A case of liver metastatic recurrence of bile duct cancer completely responding to single drug, UFT, chemotherapy

A 72-year-old man with common bile duct cancer was treated by pylorus preserving pancreatoduodenectomy with D3 lymph node dissection and preventive radiotherapy at hepaticojejunostomy. At 4 months after surgery, CT demonstrated multiple liver metastatic tumors. Single drug chemotherapy, UFT 600 mg, was started. After 6 months, the liver metastatic tumor could not be seen by CT. UFT may be a first candidate for chemotherapy for recurrence of bile duct cancer.     

A case of colorectal cancer effectively treated with UFT/LV

5-FU/LV therapy has been standard chemotherapy for advanced and recurrent colorectal cancer. Several studies reported that a new alternative chemotherapy, UFT/LV, had anti-cancer effects the same as with conventional 5-FU/LV therapy. We report a patient who had advanced and recurrent colorectal cancer treated with UFT/ LV. This 70-year-old male was admitted to our hospital because of a right lower abdominal mass, which was diagnosed as a peritoneal recurrence of transverse colon cancer by abdominal CT. UFT/LV therapy was started on an outpatient basis. After one course of chemotherapy, the intra-abdominal mass disappeared, and this therapy was continued for three courses. He did not suffer from any adverse effect during chemotherapy. Although this therapy was resumed because of the recurrence at the same site after nine months, it was refractory to chemotherapy. Thereafter, surgical resection was performed, and it was diagnosed as lymph node metastasis of previous surgery.     

A case of recurrent sigmoid colon cancer with adrenal and para-aortic lymph node metastasis successfully treated by operation and chemotherapy

We report a case of 57-year-old woman suffering from advanced sigmoid colon cancer with adrenal and para-aortic lymph node recurrence. Sigmoidectomy was performed for sigmoid colon cancer in January 2002. Pathological staging was Stage II (pT3, pN0, pM0, Cur A). She received a UFT + CPT-11 regimen as preoperative chemotherapy for liver metastasis (S2, S7) from December 2002. A partial liver resection (S2, S7) was performed for liver metastasis in July 2003, and the UFT + CPT-11 was introduced as adjuvant chemotherapy. However, adrenal and para-aortic lymph node recurrence was detected in February 2007, and mFOLFOX6 was performed as preoperative chemotherapy. Right adrenalectomy and para-aortic lymph node dissection was performed in July 2007. mFOLFOX6 as postoperative chemotherapy was done, mFOLFOX6 + bevacizumab was started because of CEA increase. The chemotherapy was performed for 23 courses and temporarily stopped due to adverse reactions, such as peripheral neuropathy (grade 2), general fatigue (grade 1), and nausea (grade 1). She had no recurrence for almost 3 years after a resection of adrenal and para-aortic lymph node metastasis.     

A case of recurrent rectal cancer with paraaortic lymph node metastasis treated by FOLFIRI therapy leading to complete response

A 56-year-old woman was referred to our hospital because of melena. After examinations she was diagnosed with rectal cancer. Anterior resection was performed and the final diagnosis was Stage IIIa. She was treated with adjuvant chemotherapy consisting of UFT/Uzel for one year, followed by UFT alone for one year. Two years after the surgery, abdominal CT suggested solitary paraaortic lymph node metastasis. As the patient denied a surgical treatment, mFOLFOX6 chemotherapy was induced. However, the patient developed a grade 3 allergic side effect, FOLFIRI was administered. Six months after the chemotherapy was started, the paraaortic lymph node metastasis had disappeared. After 50 courses, the case was considered to have achieved a clinical CR which has been maintained now. FOLFIRI was effective for recurrent rectal cancer with paraaortic LN metastasis.     

