hepatitis B. METHODS There were 69 patients with acute self-limited hepatitis B and 210 with chronic hepatitis B who had been followed for > 15 years. The hepatitis B virus (HBV) of genotypes A, B and C was detected in 14 (23%), 8 (13%) and 28 (45%) of the patients with acute self-limited hepatitis, respectively, in contrast to 11 (5%), 25 (12%) and 167 (80%) of those with chronic hepatitis. RESULTS At presentation, hepatitis B e antigen (HBeAg) in serum was the more common (82% versus 65%, P < 0.05), and the wild-type sequences of the precore region (100% versus 74%, P < 0.001) and core promoter (88% versus 36%, P < 0.00001) were more frequent in the 50 patients with acute self-limited hepatitis than the 203 patients with chronic hepatitis B who were infected with HBV of genotype A, B or C. Wild-types of both the precore region and core promoter persisted in acute self-limited hepatitis, while they decreased from 28% to 10% in chronic hepatitis over the course of > 15 years. CONCLUSION HBV with the wild-type sequences of the precore region and core promoter prevails in patients with acute self-limited hepatitis, unlike in patients with chronic hepatitis.
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Affiliation(s)
- M Kobayashi
- Research Institute for Hepatology, Dept. of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
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Yamamoto T, Matsumura A, Yamamoto K, Kumada H, Shibata Y, Nose T. In-phantom two-dimensional thermal neutron distribution for intraoperative boron neutron capture therapy of brain tumours. Phys Med Biol 2002; 47:2387-96. [PMID: 12171329 DOI: 10.1088/0031-9155/47/14/302] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to determine the in-phantom thermal neutron distribution derived from neutron beams for intraoperative boron neutron capture therapy (IOBNCT). Gold activation wires arranged in a cylindrical water phantom with (void-in-phantom) or without (standard phantom) a cylinder styrene form placed inside were irradiated by using the epithermal beam (ENB) and the mixed thermal-epithermal beam (TNB-1) at the Japan Research Reactor No 4. With ENB, we observed a flattened distribution of thermal neutron flux and a significantly enhanced thermal flux delivery at a depth compared with the results of using TNB-1. The thermal neutron distribution derived from both the ENB and TNB-1 was significantly improved in the void-in-phantom, and a double high dose area was formed lateral to the void. The flattened distribution in the circumference of the void was observed with the combination of ENB and the void-in-phantom. The measurement data suggest that the ENB may provide a clinical advantage in the form of an enhanced and flattened dose delivery to the marginal tissue of a post-operative cavity in which a residual and/or microscopically infiltrating tumour often occurs. The combination of the epithermal neutron beam and IOBNCT will improve the clinical results of BNCT for brain tumours.
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Affiliation(s)
- T Yamamoto
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
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Suzuki F, Chayama K, Tsubota A, Akuta N, Someya T, Kobayashi M, Suzuki Y, Saitoh S, Arase Y, Ikeda K, Kumada H. Pathogenic significance and organic virus levels in patients infected with TT virus. Intervirology 2002; 44:291-7. [PMID: 11684890 DOI: 10.1159/000050060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Previous reports documented the recovery of a DNA virus from a patient with posttransfusion non-A-G hepatitis and named TT virus (TTV). Although the virus was initially detected as a causative agent of hepatitis, there is doubt about its pathogenicity. The aim of this study was to clarify the relationship between TTV and liver diseases. Histopathological examination of liver biopsies from 14 patients with TTV genotype 1 positive non-B, non-C and non-G chronic hepatitis showed mild fibrosis and periportal/piecemeal necrosis. Using the real-time detection (RTD)-PCR method, we found that TTV DNA levels of genotype 1 in liver samples from 3 such patients were 100- to 1,000-fold higher than those in the paired serum samples. Further investigation using various tissues from 2 autopsies of patients with hepatitis C with hepatocellular carcinoma revealed that the concentrations of TTV DNA in the liver were also higher than in serum samples. However, the highest TTV DNA concentrations in these 2 autopsies were found in the lung and bone marrow, respectively. Our results suggest that TTV may replicate in various tissues including the liver and may cause only mild liver damage.
