A case of advanced breast cancer with meningeal carcinomas and orbital metastasis successfully treated with multi-disciplinary therapy

We report a case of advanced breast cancer with meningeal metastasis and orbital metastasis (T4bN3cM1, Stage IV) achieving a significant improvement in QOL by multi-disciplinary therapy. The patient was a 51-year-old woman who had headaches and an ulcerative breast lump with meningeal metastasis and orbital metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma positive for HER2/neu protein expression. She received 9 cycles of weekly trastuzumab and radiation therapy for meningeal metastasis and orbital metastasis. Although the size of breast tumor, orbital metastasis lesion, and meningeal metastasis lesion exhibited no change, clinical symptoms were improved. One year later, she received paclitaxel so that the sensitivity of HER2/neu dropped. However, the tumor markers relapsed and we then changed paclitaxel to TS-1. Eighteen-months later, she had no neurological symptoms. Multi disciplinary therapy can improve patient's QOL and the clinical outcomes in Stage IV advanced breast cancer.     

A case of advanced breast cancer with multiple lung and liver metastases successfully treated with multi-disciplinary therapy

We report a case of advanced breast cancer with multiple lung and liver metastases (T4bN1M1) achieving a significant improvement of QOL by multi-disciplinary therapy. The patient was a 63-year-old woman with slight jaundice who had ascites and an ulcerative breast lump with multiple lung and liver metastases. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma positive for HER2/neu protein expression. She received 6 cycles of tri-weekly docetaxel (60 mg/m2) and weekly trastuzumab. Although the ascites and the jaundice disappeared after chemotherapy, the response for breast tumor, metastatic sites in the lung and the liver were less satisfactory. Fifteen-months later, she received radiation therapy so that metastasis in the brain was recognized. But she had no neurological symptoms. Multi-disciplinary therapy can improve patient's QOL and the clinical outcomes in Stage IV advanced breast cancer.     

A case of advanced gastric cancer successfully treated with docetaxel and S-1 combined therapy

A 46-year-old woman with lower abdominal distension was diagnosed as gastric cancer in our hospital. She had multiple metastases of lungs, lymph nodes, bilateral ovaries, and uterus. After she underwent sub-total gastrectomy, bilateral oophorectomy, and total hysterectomy, she received adjuvant chemotherapy followed by docetaxel and S-1. After 6 courses of chemotherapy, PET/CT revealed no recurrences (complete response), and she was therefore administered S-1 for only 6 months. She has remained without recurrence 15 months after the operation.     

A case of advanced mullerian cancer successfully treated with S-1 chemotherapy

A 79-year-old woman was referred to our hospital with complaints of dyspnea. She was diagnosed with massive pleural effusion and cytology demonstrated the presence of adenocarcinoma, but no solid tumors were found in the systemic examination. Her serum CYFRA and CA125 level were increased. She was diagnosed with an effusion type of lung cancer or a cancer of unknown origin. S-1/CDDP was the chemotherapy of choice. After 2 courses of the treatment, her serum CYFRA level and CA125 level were normalized, and a chest CT detected no pleural effusion. Two years and 3 months after the first treatment, her CA125 level was increased. We found an FDG accumulation in her pelvic lesion by PET examination. To identify the FDG accumulated lesion in her pelvis, an operation was performed. Histopathological examination of the right ovary demonstrated the presence of an adenocarcinoma. Postoperatively, we administered 2 courses of paclitaxel/carboplatin combination treatment, considering the right ovarian tumor was the primary lesion. The patient remained alive and in good condition without any signs of recurrence 2 years after second treatment. This case suggests that S-1 therapy may be effective for patients with mullerian cancer.     

A case of advanced gastric cancer with peritoneal dissemination successfully treated with S-1 and intraperitoneal docetaxel administration

A 76-year-old man was admitted to our hospital for the treatment of remnant gastric cancer. Laparotomy revealed massive lymph node metastasis, direct invasion of the transverse colon, and peritoneal dissemination. Partial resection of remnant stomach with transverse colon and intraperitoneal infuser port implantation were performed. After surgery, he underwent chemotherapy with docetaxel(DOC)administered intraperitoneally, and S-1. CT scan showed no tumors, and the patient was judged to be a complete response(CR)without serious adverse events. We switched DOC to intravenous injection because of port damage, and grade 3 adverse events appeared frequently until the chemotherapy was stopped. It has been 30 months since we stopped the chemotherapy, and the patient is still alive with no evidence of tumor recurrence 48 months after surgery.     

