Complete histological response in advanced gastric cancer with Virchow's node metastasis after chemotherapy including S-1/CDDP--report of a case

A 63-year-old male complaining of jaundice was examined and diagnosed with advanced gastric cancer (type 3, tub 2, cT3, cN3, cH0, cM1, cStage IV), and obstructive jaundice due to lymph node metastasis. Since curative surgery was deemed not possible, we started chemotherapy with S-1+CDDP. S-1 (120 mg/day) was administered orally for 21 days, followed by CDDP (60 mg/m2) div on day 8. After the 9th course, a significant tumor reduction was obtained. Total gastrectomy and lymph node resection (D1) were performed. The histological diagnosis revealed complete disappearance of cancer cells in both the main tumor and lymph nodes. Herein we report this rare case with a view of the literature.     

A case of advanced gastric cancer showing a complete histological response after S-1/CDDP neoadjuvant chemotherapy

We experienced a case of advanced gastric cancer treated by curative operation after neoadjuvant chemotherapy with S-1/ CDDP. Gastric endoscopy was carried out on a 76-year-old man with epigastric discomfort and revealed a type 1 lesion in his stomach. Papillary adenocarcinoma was pathologically shown by endoscopic biopsy. The patient was initially treated by two courses of neoadjuvant chemotherapy with S-1/CDDP due to the large lymph node metastases around the lesser curvature of the stomach and celiac axis. Completion of chemotherapy resulted in a marked shrinkage of the primary lesion and a reduction of lymph node metastases. Later, total gastrectomy, splenectomy and D2 lymph node dissection were performed. Histopathological examination revealed no cancer cells in either the primary lesion of the stomach or dissected lymph nodes, confirming a pathologically complete response.     

Type 4 advanced gastric cancer responding to histological complete response after neoadjuvant S-1 combined with CDDP therapy-report of a case

A 75-year-old man with type 4 advanced gastric cancer was referred to our hospital. We diagnosed the tumor as cStage III B(cT4a, cN2, cM0)gastric cancer. We selected neoadjuvant S-1 combined with CDDP therapy for him. After 2 courses of chemotherapy, the extension of the gastric wall improved. After an additional 2 courses of chemotherapy, the primary tumor revealed a partial response(PR), judged from a barium meal study and upper GI endoscopic findings, and a total gastrectomy with lymph node dissection was performed. The pathological specimens showed no cancer cells in the gastric wall and lymph nodes, so the histological effect was judged as Grade 3.     

替吉奥联合顺铂新辅助化疗在胃癌中的应用

替吉奥(S-1)是一种第4代氟尿嘧啶衍生物口服抗癌剂,包括替加氟(FT)和两类调节剂吉美嘧啶及奥替拉西.日本目前晚期胃癌化疗80%以上病例使用S-1,有效率可达44.6%.新辅助化疗能减少肿瘤负荷,降低原发肿瘤分期,增加手术切除的可能性.替吉奥联合顺铂作为一种新的新辅助化疗方案,治疗胃癌总缓解率达76%,足目前为止进展期胃癌化疗方案中缓解率最高的方案.     

Complete response of highly advanced gastric cancer with peritoneal dissemination after new combined chemotherapy of S-1 and low-dose cisplatin: report of a case

TS-1(S-1) has been developed as a new oral anticancer drug based on the biological modulation of 5-fluorouracil. We treated a patient with highly advanced gastric carcinoma with a new combination chemotherapy of S-1 and low-dose cisplatin. Remarkable tumor reduction was observed after two cycles of this therapy in the primary tumor and metastatic lymph nodes, and the ascites disappeared. This was concluded to be a partial response. The only adverse effect was skin pigmentation of the fingers (grade 1), leading to early timing of operation after chemotherapy. The gastric tumor showed evident invasion to the serosa. Lymph nodes around the stomach were swollen. Peritoneal dissemination was also recognized in the omentum and mesocolon. Total gastrectomy with regional lymph node dissection was performed. Disseminated tumors were all resected. Histological examination showed that no tumor cells were detected in the gastric primary lesion, metastatic lymph nodes or disseminated peritoneal tumors, suggesting pathological complete remission. It was suggested that this regimen could be a potent combined therapy for the treatment of patients with highly advanced gastric carcinoma, and it could be useful as neoadjuvant chemotherapy. Further studies are necessary to evaluate the efficacy of this therapy.     