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Affiliation(s)
- F Suzuki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
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Karasawa S, Kumada H, Koga N, Iwamura H. Magnetic behavior of a 3:2 mixture of bis(hexafluoroacetylacetonato)copper(II) and 1,3,5-benzenetriyltris(4-pyridyldiazomethane) in a frozen solution after irradiation: photochemical formation of a solid solution magnet. J Am Chem Soc 2001; 123:9685-6. [PMID: 11572695 DOI: 10.1021/ja010936n] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Karasawa
- Graduate School of Pharmaceutical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Tsubota A, Arase Y, Ren F, Tanaka H, Ikeda K, Kumada H. Genotype may correlate with liver carcinogenesis and tumor characteristics in cirrhotic patients infected with hepatitis B virus subtype adw. J Med Virol 2001; 65:257-65. [PMID: 11536231 DOI: 10.1002/jmv.2028] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To identify the influence of hepatitis B virus (HBV) genotype on development of hepatocellular carcinoma (HCC) and clinical outcome in chronic HBV infection, 26 consecutive cirrhotic patients infected with HBV subtype adw were investigated prospectively. HBV serology was undertaken using subtype-specific antibodies against hepatitis B surface antigens. The HBV genotype was determined by sequencing directly the polymerase chain reaction products of the HBV S gene. When HCC occurred, patients underwent transcatheter arterial embolization therapy. If tumor necrosis was incomplete, additional embolization therapy was carried out after a 3- to 4-month interval. At a median follow-up of 14.1 years (range 2.2 to 31.7), HCC occurred in 9 (35%) of 26 patients. Nineteen patients were infected with genotype B and 7 with genotype C. Four of the 19 genotype B patients (21%) and 5 of the 7 genotype C patients (71%) developed HCC (P = 0.058). Patient age (<45 years or 45 < or = ) at diagnosis of cirrhosis was the only significant independent factor influencing liver carcinogenesis by multiple logistic regression analysis and Cox's regression analysis (P = 0.0069 and 0.029, respectively). When analysis was limited to the age of 45 years or more at the last visit, genotype was the only contributory factor to HCC development by univariate analysis (P = 0.038). Whereas genotype B patients responded well to embolization therapy and had no recurrence of HCC for a prolonged period of time, genotype C patients showed poor responses and died of hepatic failure due to rapid HCC progression despite embolization therapy. The cumulative incidence of survival was significantly higher in the genotype B group (P = 0.0049). The HBV genotype correlated with the development of HCC, response to embolization therapy, and recurrence of HCC. Determination of HBV genotype may be useful in predicting outcomes in HBV subtype adw-related cirrhosis.
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Affiliation(s)
- A Tsubota
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
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Abstract
Familial hypokalemic periodic paralysis is an autosomal dominant disorder. Recently, three predominant mutations were found in the muscle dihydropyridine-sensitive calcium channel alpha 1-subunit gene. We present a Japanese family that displays one of these, the Arg1239His mutation. All the affected individuals of this family displayed this mutation. Two cases had a history of recurrent episodes of muscle weakness and difficulty in running before their first paralytic attack. It is suggested that there are no racial differences with this mutation, and that mild muscle weakness occurs not only after but also preceding the first attack.
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Affiliation(s)
- M Kusumi
- Division of Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan.