A case of advanced gastric cancer resistant to S-1 successfully treated with weekly administration of paclitaxel

A 62-year-old female was diagnosed with type 2 advanced gastric cancer in May 2003. Pathological examination showed a poorly differentiated carcinoma. Computed tomography (CT) revealed paraaortic lymph node metastasis, duodenal metastasis and ascites due to peritoneal dissemination. Chemotherapy with CDDP+S-1 was started and continued. After the chemotherapy, there were progressive diseases. Therefore, paclitaxel (PTX) was administered at a dose of 80 mg/m2/day for 3 weeks followed by a week rest. Clinical symptoms were relieved, and CT scan revealed metastatic lymph nodes were reduced after 4 cycles. After 13 cycles, MRI revealed a solitary brain mass was detected. She was resected for a right temporal-occipital brain metastatic tumor, and local cerebral irradiation was performed. After this operation, she was diagnosed with brain metastasis from advanced gastric cancer. The procedure was interrupted for about 6 months. After rehabilitation, PTX treatment was restarted as 14th cycle. She has survived without recurrence more than 30 cycles after the resection. A weekly administration of PTX may be a promising regimen as second-line chemotherapy for S-1 resistant recurrent gastric cancer.     

A case of advanced breast cancer successfully treated with primary endocrine therapy

We present a case of a premenopausal woman with advanced hormone-sensitive breast cancer who was successfully treated with primary endocrine therapy consisting of ovarian ablation followed by a combined endocrine regimen of the aromatase inhibitor fadrozole 2 mg daily and tamoxifen 20 mg daily. During the 5 months treatment period, PR evaluation of the loco-regional lesions was performed The patient then underwent mastectomy with axillary lymph node dissection followed by fadrozole and tamoxifen therapy. Throughout the treatment course, no adverse events were encountered and the patient has been enjoying a favorable quality of life. As shown by this case, primary endocrine therapy is a promising treatment option for hormonesensitive breast cancer. However, this modality should be continued to be regarded as experimental.     

A case of advanced gastric cancer successfully treated by combination therapy of S-1 and docetaxel

A 70-year-old man with gastric cancer of Borrmann type 3, liver metastases and peritoneal dissemination was treated by combination therapy of S-1 and docetaxel (DOC). He received DOC intravenously at 40 mg/m(2) on day 1 and S-1 orally at 100 mg/body on day 1 to 14, repeated every 28 days. After 2 courses of treatment, a CT scan revealed improvement of the gastric wall thickness, the eminent decrease of the peritoneal fluid and the reduction of the liver metastasis. After 3 courses of treatment, the primary lesion was remarkably improved on endoscopic examination, and the tumor marker normalized after 4 courses of treatment. Toxicities included leukocytopenia (WHO grade 3), neutropenia ( grade 3), anorexia (grade 2), and nausea (grade 2). Outpatient chemotherapy was possible by reduction of dose (S-1 100--> 80 mg/body, DOC 40--> 32 mg/m2). The response was maintained on CT and endoscopic examination after 21 courses of treatment. A case of an advanced gastric cancer patient successfully treated by combination therapy of S-1 and DOC was reported.     

A case of possible retroperitoneal metastasis of breast cancer successfully treated with oral S-1 and cyclophosphamide therapy after TC therapy

We report a case of possible retroperitoneal metastasis of breast cancer successfully treated with oral S-1 and cyclophosphamide therapy after docetaxel and cyclophosphamide (TC) therapy. A 57-year-old woman with a history of bilateral breast cancer showed an increase in tumor markers during treatment with oral anastrozole as postoperative adjuvant therapy 4 years after her second cancer surgery. After careful examination, the patient was diagnosed as having multiple bone metastases and her medication was changed to oral letrozole. After 3 months, the patient developed left back pain and was referred to our hospital. CT scanning showed an enhanced mass in the region from the left perirenal and posterior pararenal spaces to the left psoas major muscle and the anterior aspect of the left iliacus muscle, suggesting retroperitoneal metastasis. TC therapy was performed and, as a result, tumor markers decreased and the mass disappeared on CT imaging. After discontinuation of TC therapy, the tumor markers increased again, following which oral S-1 and cyclophosphamide therapy were administered, and the tumor markers decreased. At the time of this writing, the patient is still undergoing therapy, and no recurrence has been observed. We concluded that oral S-1 and cyclophosphamide therapy were useful in the present case and were associated with few adverse effects.     