A patient with hepatocellular carcinoma with intraperitonial lymph node metastases in whom oral UFT treatment was markedly effective

We report a patient with hepatocellular carcinoma (HCC) with intraperitoneal lymph node metastases in whom UFT (uracil + tegafur) was markedly effective. The patient was a 70-year-old woman with chronic hepatitis C, who developed HCC mainly infiltrating the medial segment of the liver. Arterial infusion chemotherapy and embolization were performed, and radiofrequency ablation was also conducted. Despite these interventions, the serum alpha-fetoprotein level continued to increase, and reached a level as high as 208,000 ng/ml by the second month of treatment. Abdominal computed tomography (CT) revealed no recurrence in the liver, but multiple metastases to intraperitoneal lymph nodes were identified. UFT-E treatment was initiated at the dose of 400 mg/day. A subsequent abdominal CT revealed complete disappearance of the intraperitoneal lymph node metastases 2 months after the start of UFT treatment. The serum alpha-fetoprotein level returned to normal 4 months after the start of UFT treatment. We consider that the patient described here is a good example to illustrate the remarkable effectiveness of UFT in the treatment of metastatic HCC.     

A case of recurrent sigmoid colon cancer successfully treated with 5-FU and UFT

A 57-year-old female patient with recurrent sigmoid colon cancer was successfully treated with 5-FU and UFT for 8 years. The patient, with cancer recurrence in the para-aortic lymph nodes, which were palpated in the abdomen, was given oral 5-FU at a daily dose of 200 mg. During the second week of administration, the mass showed a remarkable decrease in size, and complete disappearance was achieved within one month. However, 5 years and 2 months after discontinuation of 5-FU administration, recurrence in the supra-clavicular lymph nodes and para-aortic lymph nodes was recognized. After administration of UFT at a daily dose of 600 mg, complete disappearance of para-aortic lymph node recurrence was observed. At present, the patient is under observation as an outpatient at our hospital. This case suggests the effectiveness of 5-FU and UFT for lymph node metastases of sigmoid colon cancer.     

A case of huge submandibular malignant tumor treated successfully with UFT chemotherapy

We report a patient with a huge submandibular malignant tumor showing an excellent response to chemotherapy with UFT. A 76-year-old woman complaining of a submandibular mass was referred to us. The mass had an irregular margin and measured 11 x 7 cm on CT scan. A left submandibular lymph node was enlarged slightly. Fine needle aspiration cytology of the mass indicated undifferentiated malignant tumor. We diagnosed her with unresectable malignant tumor. She was treated with oral UFT (600 mg/day), as she refused chemoradiotherapy. The malignant tumor became dramatically smaller in 4 weeks, and clinically disappeared in 6 weeks. Oral UFT was discontinued due to liver dysfunction. There has been no evidence of recurrence for 5 years after discontinuation of chemotherapy. The patient remains under observation.     

A case of long-term survival after resection of advanced undifferentiated rectal cancer treated by short-term preoperative chemoradiotherapy and postoperative adjuvant chemotherapy

A 75-year-old man with advanced undifferentiated rectal cancer, diagnosed by endoscopic biopsy, underwent preoperative short-term chemoradiotherapy (whole pelvis, 4 Gy × 5 day with UFT 400 mg/day × 7 day). Tumor size and lymph node swellings were reduced after radiation therapy. Down-staging was achieved from cT3, cN2, cStage III b to cT3, cN1, cStage III a. A curative low anterior resection with D3 lymphadenectomy including lateral lymph node dissection, was performed 4 weeks after the completion of chemoradiotherapy. Pathological findings of resected specimen showed undifferentiated carcinoma with regional lymph node involvement (pT2, pN1, pStage III a). The histological change in response to chemoradiation was evaluated as Grade 2. The postoperative course was uneventful and postoperative adjuvant chemotherapy (UFT+Uzel) was performed for six months (5 courses). No sign of recurrence has been found until 51 months after the operation. Undifferentiated rectal cancer is a rare condition with extremely poor prognosis according to the Japanese literature. Nine cases have been reported so far with only one long-term survivor. This combination of preoperative short-term chemoradiotherapy and adjuvant chemotherapy, which is one of the standard strategies for advanced rectal cancer in Western countries, but not common in Japan, may be a promising option for treatment of undifferentiated rectal cancer.     