A resected case of stage IV gastric cancer successfully treated with TS-1/CDDP as neoadjuvant chemotherapy

A resected case of gastric cancer is described. The patient was a 60-year-old woman who presented a type 3 gastric tumor complicated by invasion of the head of the pancreas and liver. Radical resection was not indicated, and we administered the following combination chemotherapy with TS-1 and CDDP. 120 mg/day of TS-1 was orally administered for 3 weeks followed by 2 drug-free weeks as 1 course and 9 5 mg (60 mg/m(2)) of CDDP was administered intravenously on day 8. After two courses, total gastrectomy and D2 lymph node dissection were performed. Radical surgery for cure was conducted. Microscopically, the histological effect was judged to be grade 1a. One year after the operation, the patient is still alive without recurrence and metastasis. TS-1/CDDP therapy is useful for advanced gastric cancer.     

Analysis of patients with advanced gastric cancer undergoing S-1/CDDP combined neoadjuvant chemotherapy

We retrospectively examined patients with advanced gastric cancer who underwent S-1/CDDP combined neoadjuvant chemotherapy. Nine patients who had the factor of curative surgery deemed not feasible for advanced gastric cancer were enrolled. 80 mg/m2 of S-1 was given orally from days 1-14, and 60 mg/m2 of CDDP was administered on day 8. Patients were treated with a three-cycle protocol. When an adverse event greater than Grade 3 showed, we judged that chemotherapy could not be continued and surgery was performed. An anti-tumor effect on the imaging was found in all cases of PR. The histological effect was judged to be Grade 3 and pathological CR in two cases. In the postoperative period, all patients received adjuvant chemotherapy. S-1/CDDP combined neoadjuvant chemotherapy is a potential regimen for advanced gastric cancer.     

Histological complete response in advanced gastric cancer after 2 weeks of S-1 administration as neoadjuvant chemotherapy

Single-agent or combined chemotherapy with the novel oral fluoropyrimidine anticancer drug, S-1 (TS-1), has been reported to be useful for the treatment of advanced gastric cancer. Here, we report a patient with advanced gastric cancer achieving a complete response (CR) after 2 weeks of administration of S-1 as neoadjuvant chemotherapy. A 78-year-old woman with epigastric pain was diagnosed as having advanced gastric cancer. S-1 was administered orally, at a dose of 50 mg twice a day every day for 2 weeks, followed by a 2-week drug-free period. No obvious adverse reactions occurred. Subsequently, the patient underwent distal partial gastrectomy with D2 lymph node dissection. Pathological examination indicated no remnant signet-ring cells in the excised specimen, no lymph node metastasis, and unnatural fibrosis in one of the No. 3 lymph nodes. The neoadjuvant chemotherapy induced a CR according to the Japanese classification of gastric carcinoma.     

紫杉醇联合奥沙利铂及S-1的新辅助化疗方案对进展期胃癌治疗效果评价

目的:研究紫杉醇联合奥沙利铂及S-1的新辅助化疗方案对进展期胃癌的治疗效果。方法:将2014年1月-2017年6月于上海市第六人民医院胃肠外科和上海市第一人民医院宝山分院普外科进行治疗的63例进展期胃癌患者分为观察组及对照组,分别在术前予以紫杉醇联合奥沙利铂及S-1的新辅助化疗方案以及奥沙利铂+卡培他滨的传统化疗方案,化疗后均行手术治疗。治疗期间记录并比较两组患者化疗效果、化疗不良反应的发生率、CT改变以及R0切除率。最后采用Spearman相关性回归分析化疗副作用与年龄、ECOG评分等一般临床资料上的相关性。结果:观察组的化疗有效率、手术R0切除率均高于对照组（均P<0.05）,在化疗毒副作用上,观察组的恶性呕吐及骨髓抑制的发生率均高于传统化疗组（均P<0.05）,但不良反应经对症处理均能缓解,不影响手术及后续治疗。Spearman相关性回归分析结果显示,恶性呕吐及骨髓抑制、白细胞减少、血小板减少、贫血与年龄以及ECOG评分呈现正相关关系（均P<0.05）。结论:紫杉醇联合奥沙利铂及S-1的新辅助化疗方案可提高胃癌患者化疗效果,增加手术R0切除率,且化疗安全性可控。     

Retrospective analysis of stage IV advanced gastric cancer treated with S-1 or other chemotherapy