A case of S-1-resistant recurrent gastric cancer successfully treated with weekly administration of paclitaxel

We report a case of recurrent gastric cancer with peritoneal dissemination and paraaortic lymph node metastases, successfully treated with weekly administration of paclitaxel. The patient was a 63-year-old man who underwent distal gastrectomy with lymph node dissection for advanced gastric cancer in February 2005. After the operation, adjuvant chemotherapy with S-1 was started and continued. He complained of abdominal distention, anorexia and nausea in April 2006. Therefore, paclitaxel (PTX) was administered at a dose of 60 mg/m(2)/day for 3 weeks followed by a week rest. Clinical symptoms were relieved, and abdominal X-ray findings showing intestinal obstruction disappeared after 2 courses. CT scan revealed metastatic lymph nodes were reduced after 3 courses. Grade 1 peripheral neuropathy and grade 2 leukocytopenia were noted, but no serious adverse reaction appeared. Weekly administration of PTX may be a promising regimen as second-line chemotherapy for S-1-resistant recurrent gastric cancer.     

A case of advanced gastric cancer with tumor embolus in the portal vein successfully treated with S-1 and CDDP therapy

A 50-year-old man with advanced gastric cancer and a tumor embolus in the portal vein was referred to our hospital. We diagnosed the tumor as cStage III B (cT3, cN2, cH0, P0, M0) gastric cancer, and selected neoadjuvant S-1 (80 mg/m2) and CDDP (60 mg/m2) therapy for him. After 2 courses of chemotherapy, the embolus in the portal vein disappeared. After additional chemotherapy, the primary tumor and regional lymph node revealed a partial response (PR), and judging from the results from the barium meal study, upper GI endoscopic findings and CT scan, a total gastrectomy with lymph node dissection was performed.     

A case of advanced gastric cancer successfully treated with S-1 and paclitaxel followed by curative resection

A 59-year-old man diagnosed with Stage IV advanced gastric cancer due to pancreatic invasion(T4)and splenic hilum lymph node metastasis(N3)was initially treated with neoadjuvant chemotherapy using S-1 and CDDP. However, it was discontinued because the tumor marker increased after 1 course. Instead of S-1 and CDDP, S-1 and paclitaxel were then administered. After 4 courses, CT scan revealed reduced tumor size and the disappearance of splenic hilum lymph node swelling that indicated PR of the chemotherapy. Moreover, serum CEA was remarkably decreased to 77 ng/mL from 1,092 ng/mL. He could undergo subtotal gastrectomy(Billroth II)with lymph node dissection(D2)and cholecystectomy. Histopathological examination revealed Stage II (pT2(SS), pN1, CY0, ly1, v2)advanced gastric cancer that showed good effect of S-1 and paclitaxel. At this writing (October 2007), the patient has remained free of disease for more than 1 year and 6 months with good nutrition. Neoadjuvant chemotherapy using S-1 and paclitaxel for advanced gastric cancer seems to have been effective.     

A case of local advanced breast cancer with multiple lung metastases successfully treated with multimodal therapy

We report a case of local advanced breast cancer with multiple lung metastases (T4bN2M1) achieving a significant improvement of QOL by multimodal therapy with chemotherapy, antibody therapy, radiation therapy and surgery. The patient was a 47-year-old woman with mental deterioration who had an ulcerative breast cancer with multiple lung metastases. Breast biopsy led to a diagnosis of an invasive ductal carcinoma positive for erbB2 protein expression. She received 6 cycles of tri-weekly docetaxel (60 mg/m2) and weekly trastuzumab. Although metastases in the lung disappeared after chemotherapy, the response of breast ulceration was less satisfactory. Simple mastectomy followed by radiation therapy (50 Gy) to the axilla was performed as a palliative treatment. No signs of recurrence were observed for more than 14 months of treatment by trastuzumab. Multimodal therapy can improve patient QOL and the clinical outcomes in Stage IV local advanced breast cancer.     

A case of advanced pancreatic cancer successfully treated by combined chemotherapy of S-1 and gemcitabine

The patient was a 71-year-old woman. In March of 2007, she experienced abdominal pain, and consulted a physician at our hospital. She was followed on a outpatient basis, but the symptom did not improve, so she consulted our division. As a result of examinations, pancreatic head tumor, multiple liver metastasis, and para-aortic lymph node swelling were detected. She was then admitted for chemotherapy in our hospital. She was treated with combined chemotherapy of S-1 and GEM. Tumor marker(CEA, CA19-9)decreased and the size of the pancreatic head tumor and liver metastasis decreased. No toxic events were observed due to this therapy. She was treated as an outpatient, and was considered to have good quality of life.     