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47
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Arase Y, Chayama K, Ikeda K, Tsubota A, Suzuki Y, Saitoh S, Kobayashi M, Suzuki F, Akuta N, Someya T, Kobayashi M, Kumada H. Randomized controlled clinical trial of lymphoblastoid interferon-alpha for chronic hepatitis C. Hepatol Res 2001; 21:55-66. [PMID: 11470628 DOI: 10.1016/s1386-6346(01)00073-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Most of chronic hepatitis C patients with HCV-genotype 1 and a high virus load fail to eradicate the HCV-RNA by the interferon (IFN) or IFN/ribavirin therapy. But in these patients, IFN is often effective with regard to normalization of alanine aminotransferase (ALT). We had therefore the following two randomized controlled clinical trials to evaluate the effect of IFN which reduce ALT and maintain normalization of ALT. One approach (study 1) was to compare the efficacy of a 6 month course of three different dosages of recombinant IFN-alpha-2a in patients with chronic hepatitis C associated with HCV-genotype 1b and a high serum HCV-RNA level of more than 1 Meq/ml. Another approach (study 2) was to make clear the significance of an additional 6 month course of IFN in patients who had biochemical response during the first 6 month course of IFN (study 1). Methods: (1) Study 1; 45 patients with HCV-genotype 1b and a high serum HCV-RNA level of more than 1 Meq/ml were randomly assigned into three equal groups; group 1 was treated with 3 million units (MU), group 2 with 6 MU and group 3 with 9 MU. They were treated with IFN 3 times weekly for 6 months. Biochemical response was defined as normalization of ALT at the 6 month after initiation of IFN; (2) Study 2; Subsequently, of 23 patients with biochemical response by the first study, 22 were randomly assigned to two groups; patients in group A were continued to receive 3 MU of IFN-alpha-2a three times a week for an additional 6 months and patients in group B were discontinued IFN therapy. Results: (1) Study 1; One patient in group 1, three in group 2 and five in group 3 withdrew from IFN therapy because of IFN-related side-effects. Biochemical response was 10 (66.7%) patients of group 1,8 (53.3%) of group 2 and 5 (33%) of group 3 by the intention-to-treat (ITT) analysis. The biochemical response rate in group 1 was slightly higher than that in other two groups by the Cochran Armitage two-tailed test (P=0.066). With respect to serum HCV-RNA level, one patient in group 1, six patients in group 2 and four patients in group 3 became negative for HCV-RNA by reversed transcription nested-polymerase chain reaction (RT nested-PCR) at the end point of first 6 month course of IFN; (2) Study 2; The maintenance rate of ALT normalization was 88.9% (9/11) in group A and 11.1% (2/11) in group B. The maintenance rate of ALT normalization in group A was significantly higher than that in group B by the Fisher exact's test (P=0.0089). With respect to serum HCV-RNA level by RT nested-PCR, four patients in group A had negative HCV-RNA at the end of an additional IFN therapy. On the other hand, all the patients in group B had positive HCV-RNA at the same time. Conclusion: Our data suggested that a prolonged IFN therapy using a dose of 3 MU of IFN-alpha-2a is safe strategy to reduce ALT and to maintain ALT normalization in patients with HCV-genotype 1b and a high serum HCV-RNA level of more than 1 Meq/ml.
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Affiliation(s)
- Y Arase
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
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Akuta N, Chayama K, Suzuki F, Someya T, Kobayashi M, Tsubota A, Suzuki Y, Saitoh S, Arase Y, Ikeda K, Kumada H. Risk factors of hepatitis C virus-related liver cirrhosis in young adults: positive family history of liver disease and transporter associated with antigen processing 2(TAP2)*0201 Allele. J Med Virol 2001; 64:109-16. [PMID: 11360242 DOI: 10.1002/jmv.1025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to clinically characterize young patients with hepatitis-C-related cirrhosis. We compared 27 patients with liver cirrhosis (Group LC) who were anti-HCV positive, aged 40 years or less at the time of diagnosis, with 323 consecutive patients with HCV-related chronic hepatitis (Group CH) matched for age and gender. Furthermore, Group LC was divided into two arbitrary groups (29-35 years, n = 8 /36-40 years, n = 19), based on the age of patients at the time of diagnosis of liver cirrhosis. Patients' characteristics and family history were investigated, and the frequency of transporter associated with antigen processing 2 (TAP2) was determined. A family history of liver disease was present in 40.7% of Group LC but in 18.0% of Group CH (P < 0.05). The younger the age of diagnosis of cirrhosis in Group LC, the higher the frequency of a positive family history (29-35 years, 87.5%; 36-40 years, 21.1%, P < 0.05). The frequency of TAP2*0201 was significantly higher in young adult patients with HCV-related liver cirrhosis than in HCV carriers with normal ALT (P < 0.05), and tended to be higher than in uninfected normal subjects (P = 0.05). The cumulative survival rate of cirrhosis patients with family history of liver diseases was significantly lower than that of cirrhosis patients without such history (P < 0.05). Our findings suggest that a positive family history of liver disease and TAP2*0201 polymorphism may be risk factors for HCV-related liver cirrhosis in young adults.