A case of long survival with unresectable duodenal papilla cancer treated with oral chemotherapy using combination UFT and cyclophosphamide

A 69-year-old female patient underwent a choledochojejunostomy for unresectable duodenal papilla cancer with para-aortic lymph node metastases. Both tegafur-uracil(UFT) and cyclophosphamide were given orally every day after surgery. Twenty-eight months from the initiation of the chemotherapy the tumor had remarkably reduced and the objective response was evaluated as a PR. The patient is now doing well. Lymph node metastasis is considered an important prognostic factor of papilla Vater carcinoma, and especially with para-aortic lymph node metastases the long-term prognosis is poor. Combination chemotherapy using UFT and cyclophosphamide would be a therapeutic option for elderly or high-risk patients.     

A case of recurrent gastric cancer with lymph node metastasis successfully treated by CPT-11/CDDP therapy

We report a case ofa 76-year-old man suffering from advanced gastric cancer with lymph node recurrence. Distal gastrectomy was performed for gastric cancer with pylorus stenosis in April 2001. Pathological staging was III A(T3, N1, M0, Cur B). He underwent outpatient treatment with oral administration of UFT 400mg/day as postoperative adjuvant chemotherapy, but stopped after two months because of loss of appetite and general fatigue. Partial liver resection(S4/5)was performed for liver metastasis(S4)in June 2002, and S-1 was administered 80mg/day as adjuvant chemotherapy. However, obstructive jaundice was detected for lymph node recurrence in March 2003, and conducted bile duct stent after PTCD. He started to undergo a biweekly combination chemotherapy of irinotecan (CPT-11)60mg/m / 2 and cisplatin(CDDP)30mg/m2. Three months later, the lymph node had decreased in size. We reduced this therapy, extended the interval, and discontinued it after 24 courses due to adverse reactions, such as leucopenia(grade 3)and general fatigue(grade 2). Afterward, he had no recurrence for over 5 years.     

A case of advanced gastric cancer showing complete response to chemotherapy of peroral carcinostatic only

The patient was a 68-year-old woman. She was referred to our hospital because of advanced gastric cancer. Endoscopic examination showed that the tumor was located in the Subcardia, with its oral margin invading the esophagus. Histologic examination of biopsy specimen led to a diagnosis of moderately to poorly differentiated adenocarcinoma. Apparent lymph node swellings (No. 7, No. 11) on enhanced CT examination indicated the metastasis of the gastric cancer. Consulting with her family, we decided to treat the cancer with chemotherapy using the peroral carcinostatic "UFT", and started it on November 18, 1997. Follow-up endoscopic examination confirmed that the tumor was reduced in size immediately after starting chemotherapy, and then finally disappeared on December 10, 1999. Since then, there has been no recurrence of the tumor. This is a rare case of gastric cancer showing complete response to chemotherapy using a peroral carcinosatatic alone.     

A case of gastric cancer with abdominal para-aortic lymph node metastases responding to TS-1 + CDDP neoadjuvant chemotherapy

The patient was a 54-year-old woman with extremely advanced gastric cancer of type 3. A CT scan of the abdomen showed enlargement of many huge abdominal para-aortic lymph nodes. Combined chemotherapy of TS-1 and CDDP was planned in order to reduce the tumor. TS-1 (100 mg/body/day) was administered for 21 days followed by 14 days rest as one course. CDDP (96 mg/body) was administered 8 days after the start of TS-1. After 2 courses of treatment, a CT scan showed complete disappearance of lymph node metastasis, and no high grade toxicities. Therefore, one month after the completion of the chemotherapy, total gastrectomy and D2 lymph node dissection were performed. The histological effect was judged to be grade 1a-1b. There were no viable cancer cells in any lymph nodes. One year after surgery, the patient is still alive without recurrence. Neoadjuvant chemotherapy with TS-1 and CDDP is so effective that can it be adapted for advanced gastric cancer with para-aortic lymph node enlargement for downstaging.     

