A case of advanced pancreatic cancer treated with gemcitabine hydrochloride

We report the case of 75-year-old man with advanced pancreatic cancer who was successfully treated with gemcitabine. The patient was admitted to our hospital suffering from anorexia and body weight loss. CT and ERCP showed pancreatic tail cancer with Schnitzler metastasis. We judged that a curative operation was impossible. Gemcitabine was infused over 30 minutes on an outpatient basis (1,000 mg/m2/week x 3/4 weeks). After 4 courses, the tumor was reduced and the tumor markers decreased. Furthermore, the patient can take sufficient meals without any adverse effects. The patient continues to undergoing the therapy with gemcitabine, and his quality of life has been preserved.     

A case of curatively resected locally advanced pancreatic cancer after chemoradiation therapy

A 68-year-old man admitted for pancreatic tumor detected by US was found by computed tomography(CT)to have locally advanced pancreatic cancer invading the portal vein and neural plexus of the superior mesenteric artery without distant metastasis. We conducted preoperative chemoradiation therapy containing S-1 and hyperfractionated accelerated radiation therapy (50 Gy). Reevaluation of CT after chemoradiation therapy showed that the primary tumor reduced 52% without distant metastasis. Based on these findings, we conducted subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection. Pathological examination revealed moderately-differentiated adenocarcinoma. Extensive fibrosis with a small amount of cancer cells was observed in the marginal area of the tumor. The portal vein was surrounded with extensive fibrosis and free from cancer cells. Extrapancreatic nerve plexus invasion and lymph node metastasis were not observed. There were no residual cancer cells (R0). The postoperative course was uneventful, and adjuvant chemotherapy (S-1) was started. The patient remains well without recurrence 12 months after surgery.     

A case of advanced colon cancer invading the rectum effectively treated with chemoradiation therapy before surgery

A 56-year-old man was hospitalized for anemia with appetite loss and body weight loss. He was diagnosed as advanced sigmoid colon cancer which invaded the rectal colon (Ra) and prostate (SI, N 0, P 0, H 0, M (-), cStage IIIa).We administered neoadjuvant chemoradiotherapy for fear of non-curative resection of the sigmoid colon and rectum after colostomy was performed. He was given radiation of the whole pelvis at a total dose of 39 .6 Gy (1.8 Gy x 22 times) combined with chemotherapy using continuous intravenous 5-FU (500 mg x 22 times). Two weeks after the chemoradiation, we administered chemotherapy (FOLFOX 4). Resectable resection was confirmed on Computed Tomography. We were able to conduct a low anterior resection of sigmoid colon and rectum. Postoperative histopathological examination of the resected sigmoid colon and rectum revealed no remnant cancer tissue. Neo-adjuvant chemoradiotherapy is considered to be effective for a study of non-curative resection of rectum.     

A case of unresectable advanced pancreatic tail cancer successfully treated with gemcitabine hydrochloride

We report a case of a 76-year-old female with unresectable advanced pancreatic tail cancer in whom systemic chemotherapy using gemcitabine hydrochloride was effective. The patient came to our hospital with a complaint of upper abdominal discomfort and was diagnosed as an advanced pancreatic tail cancer with severe vessel invasion. A curative operation was thought to be impossible, so gemcitabine hydrochloride was administered (800 mg/m2/week x 3/4 weeks). After 2 courses, the CEA, CA19-9 and SPan-1 value were decreased, and reduced tumor size was identified. Sixteen months after the first diagnosis, she died dissemination.     

A case of rectal cancer treated by preoperative chemoradiation

Fifty-one-year-old male visited our hospital suffering from anal pain and subileus. Further examination revealed that advanced rectal cancer which invaded to presacral space (Ai, N 0, P 0, H 0, M(-), stage IIIa) caused such symptom. We administered neo-adjuvant chemoradiotherapy for fear of non curative resection of the rectum. The regimen was once weekly administration of intravenous CPT-11 40 mg, plus daily oral administration of UFT-E 600 mg/day and Uzel 75 mg/day for 4 weeks. In addition we underwent radiation 2.4 Gy/day and intravenous low-dose cisplatin (CDDP) 5 mg/day, 5 days/week for 3 weeks. Four weeks after the first administration, a partial response was confirmed on CT, and so we carried out an abdominoperineal resection. The postoperative course is almost uneventful without a little perineal infection. The specimen revealed that no malignant lesion remained, which changed to necrotic tissue. The side effects were not so severe. For example, diarrhea, nausea, and mucosal dysfunction were each less than grade 2, and there was much tolerate for renal, liver, and bone marrow function. This combination chemoradiotherapy is considered to be effective for locally advanced rectal cancer.     

