A case of primary small intestinal cancer accompanied by virchow lymph node metastasis undergoing TS-1 treatment

A 72-year-old female was admitted to our hospital with the complaint of left neck lymph node swelling. Abdominal computed tomography (CT) revealed wall thickening of the small intestine and multiple lymph node metastases. Barium meal study of the small intestine showed circular stenosis. The patient was operated on under a diagnosis of tumor of the small intestine and left neck lymph node swelling. Needle biopsy of the left neck lymph node and partial resection of the small intestine was done without regional lymph node dissection because of Virchow lymph node metastasis. On the resected material a 5 x 4 cm type 2 tumor was identified. Pathological findings included poorly-differentiated adenocarcinoma, si (bladder), n 4, P 0, ly 3, v 3, H 0, M(-), Stage IV. The patient received the chemotherapy with TS-1. TS-1(80 mg/body/day) orally administered for 4 weeks followed by a drug-free 2-week period as one course. CT revealed that the metastatic lesion had shrunk markedly after the second course. A complete response (CR) was observed after one year. There were no drug side effects. At present, 3 years and 9 months after the operation, cervical and abdominal CT reveals no evidence of enlargement of the cervical and intraperitoneal lymph nodes.     

A case of rectal cancer with lymph node metastasis (N4) successfully treated with low-dose cisplatin and UFT]

A 65-year-old man was admitted to our hospital due to the swelling of bilateral inguinal lymph nodes and anal discomfort. Sigmoidoscopy revealed a type-1 tumor of the lower rectum which was histologically diagnosed as a poorly-differentiated adenocarcinoma, and inguinal lymph node biopsy showed metastatic adenocarcinoma. An abdominal CT scan revealed swelling of the paraaortic lymph nodes. After a full explanation of the treatment options, the patient chose chemotherapy. Treatment by intravenous infusion of 7.5 mg/body/day of cisplatin for 5 days a week and oral administration of 600 mg/day of UFT was carried out. After 4 weeks of treatment, the primary tumor and swelling of the paraaortic lymph nodes had disappeared, and there was a 61% reduction in the inguinal lymph nodes. Four months later, the primary lesion recurred but vanished again following the same treatment regimen for 6 weeks. The patient has been in good health for over 9 months with no adverse effects from the chemotherapy.     

A case of type 4 gastric cancer with positive peritoneal lavage cytology, which relapsed at the peritoneum at the time of seven years and eight months after resection

A 55-year-old woman was admitted to our hospital with a complaint of appetite loss and body weight loss. Upper digestive endoscopy showed a giant fold at the greater curvature stomach and diffused edematous gastric mucosa. Abdominal contrast CT demonstrated a significant thickening of the gastric wall and a large number of lymph node swelling. A clinical finding was Stage IIIB (T3N2M0) Type 4 gastric cancer of poorly differentiated adenocarcinoma. Total gastrectomy, splenectomy and D2 lymph node dissection were performed. Although there was no peritoneal dissemination, peritoneal lavage cytology was positive. After the operation, S-1 alone chemotherapy was administered for four years. No recurrence had occurred for about seven years and eight months after resection. However, the patient was pointed out the signs of recurrence (ascites and induration) by CT. Now, S-1 alone chemotherapy was performed again, and the patient has been in good health.     

A case of advanced esophageal cancer with extensive lymph node metastases successfully treated with multimodal therapy

Advanced esophageal cancer patients with extensive lymph node metastases show extremely poor prognosis and the long-term outcome is poorer with the involvement of more lymph nodes. We report here a long-surviving case of advanced esophageal cancer with histologically 34 lymph node metastases, in which surgical resection with three-field lymphadenectomy followed by adjuvant chemotherapy and radiotherapy was performed. A 53-year-old male was diagnosed as advanced middle esophageal cancer with multiple regional lymph node metastases such as paraesophageal, pretracheal, tracheobronchial and bifurcational lymph nodes and three intramural metastatic lesions. Subtotal esophagectomy with three-field lymphadenectomy was performed for the tumor. Histopathologically, the tumor was poorly differentiated squamous cell carcinoma and 34 lymph nodes including ligamentum arteriosum lymph nodes and pretracheal lymph nodes were proved to be metastatic. Numerous tumor cells were found in the lymphatic vessels near the metastatic lymph nodes. Chemotherapy [3000 mg of 5-fluorouracil (5-FU), 50 mg of cisplatin (CDDP) and 30 mg of methotrexate (MTX)] was administered in two courses, followed by radiation therapy (field size 21 x 20 cm in mediastinum, 10 MV X-rays, 2 Gy/fr, 5 fr/week, total 46 Gy). Subsequently, 1000 mg of 5-FU and 200 mg of CDDP were administered every 3-4 months without any significant toxicities. The patient has been alive and well without recurrence for 5 years following operation. For treatment of advanced esophageal cancer with extensive lymph node metastases, a wide resection of the tumor and regional lymph nodes should be performed, followed by adjuvant chemotherapy and radiotherapy.     