Background We retrospectively analyzed the influence of various clinicopathologic factors on the survival of patients treated with chemotherapy. Methods A retrospective analysis was made of 110 patients with stage IV gastric cancer who were treated from January 1996 to June 2004. Results Median survival time was 429 days for patients treated with S-1 therapy and 236 days for patients without S-1 therapy. A better survival was demonstrated in patients who had good performance status, one metastatic site, or had been given a second-line chemotherapy (P < 0.01). But very few patients (17%; 5/29) with multiple metastatic sites were able to receive the second-line chemotherapy. Conclusion Patients treated with S-1 therapy had a better prognosis than patients without S-1. One metastatic site and being given second-line chemotherapy were other factors for better prognosis. For patients with only one metastatic site, a good prognosis can be obtained by second-line chemotherapy for those refractory to S-1. The prognosis of patients who had more than two metastatic sites remained poor; more effective chemotherapy might improve the survival of such patients if they retain good performance status.     

Two cases of stage IV gastric cancer responding to chemotherapy with S-1 or UFT

We report patients with advanced Stage IV gastric cancer responding to chemotherapy with S-1 or UFT. Case 1: The patient was a 59-year-old man with Stage IV gastric cancer because of CY 1. After surgery, chemotherapy with S-1 (100 mg/body/day) was performed for one year and 11 months. At present, 5 years and 5 months after surgery, this patient shows no signs of tumor recurrence. Case 2: The patient was a 68-year-old woman with Stage IV gastric cancer because of P 1. She was treated with 200 mg/day of UFT for one year and 9 months. At present, 5 years after surgery, she shows no signs of tumor recurrence. We considered that the longterm survival of such patients is attributable to chemotherapy with S-1 or UFT. The OPRT activity of the two cases was high, so chemotherapy with S-1 or UFT was thought to be effective for them.     

A case of stage III B advanced gastric cancer with psoriasis vulgaris responding to S-1/CDDP neoadjuvant chemotherapy leading to a pathologically complete response

A 39-year-old man with psoriasis vulgaris who complained of severe anemia was examined and diagnosed with advanced gastric cancer (UM, Type 3, cT3 cN2 cH0 cP0 cM0, cStage III B). He was treated with S-1/CDDP as neoadjuvant chemotherapy. S-1 (120mg/day) was administered orally for 14 days, followed by 7 drug-free days as a course, and CDDP (100mg/ body) was administered by intravenous drip on day 8. After the third course, a significant tumor reduction was obtained. Total gastrectomy and lymph node dissection (D2) were performed. The histological diagnosis revealed a complete disappearance of cancer cells in the stomach and all of the lymph nodes. He has been doing well without any recurrence for 9 months since the start of treatment.     

Evaluation of S-1 for stage IV gastric cancer

To evaluate the efficacy of S-1 for Stage IV gastric cancer, we retrospectively examined 124 patients with Stage IV gastric cancer. We classified patients into two groups based on the presence or absence of S-1 administration: the S-1 therapy group (n= 56) and the non-S-1 therapy group (n=68). Basically, patients received S-1 orally at 40 mg per square meter of body surface area twice daily for 4 weeks, followed by 2 weeks without chemotherapy. When side effects appeared, we tried dose reduction or cut short the administering period according to the dose modification criteria. Major patient characteristics were as follows: gender (male/female: 76/48), and age (median[range]: 63[24-83]). The median S-1 dosage was about 5 courses, and the median of the S-1 total dosage was 10. 08 g, based on the amount of tegafur. The relative dose intensity (RDI) was well maintained (average: 74. 9%). The survival rate in the S-1 therapy group was significantly higher than in the non-S-1 therapy group. The median survival time (MST) was 308 days in the S-1 group and 157 days in the non-S-1 group. In the S-1 therapy group, the MST was 629 days for those receiving 10 g or more, while that of those receiving less than 10 g was 209 days. The MST of patients administered 10 g or more was significantly longer than that of those receiving less than 10 g (p<0. 0001). Therefore, we consider that S-1 therapy improves survival in patients with Stage IV gastric cancer.     