A case of advanced gastric cancer successfully treated by surgery after chemotherapy with S-1/CDDP

A-46-year-old male with advanced-stage IV multicentric gastric cancer was treated with S-1/CDDP as neoadjuvant chemotherapy. S-1(initially 100 mg/day, up to 120 mg/day)was orally administered for 3 weeks(day 1-21)followed by 1 drug-free week as a course, and CDDP(initially 60 mg/day, up to 100 mg/day)was administered by intravenous drip on day 8. After the fourth course, a significant tumor reduction was obtained and curative surgery was performed. Thereafter, S-1 therapy was continued. There has not been any recurrence for 19 months postoperatively.     

A case of advanced breast cancer successfully treated with combined tamoxifen and epitiostanol

A patient with stage IV advanced breast cancer with multiple metastasis (bones of the whole body, lungs) were treated by ovariectomy, administration of an non-steroidal antiestrogen (tamoxifen) and mild chemotherapeutic drugs, with favorable results. After four years, however, the patient had a relapse of the cancer. A steroidal antiestrogen (epitiostanol) was then administered with satisfactory results. When a breast cancer relapse occurs in patients once treated successfully with endocrinotherapy, a different form of endocrinotherapy should be tried. There is a possibility that the mechanism of action of Epitiostanol, which is regarded as a steroidal antiestrogen, is different from that of tamoxifen in which an estrogen receptor (ER) system is included.     

A case of advanced gastric cancer successfully treated with TS-1

A patient with advanced gastric cancer complicated with liver and lymph node metastases was successfully treated with a novel oral anticancer drug, TS-1, TS-1 was administered at a dose of 100 mg/day. One course consisted of consecutive administration of TS-1 for 28 days and withdrawal for 14 days. At the end of 3 courses a partial response of the liver metastases was achieved. Although the patient has had complications with ascites collection due to hypoalbuminemia, he has been well without regrowth of any metastases for over 8 months.     

A case of liver metastasis successfully treated with S-1 monotherapy in the patient with recurrent breast cancer

We experienced a case of recurrent breast cancer resistant to prior medications, which was treated with oral S-1, a fluoropyrimidine-class anticancer drug, and exhibited the marked shrinkage of liver metastasis. The prior treatments including anthracycline and taxane were judged not effective because of the progressive disease. Then the oral treatment with S-1 was started at 120 mg/day bid. targeting metastatic lesions of the liver. At the end of the second cycle,a significant improvement was noted with a decrease rate of 82.5%. The S-1 monotherapy was thus considered to be an effective treatment for advanced or recurrent breast cancer resistant to anthracyclines and taxanes.     

A case of gastric cancer with peritoneal dissemination and massive ascites successfully treated with S-1/docetaxel therapy

A 49-year-old woman who complained of abdominal bloating and numbness in the bilateral lower limbs was diagnosed as advanced scirrhous gastric cancer with massive ascites. The biopsy specimen showed a poorly-differentiated adenocarcinoma. She was therefore treated with combined chemotherapy of tri-weekly docetaxel(40mg/m2, day 1, 22)and S-1(60mg/m2, day 1-14 with 1-week rest)for unresectable gastric cancer. After 5 courses, computed tomography showed no ascites. Furthermore, after 31 courses, the loss of ascites continued, and the thickening of the stomach walls was reduced. These findings suggested that a complete response in terms of Evaluation Criteria in Solid Tumors(RECIST)was obtained. The side effects throughout chemotherapy were Grade I anemia and Grade I alopecia. Docetaxel and S-1 chemotherapy may well be one of the effective treatments for advanced scirrhous gastric cancer.     

A case of hypopharyngeal cancer successfully treated with concurrent S-1, nedaplatin and radiotherapy

A 68-year-old man was admitted with hoarseness. Laryngofiberscopy showed a tumor that obstructed the posterior hypopharyngeal wall and the larynx, and biopsy revealed well-differentiated squamous cell carcinoma. CT demonstrated bilateral cervical lymph node metastases. The patient was diagnosed as having hypopharyngeal cancer(T4N2cM0)and was treated with concurrent S-1, nedaplatin and radiotherapy(hereafter referred to as SN therapy). CT and endoscopy after primary treatment showed disappearance of the tumor, and the treatment outcome was assessed as complete response(CR). Currently, the patient is being treated with S-1 as adjuvant chemotherapy in the outpatient setting, and no recurrence or metastasis has been observed. These results suggest that SN therapy was effective for advanced hypopharyngeal cancer from the viewpoint of both curative treatment and organ and function preservation.