A case of multiple liver metastases from colon cancer successfully treated with modified pharmacokinetic modulating chemotherapy using Leucovorin

A 51-year-old man underwent right hemicolectomy due to ascending colon cancer with multiple liver metastases. Administration of modified pharmacokinetic modulating chemotherapy (PMC) using Leucovorin (intravenous infusion of 5-FU, 600 mg/m2/24 hours; oral administration of UFT, Taiho Pharmaceutical Co., Tokyo, Japan, 400 mg/day; and Isovorin, Wyeth Lederle Co., Tokyo Japan, 250 mg/body) was started postoperatively. Two months of modified PMC produced a drastic tumor reduction without any adverse reactions such as diarrhea or myelosuppression observed. At present the patient continues to tolerate the chemotherapy and is being followed as an outpatient clinic. This case suggests the usefulness of modified PMC using Leucovorin for progressive recurrent colon cancer.     

A case of successfully treated unresectable multiple liver metastases from colon cancer by hepatic arterial infusion chemotherapy and systemic chemotherapy

Sigmoidectomy was performed for a 69-year-old man with sigmoid colon cancer and unresectable multiple liver metastases. The histological diagnosis was undifferentiated carcinoma of sigmoid colon. Hepatic arterial infusion chemotherapy with 5 FU and systemic chemotherapy with CPT-11 were performed after the operation. A complete response (CR) was achieved for liver metastases. The recurrent sign was not found at 23 months after the operation. This combination therapy is expected to be an alternative treatment of colorectal cancer with unresectable multiple liver metastases.     

A successfully resected case of colorectal cancer with multiple liver metastases treated with systemic chemotherapy

The patient was a-54-year-old man. Sigmoidectomy was performed for sigmoid colon cancer in 1991. Partial liver resection in 1992 and microwave coagulation therapy (MCT) in 1994 were carried out for liver metastasis. Complete remission of the metastasis was achieved. In June 2002, multiple liver and lung metastases were identified. 5-FU, CDDP therapy was applied as systemic chemotherapy. The liver metastasis was improved and the level of CEA was reduced. However, a new lesion appeared in the right lobe of the liver, followed by an increase of the CEA level. Although CPT-11, 5-FU, CDDP therapy was applied, it was not effective. The reason was considered to be from the decrease of drug delivery resulting from an unbalanced blood supply in the right lobe of the liver. Right lobectomy and radio-frequency ablation was performed on June 17, 2003. The level of CEA was dramatically decreased. Additionally, CPT-11, 5-FU, CDDP therapy was applied. The patient has survived for 11 years after liver metastasis was first detected.     

A case of multiple liver metastases of colon cancer with PyNPase-positive successfully treated with 5'-DFUR

A 75-year-old man was diagnosed with transverse colon cancer. We therefore performed a transverse colectomy. Diagnosis of multiple liver metastases was made by intraoperative palpation, core needle biopsy and postoperative abdominal CT scan. 5'-deoxy-5-fluorouridine (5'-DFUR) 800 mg/day was administered orally after the surgery. After 2 months of administration, an abdominal CT scan showed the metastatic lesions of liver were reduced. After 8 months, an abdominal CT scan showed no evidence of liver metastases. Pyrimidine nucleoside phosphorylase (PyNPase), an enzyme that converts 5'-DFUR to 5-FU, has an important role in the expression of the anti-tumor activity of 5'-DFUR. Primary specimens of this case were regarded as PyNPase-positive. We think that administration of 5'-DFUR may be a useful treatment for advanced colon cancer that is PyNPase-positive.     

A case of liver metastases from gastric cancer successfully treated with induced hypertensive chemotherapy

We report a 77-year-old patient with gastric cancer who has survived 5 years after multidisciplinary treatment for both liver and brain recurrences. He underwent a D2 distal gastrectomy for macroscopically type 2 cancer at the lower third of the stomach on May 1997. The histopathological findings were as follows: O-IIc (SM2), poorly differentiated adenocarcinoma, pN2, ly2, v2, stage II. One year after surgery, a follow-up abdominal CT scan revealed multiple liver metastases. He received both hepatectomy and prophylactic hepatic arterial infusion of mitomycin C with induced hypertensive chemotherapy (IHC), a drug delivery system using the difference in blood flow between normal and tumor vessels by intravenously injected angiotensin-II. IHC was carried out monthly and the total dose of MMC was 74 mg (6 courses). Although he was disease-free for about 2 years, brain metastases were found on December 2000. He then underwent excision of the brain metastases and consecutive radiation by X-knife. Although he had a relapse of liver metastases on April 2002, he is still alive now. We consider multidisciplinary treatment including complete surgical resection as effective, even for recurrent or highly malignant gastric cancer.     