A case of advanced gastric cancer patient who died from meningitis carcinomatosa after S-1 + CDDP therapy with good response

A 68-year-old male who had undergone a distal gastrectomy for gastric cancer in 1996 visited our hospital. Gastroscopy revealed a type 2 tumor at upper corpus, and its biopsy showed poorly differentiated adenocarcinoma. Because enhanced CT showed lymph node swelling at para aorta, S-1 (100 mg/day) was administered for 14 days and CDDP (20 mg/day) was administered for 4 days as 1 course. After 2 courses, the main tumor and lymph node swelling reduced evidently. A total gastrectomy was performed and the pathology revealed no cancer cells in the stomach and dissected lymph nodes. Two months after the operation, speech disturbance and numbness of the left hand appeared. CT showed 3 metastatic brain tumors, and radiation therapy was administered. Four months after the operation, headache appeared and cerebrospinal fluid examination showed adenocarcinoma cells. Although MTX (10 mg) was administered intrathecally, he was died 5 months after the operation.     

Efficacy of chemotherapy combined with dissection of para-aortic lymph node metastasis following gastric cancer surgery -- case report

A 64-year-old man visited our hospital complaining of epigastric pain. An upper gastrointestinal endoscopy revealed a type 2 gastric cancer at the lower portion of the lesser curvature of the stomach. We performed a distal gastrectomy with D2 dissection. The histopathological diagnosis was well-differentiated tubular adenocarcinoma, mp, ly2, v0, n2(+), No. 11p(1/ 1), Stage III a.We used postoperative chemotherapy with a combination of S-1(80 mg/body)and low-dose cisplatin(10mg/ body × 10 days). After 1 course, we continued only S-1(80 mg/body)for 3 weeks followed by a 2-week interval. About 1 year after the operation, the CEA value was abnormally high. An abdominal CT scan showed a marked swelling of the paraaortic lymph node. The patient was then treated with the same protocol of S-1 and cisplatin again, but the CEA value did not decrease; therefore, a para-aortic lymph node dissection(No. 16a2b1 latero)was performed. Although the CEA value had decreased to normal, a few months later it was high again, and so we increased the S-1 dosage from 80 mg/body to 100mg/ body. But 6 months after the first para-aortic lymph node dissection, positron emission tomography(PET)revealed a swelling of paraaortic lymph node below the first recurrence site again. We changed the postoperative chemotherapy from S-1 and cisplatin to S-1(100mg/body)and irinotecan(80 mg/m2 day 1, 8). Since the CEA value was not decreased, we performed a second para-aortic lymph node dissection(No. 16b1b2 latero)13 months after the first dissection. The patient is presently alive with no signs of recurrence after over 1. 5 years. Para-aortic lymph node dissection combined with postoperative chemotherapy appeared to be effective for para-aortic lymph node metastasis in this case.     

A case report of primary hepatic carcinoid with lymph node metastasis--treatment of hepatic arterial infusion to post-reoperative liver and radiation to metastasis of para-aortic lymph nodes

We report a case of primary liver carcinoid. A 50-year-old woman had undergone left nephrectomy six years earlier for renal cell carcinoma. She developed abdominal pain. CT scans showed a low-density area in the lateral segment of the liver and lymph node swelling to the left of the abdominal aorta. Angiography showed a hypovascular tumor. After lateral segmentectomy and examination of the gastrointestinal tract, we diagnosed primary liver carcinoid. Unfortunately, the tumor recurred at multiple sites in the residual liver about 9 months after the first operation. She underwent further liver resection and microwave coagulation therapy. At that time, lymph node biopsy confirmed metastatic carcinoid. We began hepatic arterial chemotherapy for the residual liver and radiation therapy for the para-aortic lymph nodes (total 45 Gy). During chemotherapy, no recurrence was seen. At 11 months after reoperation, however, multiple liver metastases occurred with severe liver dysfunction and jaundice. She died about 24 months after the first liver resection.     