A case of liver metastatic recurrence of bile duct cancer completely responding to single-drug S-1 chemotherapy

A 65-year-old man with common bile duct cancer was treated by pylorus-preserving pancreaticoduodenectomy with D2 lymph node dissection. Three months after surgery, tumor marker was increasing, and CT demonstrated multiple liver metastatic tumors. Single drug chemotherapy with S-1(100 mg/body/day)was administered. After 6 months, the liver metastatic tumors could not be visualized by CT. S-1 may be the chemotherapy of choice for recurrence of bile duct cancer.     

Two patients with recurrent colon cancer who underwent surgery following a combination of irinotecan and UFT

One patient with pulmonary metastasis from colon cancer and one with para-aortic lymph node metastasis were treated with a combination of irinotecan and UFT. Irinotecan (100 mg/m2) was given by 24-hour intravenous infusion on day 1, and UFT (600 mg/day) was given orally on days 3 to 7 and days 10 to 14 of a 2-week course, which was then repeated. In the patient with pulmonary metastasis, the lesions in the lung resolved after 7 courses of chemotherapy. Surgery was performed after 10 courses. The patient with para-aortic lymph node metastasis had a partial response after 4 courses of chemotherapy, and underwent surgery after 6 courses. The only adverse effects were grade 2 myelosuppression and hair loss, none of which were severe enough to require treatment. With this chemotherapy regimen, patients are admitted for two days biweekly for 24-hour intravenous infusion of CPT-11. Thus, most of the treatment can be performed on an outpatient basis. The combination of irinotecan and UFT is expected to be useful for metastatic or recurrent colon cancer.     

A case of lateral lymph node metastasis of submucosal rectal cancer

We report a case of lateral lymph node metastasis of submucosal rectal cancer. A 54-year-old man was pointed out with stool occult blood reaction positive. Screening colonoscopy revealed an 18 mm 0-Is rectal cancer in Rb 6 cm from anal verge. Endoscopic mucosal resection (EMR) was performed. Tumor appeared to be well treated, but pathological findings demonstrated the tumor invasion into submucosally (1,300 μm) with lymphovascular invasion ie ly (+) and v (+). Laparoscopic low anterior resection was then performed and no metastasis of lymph nodes (pSM, N0/stage I) was found. But he suddenly had an elevation of CEA (4 ng/mL to 26 ng/mL) after 14 months and following MRI and PET-CT revealed a recurrence in a right lateral lymph node (#283). Chemoradiation therapy (CRT) with CPT-11, UFT and LV was performed. After CRT, lateral lymph nodes and para aortic lymph nodes dissection were performed. Despite of the chemotherapy, he died after 13 months from a recurrence of lateral lymph node metastasis.     

Two cases of stage IV gastric cancer undergoing adjuvant surgery after down staging by chemotherapy

CASE 1: A 72-year-old man with epigastralgia was diagnosed with gastric cancer and referred to our hospital. An abdominal CT scan revealed liver metastasis and para-aortic lymph node metastasis. He was treated with S-1+CDDP. After 4 courses of this treatment, the liver metastasis and para-aortic lymph node metastasis disappeared, and adjuvant surgery was performed. There has been no recurrence for 16 months postoperatively. CASE 2: A 66-year-old man with anorexia was diagnosed with gastric cancer and referred to our hospital. An abdominal CT scan revealed para-aortic lymph node metastasis. He was treated with S-1+CDDP. After 9 courses of this treatment, para-aortic lymph node metastasis disappeared, and adjuvant surgery was performed. Eight months after the operation, lymph node metastases were confirmed by abdominal CT scan, and he was treated with chemotherapy as an outpatient as of 13 months after the operation. We experienced two cases of Stage IV gastric cancer undergoing adjuvant surgery after down staging by chemotherapy. It was suggested that adjuvant surgery to highly advanced gastric cancer could improve the prognosis of patients.     