A case of highly advanced ascending colon cancer with multiple bone and liver metastases and pleuritis carcinomatosa treated with pharmacokinetic modulating chemotherapy and low-dose CPT-11

A 54 year-old male was admitted for highly advanced ascending colon cancer with multiple bone and liver metastases and pleuritis carcinomatosa. He was treated with pharmacokinetic modulating chemotherapy (PMC) and low-dose CPT-11. UFT (400 mg) was orally administered daily and a 2-hour infusion of l-leucovorin (250 mg/m2/day) with a continuous infusion of 5-FU (600 mg/m2/24 h) was given once a week on an outpatient basis. CPT-11 (80 mg/body/2 h) was administered every 2 weeks. Partial response was obtained in the liver for 6 months and in the primary lesion for 9 months. Significant decrease of pain from the multiple bone metastases was observed for 4 months without severe side effects, which led to an improvement in performance status and quality of life for the patient. He survived more than 11 months after initial treatment. The duration of his stay at home was 288 days, accounting for 83% of the treatment period. This case suggests the efficacy of home anticancer therapy with PMC and low-dose CPT-11 for highly advanced colon cancer in terms of QOL.     

A case of multiple liver metastases from sigmoid carcinoma treated successfully with arterial infusion chemotherapy

A 63-year-old female, who had undergone sigmoidectomy for sigmoid carcinoma one year before, was admitted for multiple liver metastases. A urokinase-immobilized catheter was introduced into the proper hepatic artery via the gastroepiploic artery operatively. A daily arterial infusion of 5-FU (250 mg) was combined with a weekly arterial infusion of adriamycin (30 mg) or MMC (10 mg). After discharge, 5-FU (200 mg/day) was given orally and MMC (10 mg) was infused intraarterially every other week at an outpatient clinic. ADR or MMC was infused with angiotensin II, known to increase arterial blood supply to a malignant lesion. Ultrasonography demonstrated 35 to 50% reduction in tumor diameter. The density of metastases seen in computerized tomography became low indicating tumor necrosis. Plasma CEA level, which had initially been as high as 864 ng/ml, decreased rapidly and has remained within normal limits up to the present time. Arterial infusion chemotherapy using 5-FU, ADR or MMC in combination with angiotensin II seems to be effective in the treatment of multiple hepatic metastases from colorectal carcinoma.     

A case of multiple liver metastases from colon cancer successfully operated after intraarterial chemotherapy performed in home

A 60-year-old male patient had unresectable multiple liver metastases from a sigmoid colon cancer that had been resected, and thus hepatic arterial infusion therapy was planned. A heparin coated catheter was inserted from the left thoracoacromial artery to the proper hepatic artery. 5-fluorouracil (1,000 mg) was administered via the catheter 24 hours/week using an implantable vascular device and a small disposable pump in his home. After 59 weeks, the metastatic liver tumors had decreased remarkably in size, and all tumors could be resected completely through surgery. Three weeks after the operation, the same intraarterial chemotherapy was restarted to prevent the recurrence in the liver. However, the patient died of lymph node recurrences. The intraarterial chemotherapy is thought to be useful for neoadjuvant therapy in patients with inoperable liver metastasis from colon cancer.     

A case of successfully treated sigmoid colon cancer with multiple regional metastases by chemotherapy and radiation therapy

Multiple regional metastases due to colon cancer usually show poor prognosis. Various treatments such as chemotherapy and radiation therapy are not sufficient, and the outcome is generally poor in many cases. We report here on a patient with multiple regional metastases who was successfully treated with several therapies and remains still alive. A 69-year-old man presented with fever and epigastralgia. A colonoscopy revealed primary sigmoid colon cancer. A computed tomography showed multiple hepatic metastases, and metastases to supraclavicular, mediastinal and para-aortic regional lymph nodes. The bone metastases were detected by scintigram. He was treated with combination chemotherapy of 5-FU via hepatic artery and CPT-11 by systemic administration. The primary tumor had completely disappeared (complete response), and metastases to liver and lymph nodes showed a remarkable shrinkage (partial response) after the chemotherapy. In contrast, bone metastases showed progressive growth (progressive disease). Radiation therapy and bisphosphonate infusion for bone metastases were achieved, and the treatments have controlled the growth of the metastases. Primary tumors and metastases are still controlled well for 3 years after the initial chemotherapy.     