A case of unresectable advanced pancreatic cancer treated by S-1 with concurrent radiotherapy

Chemotherapy (5-FU) with concurrent radiotherapy is recommended as an effective treatment for locally unresectable pancreatic cancer. A phase I study of S-1 with concurrent radiotherapy demonstrated promising results in late years. A 70-year-old man was revealed to have metastatic pancreatic cancer (T 4 N 3 M 1 (PER), Stage IVb). Since a curative operation was impossible in this case, he was treated with systemic chemotherapy using S-1 combined with irinotecan hydrochloride (CPT-11) as first-line chemotherapy. Because the primary lesion was increased in size after two courses,he was then treated by radiotherapy combined with S-1 as second-line treatment. S-1 (80 mg/body/day) was orally administered (2 consecutive weeks, 1-week break), and concurrent radiotherapy was performed at a daily fraction of 1.8 Gy, 5 days/week, total amount 45 Gy. Although in the early period of chemoradiotherapy, transfusion for anemia and morphine hydrochloride for pain control were necessary, his symptoms gradually improved by the reduction of primary lesion. The patient has been receiving systemic chemotherapy as an outpatient for 12 months without deterioration of quality of life.     

Prognostic factors in patients with unresectable locally advanced pancreatic adenocarcinoma treated with chemoradiation

BACKGROUND: Although patients with locally advanced pancreatic cancer (LAPC) have an extremely poor prognosis, they are a heterogeneous group. Prognostic factors are inadequately defined for disease-free survival and overall survival in patients with LAPC who are receiving chemoradiation, so more definitive prognostic factors would be very useful for designing clinical trials. METHODS: Between December 1993 and July 2005, 247 patients with nonmetastatic LAPC were treated at M. D. Anderson Cancer Center (Houston, Tex) with concurrent chemoradiation (CRT). Median radiation dose was 30 Gy (range, 15-52.2 Gy). Radiosensitizers included 5-fluorouracil (54%), gemcitabine (33%), and capecitabine (13%). Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for disease-free survival and overall survival. RESULTS: Median follow-up was 4.3 months (range, 1-63 months). Median disease-free survival and overall survival were 4.2 months and 8.5 months, respectively. On univariate analysis, prognostic factors for improved disease-free survival were a Karnofsky performance scale (KPS) status of >80 (P < .01) and a hemoglobin (Hgb)level at presentation of >/=12 (P = .03). On multivariate analysis, KPS was the only independent prognostic factor for disease-free survival. Median disease-free survival was 4.9 months among patients with a KPS score of >80 and was 3.9 months among those with a KPS score of /=12 (P = .02), KPS>80 (P < .001), and <5% weight loss (P = .03). On multivariate analysis, Hgb and KPS were independent prognostic factors for overall survival. CONCLUSIONS: In the current study, KPS score was an independent prognostic factor for disease-free and overall survival among patients treated with chemoradiation for LAPC. The pretreatment Hgb level was an additional independent prognostic factor for overall survival.     

A case of advanced pancreatic cancer treated successfully with self-expandable stent, PTEG and chemotherapy

A 52-year-old male admitted to our hospital for ileus was diagnosed with advanced pancreatic cancer. He was complicated with multiple alimentary tract stenosis (duodenal third portion, ascending portion and splenic-flexure portion of colon) due to intraabdominal spread of malignancies. The self-expandable metal stent was successfully placed in each stenotic portion with being effectively decompressed of his intestinal obstruction by the procedure of percutaneous transesophageal gastro-tubing (PTEG). These treatments improved his symptoms to ingest orally in addition to the tube feeding per PTEG. Furthermore, he has been receiving adjuvant chemotherapy with GEM, S-1, and CPT-11 for 9 months at outpatient department. We concluded a combined procedure of self-expandable stent and PTEG was useful palliative treatment in malignant gastrointestinal obstruction of advanced pancreatic cancer.     

Response in a case of advanced rectal cancer treated by chemoradiation with S-1/oxaliplatin

A 62-year-old male was admitted to our hospital because of anal pain and bloody stool. After careful examination, a locally advanced rectal cancer was found, and an invasion of the prostate was suspected. The prevention of pelvic recurrence and downstaging for S-1/oxaliplatin (SOX), combined with preoperative chemoradiation (CRT) make, PR decision (reduction rate 70%), and surgery (APR+central D3) were performed. The postoperative course was uneventful and the patient was discharged 18 hospital days after surgery. The outpatient is receiving the adjuvant chemotherapy by single S-1 now. Advanced lower rectal cancer S-1/oxaliplatin (SOX), combined with preoperative chemoradiation (CRT), have fewer adverse events and are considered to be useful.     

