Takashi Hirayama

Cytokine dynamics and quality of life: unraveling the impact of cell-free and concentrated ascites reinfusion therapy in ovarian cancer patients

Abstract Background The quality of life (QOL) of ovarian cancer patients is often impaired by refractory ascites. Cell-free and concentrated ascites reinfusion therapy (CART) is a palliative treatment for refractory ascites, but adverse events, such as fever, are problematic. Several cytokines have been suggested to be responsible for the adverse events, but they have not been investigated in detail. Thus, we comprehensively analyzed cytokines in ascites fluid (AF) and serum before and after CART to determine the influence of cytokines on the safety and efficacy of CART. Methods Thirteen ovarian cancer patients with refractory malignant ascites who underwent CART were enrolled. We comprehensively analyzed 27 cytokines in AF and serum before and after CART. Simultaneously, vital measurements, blood tests, adverse event recordings, and QOL assessments were performed to examine the relationships between the cytokines in AF and serum. Results Interleukin (IL)-5, IL-6, IL-10, and monocyte chemoattractant protein-1 levels were increased in the concentrated AF and in the serum immediately after reinfusion, but they decreased after 24 h. Body temperature also increased immediately after reinfusion, and decreased after 24 h. The CRP level at 24 h after reinfusion was increased, and was positively correlated with the IL-6 level. A QOL assessment using the Cancer Fatigue Scale revealed significantly lower scores after CART. Conclusions The results indicate that the cytokine-induced fever and increased inflammatory response after CART were temporary, and that CART is safe. Additionally, QOL improved after CART. Thus, CART appears safe and effective for treating patients with refractory cancerous ascites.

A case of transient hyperthyroidism induced by placental site trophoblastic tumor

AbstractWe report a case of placental site trophoblastic tumor (PSTT) with transient hyperthyroidism. A 29‐year‐old gravida 2 para 2 woman presented with abnormal genital bleeding 6 months after delivery. Endometrial histology suggested PSTT. Serum human chorionic gonadotropin (hCG) was 117 mIU/mL and serum estradiol (E2) were 51 pg/mL. She reported increased appetite, sweating, fatigue, and 7‐kg weight loss within 3 months. Blood samples showed a thyroid‐stimulating hormone (TSH) level <0.01 μIU/mL, FT3: 24.3 pg/mL, FT4: 5.3 ng/mL. The patient was diagnosed with hyperthyroidism. After thyroid function normalized, laparoscopic hysterectomy and bilateral salpingectomy were performed. Two years postsurgery, there was no recurrence, and thyroid function improved. The hCG produced from gestational trophoblastic disease has stronger TSH activity than that from gestational trophoblasts. However, in PSTT, the E2 level, which increases thyroid‐binding proteins and suppresses elevated thyroid hormone levels, is low and may induce hyperthyroidism. In cases of suspected PSTT, thyroid function should be evaluated when hyperthyroid symptoms are present.

Cell‐Free and Concentrated Ascites Reinfusion Therapy ( CART ) Shows Enhanced Efficacy in Gynecological Cancer Patients: A Post‐Marketing Surveillance Study

ABSTRACT Introduction Ascites management is crucial for gynecological cancer patients requiring long‐term treatment. Cancer type‐specific differences may influence CART outcomes, but comparative data remain limited. This study evaluated CART efficacy in gynecological versus other cancers. Methods This subgroup analysis included 125 cancer patients undergoing 296 CART sessions at 22 Japanese centers (2014–2015). Patients were divided into gynecological cancer (Group G, n  = 46) and other cancer groups (Group O, n  = 79). Results Group G had significantly higher concurrent chemotherapy rates (41.2% vs. 12.3%, p  < 0.001) and ascitic protein/albumin concentrations. Group G showed significant renal function improvements: decreased serum creatinine (0.7 ± 0.3 to 0.6 ± 0.3 mg/dL, p  < 0.001), decreased BUN (17.9 ± 8.7 to 14.5 ± 9.0 mg/dL, p  < 0.001), and increased eGFR (72.7 ± 24.8 to 81.3 ± 27.6 mL/min/1.73 m 2 , p  < 0.001). Drainage intervals were longer in Group G (20.0 ± 13.8 vs. 11.7 ± 10.9 days, p  < 0.001). Conclusion CART demonstrates enhanced efficacy in gynecological cancer patients, particularly improving renal function, potentially reducing chemotherapy‐related toxicity, and improving treatment tolerability.