A case of stage IV advanced gastric cancer responding to TS-1/CDDP neoadjuvant chemotherapy which leads to a pathological complete response

A 72-year-old male with advanced gastric cancer (cT3N2M0H0P0CY1, cStage IV) was treated with TS-1/CDDP as neoadjuvant chemotherapy. TS-1 (60 mg/m(2)/day) was orally administered for 3 weeks followed by 2 drug free weeks as a course, and CDDP (60 mg/m(2)) was administered by intravenous drip on day 8. After the fourth course,a significant tumor reduction was obtained. Total gastrectomy, splenectomy, and D 2 type nodal dissection were performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and all of the lymph nodes, which is a so-called pathological complete response. The patient has now been in good health without a recurrence for 24 months after surgery. This case suggests that neoadjuvant chemotherapy with TS-1/CDDP is a potential regimen for advanced gastric cancer.     

A case of stage IV gastric cancer with multiple liver metastases responding to chemotherapy with weekly PTX after failure of chemotherapy with S-1 and CDDP combination

A 65-year-old male with type 5 gastric cancer and two lesions of liver metastases was initially treated with S-1/CDDP. After completion of the second course, however, the progression of liver metastases and appearance of massive ascites were detected with CT scan, and dysphagia appeared. Total gastrectomy was performed to improve the symptoms. Later, chemotherapy with weekly PTX was performed, demonstrating the regression of liver metastases and disappearance of ascites after 2 courses. Thus, partial liver resection for liver metastases was performed. PTX has been readministered weekly, and the patient is currently attending the outpatient clinic without recurrence, although two years have passed since his first examination.     

Complete response in a case of advanced esophageal cancer treated with docetaxel/5-FU/CDDPand S-1/docetaxel as neoadjuvant chemotherapy

A 64-year-old woman with advanced esophageal cancer underwent chemotherapy with docetaxel/5-FU/CDDP (DFP). Adverse reactions were severe nausea and general fatigue, so the patient decided to discontinue DFP therapy. The treatment was changed to S-1/docetaxel. Adverse reactions were not so severe, so she could receive 1 course of the medication completely. After the treatment, the primary lesion showed a partial response, so we performed surgery. In the resected specimen, no malignant cell could be seen microscopically. Though the advanced esophageal cancer was regarded as a systemic disease, the appropriate combination of chemotherapy and surgery proved effective.     

A case of advanced gastric cancer showing pathological CR after neoadjuvant chemotherapy with docetaxel, cisplatin and S-1 combination

A 69-year-old man suffering from heart-burn was referred to our hospital, and diagnosed as type 3 advanced gastric cancer with lymph node metastasis. Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin and S-1 was attempted. After two courses of chemotherapy were completed, distal gastrectomy with D2 lymphadenectomy was performed. Pathologically, there were no viable cancer cells remaining in the primary lesion and lymph nodes. The pathological response of NAC was judged to be grade 3. The postoperative course was uneventful, and the patient is currently visiting our outpatient clinic for treatment with S-1 as postoperative adjuvant chemotherapy.     

A case of advanced gastric cancer with peritoneal dissemination responding to S-1/CDDP neoadjuvant chemotherapy

The patient was a 72-year-old male diagnosed with type III poorly-differentiated adenocarcinoma in the lesser curvature by gastric fiberscopy. An abdominal computed tomography (CT) scan showed the thickness of the gastric wall and the enlarged lymph node around the stomach and laparoscopic examination revealed peritoneal dissemination. The patient received neoadjuvant combined chemotherapy with S-1 and CDDP. S-1 (100 mg/day) was orally administered for 3 weeks followed by 2 drug-free weeks as a course, and CDDP (100 mg/body) was administered by intravenous drip on day 8. After the third course, significant tumor reduction was obtained. Total gastrectomy, splenectomy and D2 nodal dissection were performed. Peritoneal dissemination disappeared, and the histological diagnosis revealed complete disappearance of cancer cells in the ascites and no metastasis in all lymph nodes. The patient has now been in good health with no recurrence for 22 months after surgery. The combined neoadjuvant chemotherapy with S-1 and CDDP can be an effective treatment of choice for advanced gastric carcinoma with peritoneal dissemination.     

A case of S-1/CDDP chemotherapy for inoperable advanced gastric cancer which led to gastrectomy with histological complete response

As the treatment for inoperable advanced gastric cancer, S-1/CDDP combination therapy (SP chemotherapy) has become a standard treatment. In our hospital, a second course of chemotherapy was performed on an outpatient basis in order to improve a traditional QOL. In this case, it showed remarkable effects in 15 months after starting chemotherapy. Then gastrectomy was performed. Histological findings of the resected specimens confirmed pCR in all tumors. We report on progress of this case and explain about the ingenuity of SP chemotherapy.