A 6-year survival case of locally advanced unresectable pancreatic tail cancer treated with chemo-radiation therapy

We report a case of locally advanced unresectable pancreatic tail cancer patient who survived over 6 years by chemo-radiation therapy (CRT). A 61-year-old male was pointed out by CT to have pancreatic tail cancer of 5.6 cm in diameter that invaded to the stomach, left kidney and adrenal gland, nerve plexus of celiac and superior mesenteric artery, was diagnosed as locally advanced unresectable pancreatic tail cancer. CRT of gemcitabine (GEM) with RT to a primary lesion was successful. After two years and 11 months, Schnitzler's metastasis appeared and RT was effective to recover from rectal stricture. At three years and 3 months, GEM was converted to S-1. After 4 years and 5 months, paraaortic lymph node metastasis was enlarged, so chemotherapy was changed to combination of GEM + S-1. After 4 years and 10 months, upper mediastinal lymph node metastasis appeared. At 6 years and 1 month, RT to upper mediastinum for pain control was performed. Finally, 6 years and 6 months after the first diagnosis, he died of pancreatic cancer. A long-term survival of locally advanced unresectable pancreatic cancer is very rare. In the case of pancreatic cancer that CRT is effective to the remission of primary lesion, CRT is potentially useful to perform for the control of metastatic lesion or palliative therapy.     

A case of stage IV esophageal cancer successfully treated by chemoradiation

A 63-year-old man was admitted to our institution with a hard tumor on the left side of the neck. He was diagnosed as having advanced esophageal cancer (Stage IV) with a massive supraclavicular lymph node metastasis, and the lesion was thought to be unresectable. He was treated with chemotherapy (CDDP-VDS-5-FU) and radiation therapy, and all the tumors completely disappeared on endoscopic and CT examination. A stricture with scarring was detected in the esophagus at 6 months after treatment. No neoplastic tissue was detected in the lesion, and his dysphagia was relieved by dilation of the stricture. Recurrence on the left side of the neck was detected by CT at 2.5 years after chemoradiation therapy. However, the tumor has not grown over the 2-year interval since then, so it seems to be dormant. He has now survived with a good QOL for 5 years since the first hospital admission. We conclude that advanced esophageal cancer can be treated with chemoradiation therapy if the patient is in sufficiently good overall condition.     

A case of advanced esophageal carcinoma successfully treated with chemoradiation therapy with low-dose cisplatin and 5-fluorouracil

We have experienced a case of advanced esophageal carcinoma successfully treated with chemoradiation therapy together with low-dose cisplatin and 5-fluorouracil, having only minor toxicity. A 55-year-old man was admitted to our hospital because of dysphagia. Cervical esophageal carcinoma was found to have invaded the larynx through endoscopy, and invasion to thyroid gland and trachea was suspected from a cervical CT. We diagnosed the condition as advanced esophageal carcinoma (A2N(-)M0Pl0 Stage III). We then treated the patient by chemoradiation therapy. After the treatment, the carcinoma could not be detected by CT and endoscopy, and endoscopic biopsy revealed there were no active carcinoma cells. The side effects of the therapy were very mild, therefore the patient could be discharged after a short time. No evidence of a tumor relapse was found 5 months after the therapy. We treated 4 patients with esophageal carcinoma using the same regimen, and the results of the therapy were 2 CR, 1 PR, and 1 PD, with an overall response rate of 75%.     

Initial experience combining cyclooxygenase-2 inhibition with chemoradiation for locally advanced pancreatic cancer

Pancreatic cancer is a lethal disease that is resistant to chemotherapy and radiotherapy. Gemcitabine has recently been shown to be an improvement over 5-fluorouracil in patients with advanced disease. It is also a potent radiosensitizer, which has led to the investigation of gemcitabine with concurrent radiotherapy. However, preliminary results indicate that there are significant limitations to this approach in this challenging disease. Pancreatic cancer cells have alterations in many molecular signaling pathways that may be responsible for their resistance to cytotoxic therapy and aggressive behavior. Cyclooxygenase-2 (COX-2) is commonly overexpressed in pancreatic tumors, and preclinical evidence indicates that selective COX-2 inhibition enhances both chemotherapy and radiotherapy response, without affecting normal tissue damage. We have initiated preclinical studies as well as a phase I clinical protocol evaluating the combination of gemcitabine and celecoxib (Celebrex) with radiotherapy. In preclinical studies, celecelecoxib strongly enhanced the antitumor efficacy of chemoradiation. However, preliminary observations from both the preclinical experiments as well as the clinical protocol have revealed more toxicity with this combination than with gemcitabine and radiotherapy alone. These observations require further study, but are cause for concern when combining gemcitabine, radiotherapy, and celecoxib.     