A case of recurrent esophageal cancer responding to second-line chemotherapy of TS-1/docetaxel combination

A 70-year-old man suffering from advanced esophageal cancer (Stage II) underwent subtotal esophagectomy in December 2000. He then had postoperative chemotherapy, called low-dose FP, and was followed in an ambulatory setting. In December 2003, he was diagnosed as a recurrence of esophageal cancer with multiple liver metastases and upper mediastinum lymph node, so he was treated by combined chemotherapy consisting of TS-1 and docetaxel as a second-line chemotherapy. After 3 courses of this therapy, CT scan showed that the size of liver and lymph node metastases was reduced and the effect of this therapy was PR. PR continued for about 6 months. This chemotherapy made it possible to treat liver and lymph node metastasis in an ambulatory setting. It is conceivable that this combination chemotherapy might be a promising regimen for a short period.     

A long-term survival case of advanced sigmoid colon cancer with massive metastases to the para-aortic lymph nodes

We report a long-term survival case of advanced sigmoid colon cancer with massive metastases to the para-aortic lymph nodes. The patient was a 63-year-old male. He underwent sigmoidectomy with D3 + para-aortic lymphadenectomy for advanced sigmoid colon cancer. Histological examination showed a moderately differentiated adenocarcinoma, ss, ly2, v2, n4 (total 30/64, para-aortic lymph nodes 18/39). From 6 months to 4 years after the operation, tegafur/uracil (UFT) was performed as chemotherapy. After 8-year disease-free interval, CT showed solitary mediastinal lymph node metastases. He underwent thoracoscopic mediastinal lymphadenectomy. Histological examination revealed metastases from colon cancer.     

A case of survival--excellent response to chemotherapy in long-term postoperative recurrence of non-small cell lung cancer

A 63-year-old female underwent lobectomy with ND2a lymph node dissection for left lung cancer in April 1999. Histopathological examination revealed moderately-differentiated adenocarcinoma (pT2N2M0, pStage III A). She received one course of a combination of etoposide (ETP) and cisplatin(CDDP)as adjuvant therapy, followed by oral intake of UFT. At 9 months post-operatively, she received radiation therapy for lymph node recurrence, at which time new multiple lung metastases were found. After receiving 3 courses of a combination of vinorelbine (VNR) and CDDP, a complete response (CR) of all metastatic lesions was achieved. Three years after the original surgery, metastatic lesions recurred, and a total of 9 courses of a combination of VNR and carboplatin (CBDCA) and partial resection of the right lung for pulmonary metastasis were performed in succession. Following this therapy, treatment with gefitinib was initiated for about 6 months, and computed tomography (CT) showed progressive disease. For 8 years following the original operation, the patient received oral chemotherapy using S-1 and has maintained CR on CT. We conclude that oral administration of S-1 is useful as palliative chemotherapy without serious adverse events or worsening of quality of life. Patients like this case are thus able to continue chemotherapy for a long time.     

A case of recurrent pancreatic cancer responding to TS-1 combined gemcitabine chemotherapy after UFT combined gemcitabine chemotherapy resulting progressive disease

The patient diagnosed as recurrent pancreatic cancer was treated with UFT combined gemcitabine (GEM) chemotherapy. After one cycle of therapy, the anti-tumor effect was progressive disease with obstructive jaundice and enlargement of lymph node metastasis and liver metastasis. The chemotherapy was changed to TS-1 combined GEM chemotherapy and resulted in partial response. Only grade 3 leukopenia was observed as an adverse effect. Some cases may be effectively treated by TS-1 combined chemotherapy after treatment failure of UFT combined GEM chemotherapy. This therapy is simple and possible to continue safely on an ambulatory basis while maintaining quality of life.