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Affiliation(s)
- N Akuta
- Division of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
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Arase Y, Kumada H. [A trial of new interferon therapy for the patients with chronic hepatitis C resistant to interferon therapy]. Nihon Rinsho 2001; 59:1309-14. [PMID: 11494543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
HCV-RNA clearance rates are reported to be about 30-40% of the patients treated with IFN for less than 6 months. But IFN therapy is ineffective for chronic hepatitis C patients with HCV-genotype 1b and a high virus load. We evaluated the efficacy of different IFN therapy compared with standard IFN therapy for chronic hepatitis C patients resistant to interferon therapy. That is, we assessed the following therapy; 1) prolonged IFN therapy, 2) IFN-beta therapy of twice a day, 3) IFN-beta therapy daily for 24 weeks, 4) combination therapy of IFN-alpha and IFN-beta. In some cases, these IFN therapies were effective than a standard IFN therapy.
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Affiliation(s)
- Y Arase
- Department of Gastroenterology, Toranomon Hospital
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Arai M, Minatoguchi S, Kumada H, Uno Y, Nishida Y, Hashimoto K, Wang N, Takemura G, Fujiwara T, Higashioka M, Kuwano K, Fujiwara H. Role of protein kinase C in the reduction of infarct size by N-methyl-1-deoxynojirimycin, an alpha-1,6-glucosidase inhibitor. Br J Pharmacol 2001; 133:635-42. [PMID: 11429386 PMCID: PMC1572825 DOI: 10.1038/sj.bjp.0704107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Preischaemic treatment with N-methyl-1-deoxynojirimycin (MOR-14), an alpha-1,6-glucosidase inhibitor, attenuates glycogenolysis and lactate accumulation during ischaemia and markedly reduces infarct size in rabbit hearts. In the present study, we have investigated whether protein kinase C (PKC), a principal mediator of ischaemic preconditioning, is also involved in the cardioprotective effect of MOR-14. To assess the effect of PKC inhibition on infarct size in MOR-14-treated hearts, 38 rabbits were subjected to 30 min of ischaemia followed by 48 h of reperfusion. Infarct size, as a per cent of area at risk, was significantly smaller in rabbits administered 100 mg kg(-1) of MOR-14 10 min before ischaemia (17+/-2%, n=10), than in a control group (46+/-5%, n=10). This beneficial effect of MOR-14 was abolished when 5 mg kg(-1) of chelerythrine, a PKC inhibitor, was given 10 min prior to MOR-14 injection (39+/-4%, n=10), although chelerythrine alone did not alter infarct size (43+/-4%, n=8). Further, chelerythrine had no effect on MOR-14-induced attenuation of glycogen breakdown and lactate accumulation in hearts excised at 30 min of ischaemia. Immunoblot analysis of PKC in homogenates of Langendorff-perfused rabbit hearts revealed that MOR-14 significantly increased levels of PKC-epsilon in the particulate fraction at 20 and 30 min of ischaemia and in the cytosolic fraction at 30 min of ischaemia. Taken as a whole, our data suggest that PKC acts downstream of the inhibition of glycogenolysis by MOR-14 to reduce infarct size. Thus, activation of PKC is a more direct mediator of the cardioprotection afforded by MOR-14 than is inhibition of glycogenolysis.
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Affiliation(s)
- M Arai
- The 2nd Department of Medicine, Gifu University School of Medicine, Gifu, Japan
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