A case successfully treated with abdominoperineal resection after preoperative chemoradiation therapy for anal cancer

A 46-year-old female was diagnosed with anal squamous cell carcinoma. Chemoradiation therapy was administered for a first-line therapy. Two courses of enforced 5-FU/MMC combination therapy were administered along with radiotherapy (60 Gy). This chemoradiation therapy had complete response. However, three months after, anal cancer had a local recurrence. Since there was no distant metastasis, abdoninoperineal resection was performed. No complications were observed after the operation. We conclude that abdominoperineal resection may be effective in the treatment of anal cancer in cases which the local recurrence was observed after chemoradiation therapy.     

晚期胰腺癌姑息术后放射治疗和同步化疗疗效分析

目的　评价放射治疗 +同步化疗治疗不能手术切除的胰腺癌的临床疗效和毒副反应。方法　 32例晚期不能手术切除的胰腺癌于姑息术后 ,给予放射治疗 +同步化疗 (S +R +C组 ) ,化疗方案采用 5 氟尿嘧啶 5 0 0mg /m2 +甲酰四氢叶酸钙2 0 0mg /m2 ,第 1～ 3天 ,第 2 2～ 2 4天。并与同期 31例姑息手术 +放射治疗 (S +R组 )和 34例姑息手术病人 (S组 )的治疗结果对照。结果　S +R +C组 7例 (2 1.9% )病灶缩小 ,16例 (5 0 % )病灶稳定 ;S +R组 5例 (16 .1% )病灶缩小 ,15例 (48.4 % )病灶稳定。S +R +C组病人有效率为 2 1.9% ,S +R组为 16 .1%。伴有疼痛的病人经治疗 ,疼痛缓解率分别为 5 2 .4 %和 4 2 .1%。S +R +C组和S +R组、S组比较 ,中位生存时间分别为 9.6月和 7.2月、5 .8月。S +R +C组与S组比较 ,有生存率优势 (P <0 .0 5 )。结论　放射治疗 +同步化疗可提高不能手术根除的胰腺癌病人的局部控制率和生存率。     

A case of advanced bladder cancer successfully treated with intraarterial chemotherapy

A 79-year-old Japanese male came to our hospital with complaints of protraction and macroscopic total hematuria. The medical imaging methods revealed a large papillary tumor in the left lateral wall of the bladder with the staging of T3N0M0. The pathological diagnosis was transitional cell carcinoma, G3. He received intraarterial chemotherapy with CDDP, ADM and MTX, which was called IA-MAC regimen. After two IA-MAC, no medical imaging method could reveal the tumor. The biopsied specimen, which was taken using the transurethral resection of the bladder mucosa, demonstrated no malignant cells. The new chemotherapeutic regimen "IA-MAC" is useful for the treatment of localized advanced bladder cancer in clinical use and enables one to preserve the organ.     

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 advanced breast cancer effectively treated with tamoxifen]

A 69-year-old female with advanced breast cancer was daily administered 20 mg of tamoxifen. After 4 months, her left breast tumor decreased in size. Left breast tumor and metastatic lymph nodes disappeared completely (CR) 7 months later. CR has been continued for 6 months up to the present, and the patient has been enjoying favorable quality of life.     

A case of advanced male breast cancer treated effectively with estrogen

A 47-year-old man was admitted because of a left axillary tumor. A biopsy of the tumor disclosed adenocarcinoma. The bone survey showed multiple sclerotic metastases. Thirteen months after his first admission, a left breast tumor developed and a simple mastectomy revealed a papillotubular carcinoma. Skin metastases appeared postoperatively and were exacerbated with accumulation of pericardial effusion and a high CEA level (401.7 ng/ml) despite radiation and chemotherapy. Estrogen therapy with diethylstilbestrol sodium phosphate was started, resulting in the disappearance of pericardial effusion and skin metastases. The patient remains well 10 months after starting estrogen therapy with a normal CEA level.     

A case of local advanced penile cancer treated with multimodality therapy

A 61-year-old man presented to our institution complaining of a putrescent left inguinal ulcerated tumor. Our diagnosis was penile cancer with bilateral inguinal lymph node metastasis and clinical staging T4N3M0. Here we report a case of local advanced penile cancer experimentally treated with a multimodal approach.