A case of colon cancer with multiple liver metastases and lymph nodes metastases successfully treated by 5'-deoxy-5-fluorouridine

In a 79-year-old man with ascending colon cancer, multiple liver metastases were detected by computer tomography. The patient underwent right hemicolectomy. Paraaortic lymph nodes metastases were found intraoperatively. After surgery, 5'-deoxy-5-fluorouridine (5'-DFUR) was administered orally at 600 mg daily. Abdominal CT showed disappearance of the liver metastases 6 months after operation. At a follow-up exam 24 months after the beginning of the chemotherapy, the patient remained in remission and reported no side effects. We consider oral administration of 5'-DFUR to be a useful treatment for advanced colon cancer.     

A case of multiple liver metastases from breast cancer successfully treated with intra-arterial administration of docetaxel

Docetaxel is an excellent agent with a high antitumor effect for the treatment of advanced/recurrent breast cancer. A 55-year-old female with metastatic liver tumors from breast cancer showed a remarkable response to intra-arterial administration of docetaxel (20 mg/week, or 40 mg/2 weeks). Since CT and MRI imaging revealed multiple metastases in the liver, intra-arterial chemotherapy was selected. No critical side effect was found during this chemotherapy. A CT scan 3 months after chemotherapy showed a partial response. We conclude that this intra-arterial chemotherapy using docetaxel will be safe and useful for liver metastases from breast cancer.     

A case of rectal cancer with multiple liver metastases that responded dramatically to pharmacokinetic modulating chemotherapy/CPT-11 therapy

A 67-year-old male patient suffering from rectal cancer complicated by multiple hepatic metastases underwent low anterior resection, cholecystectomy and hepatic arterial cannulation. He was treated postoperatively with arterial infusion pharmacokinetic modulating chemotherapy (PMC) and venous infusion CPT-11 (modified PMC). After three courses of modified PMC, a complete response (CR) of the hepatic metastatic lesions was noted. PMC/CPT-11 therapy was managed at our outpatient clinic, and seems to be a useful treatment option.     

A case of multiple bone metastases from gastric cancer successfully treated with chemo-radiotherapy

A 75-year-old man underwent distal gastrectomy for gastric cancer (CY+, Stage IV) in June 2009. About 4 months after surgery, he had a strong pain in a right shoulder, and became writing difficulty. Some imaging examinations revealed multiple bone metastases, and it was diagnosed that the pain was caused by the tumor of cervical spine. Systemic chemotherapy was started using a regimen of S-1/CDDP, and radiotherapy (30 Gy) was performed for the cervical tumor at the same time. After two-course of the chemotherapy, the shoulder pain disappeared. About 12 months after surgery, he had a strong pain in a left leg, and became walking difficulty. Some imaging examinations revealed a progression of the tumor of lumbar spine. Radiotherapy (30 Gy) was demonstrated for the tumor. After the treatment, the leg pain disappeared. We experienced a case of multiple bone metastases successfully treated with chemo-radiotherapy.     

A case of multiple liver metastases from breast cancer successfully treated with intra-arterial administration of paclitaxel]

A 57-year-old woman underwent modified radical mastectomy for left breast cancer (T4bN1M1: stage IV) in September 1999. Four-cycle CAF therapy had been administered as adjuvant therapy, but multiple recurrent tumors in the liver had grown bigger and the tumor marker (CEA) increased in value. Because CAF therapy was not effective, we tried to treat the patient with systemic and intra-arterial chemotherapy using paclitaxel. The side effects of this treatment were mild nausea and appetite loss, which required no treatments. This treatment reduced the multiple liver metastases on an abdominal CT and was thought to produce a partial response (PR). The time to response was the 101st day and PR has been continued.     

A case of colon cancer with multiple liver metastases effectively treated with hepatic arterial infusion followed by systemic chemotherapy

A 63-year-old female was diagnosed as descending colon cancer with severe liver dysfunction caused by multiple liver metastases. Her performance status (PS) was 3 because of liver dysfunction and high fever. Initially, hepatic arterial infusion (HAI) chemotherapy was started to reduce the size of metastatic tumors and to prevent a liver failure. After 10 courses of HAI chemotherapy, she recovered from liver dysfunction, and CapeOX plus bevacizumab regimen was started. A partial response of metastatic liver tumors was observed after 8 cycles of this regimen and metastatic lung tumors were disappeared. The patient was alive after 12 months with PS 0 and CapeOX was continued.     

