Gan to kagaku ryoho. Cancer & chemotherapy
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From July 1 in 2003 through December 31 in 2008, 150 terminal lung cancer patients were provided home hospice care by us and died at home, whereas the following clinical characteristics along with the practical care we provided were examined by comparing with 432 non-lung cancer patients who died at home during that period. The frequency of home death (lung cancer/control group, 96.8/96.2%) and the duration of caring at home (48.7/54.6 days) did not show a significant difference. Significant differences were observed in suffering of breathing (62.7/31.5%), use of the opioids (96.0/ 87.5%), slow releasing oral morphine (32.7/18.1%), morphine suppository (73.3/56.5%), morphine injected subcutaneously (37.3/25.7%), slow releasing oral oxycodone (61.3/37.3%), and fentanyl (20.0/46.1%). These findings led us to conclude: (1) the main symptom, in case of the terminal lung cancer patients, was to control a difficulty in breathing, (2) the appropriate opioids were morphine and oxycodone in palliation of respiratory difficulties, (3) fentanyl was inappropriate for palliation of respiratory difficulties.
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Pain relief is a quite important subject for maintaining the home medical care of patients with terminal cancer. Therefore, the opioid rotation should be made in conjunction with an individual medical condition, which is of growing importance in a proper pain management. ⋯ The most important thing in the opioid rotation at home is to perform a rotation before exacerbation of pain becomes apparent. For this purpose, morphine hydrochloride injection is thought to be the best dosage form because it has advantages of: (1) quickness in varying the amount, (2) immediate rescue efficacy, and (3) usefulness in case of ingestion.
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In Japan, a pain relief for terminally ill cancer patients has been improved greatly in the past twenty years owing to the appearance of several new opioids and manuals available, loosening the usage of opioids legally, and so on. Medical institutions including clinics which are involved in home palliative care have the knowledge and techniques in certain levels. ⋯ Though very few, certain clinics can do the continuous subarachnoid morphine injection using subcutaneous indwelling port. Considering that home palliative care including pain control required a professional knowledge and techniques, it is necessary to establish a new system in the district which enables to provide the palliative care of high quality by a team in which palliative care clinic or PCC exists as the main medical center.
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Gan To Kagaku Ryoho · Nov 2009
Case Reports[A case of mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer after radical operation for lung cancer].
We herein report a case of thoracic esophageal cancer operated on by mediastinoscope-assisted transhiatal esophagectomy after a right upper lobectomy for primary lung cancer. A 70-year-old male with non-small-cell lung cancer (T4N2M0, cStage III B) underwent chemo-radiation therapy followed by an upper lobectomy of the right lung with mediastinal lymph node dissection. The lung cancer histologically showed complete remission (CR), and no recurrence has been shown. ⋯ He was alive for 11 months after the operation for esophageal cancer, although a local recurrence was observed. There are still many problems remained of the treatment for esophageal cancer patients who had previously undergone a radical operation for lung cancer. However, mediastinoscope-assisted transhiatal esophagectomy may become a procedure for surgical approach if it seems to be difficult to approach the esophageal cancer by thoracotomy again.
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Gan To Kagaku Ryoho · Nov 2009
Case Reports[A case report-neoadjuvant chemoradiotherapy with combination of S-1 and gemcitabine in a patient with locally advanced pancreatic cancer].
A 63-year-old woman was pointed out pancreatic tumor by a follow up CT after operation for the corpus uteri cancer. She was diagnosed as having locally advanced pancreatic cancer which involved the superior mesenteric vein (SMV). She was treated with radiation (1.8 Gyx28 Fr) and the combination chemotherapy of S-1 plus gemcitabine (S-1: 80 mg/m2/dayx28 days, gemcitabine 200 mg/m2/dayx6 fr, 1 fr a week). ⋯ Four weeks later from completion date, a reduction of the tumor size and an improvement of involving SMV were observed by diagnostic imaging. Subsequently, pylorus-preserving pancreatoduodenectomy (PpPD) with a partial resection of SMV and intraoperative radiation were undergone. She was discharged 19 days after the operation without any surgical complications, and is undergoing adjuvant chemotherapy.