A case of colon cancer with liver metastases and lymph node metastases successfully treated with surgery followed by CPT-11 and 5-FU chemotherapy

A sixty-year-old woman underwent right hemicolectomy and D2 lymph node dissection. However, a solitary liver metastasis and para-aortic lymph node metastasis were detected three months after surgery. Chemotherapy using CPT-11 and 5-FU (civ) was immediately performed. After one course of this regimen, the chemotherapeutic effect was evaluated as a partial response (PR) in the liver metastasis, and as a complete response (CR) in the para-aortic lymph node. There was a massive therapeutic effect without side effects. Two further courses of chemotherapy were performed after changing from 5-FU to 5'-DFUR. Both regions of metastasis (liver and lymph nodes) continue to exhibit CR and the patient is free from any symptoms almost one year after surgery. The authors believe that this regimen is very effective and will contribute quality of life in advanced colon cancer patients.     

A case of synchronous multiple liver metastases of rectal cancer successfully treated with tegafur/uracil and oral leucovorin chemotherapy

We report a case of synchronous multiple liver metastases of rectal cancer successfully treated with tegafur/uracil(UFT) and oral Leucovorin (LV) chemotherapy. Lower anterior resection was carried out on the rectal cancer patient (an 80-year- old man), who had synchronous multiple liver metastases. The UFT (450 mg/day) and oral LV (75 mg/day) were orally administered for 4 weeks, followed by a 1-week interval after the surgical procedure. After completion of 16 courses, CT scan showed no liver metastases, and the patient was judged to have achieved a complete response (CR). The interval of CR was maintained for sixteen months until the age of 82. This chemotherapy is expected to have a potent therapeutic efficacy for older adult patients with advanced rectal cancer, because it is convenient and causes no severe diverse events.     

A case of rectal cancer with synchronous multiple liver metastases successfully treated with combined chemotherapy of modified FOLFOX6 and bevacizumab

We report here a case of rectal cancer with synchronous multiple liver metastases successfully treated with a combined chemotherapy of modified FOLFOX6 (mFOLFOX6) and bevacizumab. A 49-year-old man was admitted to our hospital due to constipation and anorexia. Abdominal ultrasonography and abdominal computed tomography (CT) scan revealed a rectal tumor (Rs) and abdominal abscess and 11 mm hepatic nodular lesion in S3 and 21 mm and 14 mm hepatic nodular lesions in S4. We diagnosed the patient had penetrated rectal cancer (Rs) and multiple liver metastases. We underwent a low anterior resection with D3 lymphadenectomy for the first time. After the operation, an 8 mm new liver metastasis in S6 appeared. We performed a combined therapy of mFOLFOX6 and bevacizumab 16 days after post operation. After the 8th course, there were a notable reduction in S3 and S4 liver metastases, and S6 liver metastasis was unidentifiable upon imaging. At this point, we underwent liver left lobectomy using the Liver Hanging Maneuver Method. After the second operation, there has been no recurrence and same chemotherapy is being continued.     

A case of colonic cancer with multiple liver metastases effectively treated by intra-arterial chemotherapy

A 36-year-old female underwent sigmoidectomy and insertion of an intra-hepatic arterial catheter for advanced sigmoid cancer with multiple liver metastases. After the operation, intra-hepatic arterial infusion of the chemotherapeutic agents that showed sensitivity in the histoculture drug response assay (HDRA) to the liver metastasis was done for one year. The metastatic liver lesions other than those in the lateral segment which were fed by an accessory artery decreased remarkably. Therefore, we performed lateral segmentectomy. The patient has been doing well without recurrence for 18 months after the first operation. Intra-hepatic arterial infusion chemotherapy for liver metastasis from colorectal cancer can produce an excellent result with the use of sensitive chemotherapeutic agents.     

A case of multiple liver metastases of gastric cancer successfully treated by combination chemotherapy of S-1 and paclitaxel

A 54-year-old man underwent distal gastrectomy for early gastric cancer in September 2002. CT performed 6 months after the operation revealed liver metastases, and they were resected. Hepatic arterial infusion therapy of 5-FU was performed; however, multiple liver metastases appeared in October 2003. We added arterial infusion of CDDP to 5-FU, but liver metastases increased. We then applied a combination chemotherapy of S-1 and paclitaxel from February 2004. Subsequently, stable disease continued, and after 67 courses of S-1 plus paclitaxel, we changed the administration to S-1 alone from August 2009. After that, liver metastases did not increase, so we discontinued chemotherapy on August 2010, followed by observation. Progression of liver metastases has not been to date.