A case of gastric cancer with abdominal paraaortic lymph node metastases responding to TS-1 plus CDDP neoadjuvant chemotherapy

A 62-year-old woman was admitted because of epigastralgia and tarry stool. An endoscopic examination revealed type 3 cancer in the lower body of the stomach, and abdominal CT scan demonstrated enlarged abdominal paraaortic lymph nodes. The preoperative diagnosis was cStage IV gastric cancer (cT3, cN3, cH0, cP0, cM0). Since a curative operation was deemed impossible, we started neoadjuvant chemotherapy using TS1 plus cisplatin (CDDP) for downstaging. TS-1 (100 mg/day) was orally administered for 3 weeks, and CDDP (90 mg/body) was administered intravenously on day 8. Appetite loss of grade 3 and leucopenia of grade 1 were observed. After two courses of chemotherapy, the primary lesion was reduced in size, and the paraaortic lymph nodes disappeared on abdominal CT scan. The serum tumor marker became normal. Subsequently, she underwent curative total gastrectomy with splenectomy and lymph node dissection. Histological examination of the primary lesion revealed marked fibrosis and a small amount of residual cancer cells. The histological changes by neoadjuvant chemotherapy were judged to be grade 2 for the main tumor. It is suggested that neoadjuvant chemotherapy using TS-1 plus CDDP is effective for advanced gastric cancer with massive lymph node metastases.     

A case report--The marked response to gemcitabine combined with irinotecan and low-dose cisplatin chemotherapy for advanced gastric cancer with multiple liver metastases

A 69-year-old man with no sign of symptoms was admitted to our hospital for further examination and treatment of gastric cancer. Endoscopy revealed a Borrmann 3-type tumor in the cardia of the stomach. CT of the abdomen demonstrated a marked thickening of the stomach wall near the esophago-gastric junction, multiple liver metastases in bilateral liver lobes, and regional lymph node swelling around the cardia of the stomach. He consented and received systemic chemotherapy consisting of 0.5 h infusion of cisplatin (25 mg/body) followed by 0.5 h infusion of gemcitabine (800 mg/body) and 2.5 h infusion of irinotecan (60 mg/body) every 14 days as described below. Only the initial 1 course was administered with 5-FU (500 mg/body) as an inpatient, and further courses were performed as an outpatient with no severe adverse events. His tumors responded immediately to the chemotherapy, and restaging abdominal CT after 4-cycles of chemotherapy showed almost complete regression of liver metastases, and partial response to lymphadenopathy. The patient currently undergoes regular chemotherapy and remains in remission more than 6 months after the diagnosis of unresectable gastric cancer with liver metastases. It may be possible that the current chemotherapy will be neoadjuvant chemotherapy, and curative surgical resection can be performed.     

A case report of primary duodenal adenocarcinoma responding to chemotherapy with S-1 and irinotecan

A 5 3-year-old woman was admitted to our hospital because of vomiting. CT scan and gastroduodenoscopy showed severe stenosis of the duodenal 3rd portion. There was no evidence of malignancy. We diagnosed a stricture due to a duodenal ulcer and laparotomy was performed. By means of biopsy of No.14d lymph node in the operation, adenocarcinoma of the duodenum was pointed out and we performed a pancreatoduodenectomy. Although adjuvant chemotherapy with S-1/paclitaxel (S-1 80 mg/body, po, day 1-14 and paclitaxel 120 mg/body iv day 1, 8)was administered after operation, the patient's serum CEA was elevated and metastic lymph nodes around the supra mesenteric artery were pointed out. The patient was started on combined chemotherapy with S-1/CPT-11(S-1 80 mg/body, po, day 1-14 and CPT-11 120 mg/body iv day 1), serum CEA levels returned to normal range, and marked reduction of lymph node size was observed on CT. The patient is still alive and free of disease three years after the operation. S-1/CPT-11 could therefore be a treatment option for patients with duodenal carcinoma.     

A case of gastric cancer with paraaortic lymph node metastasis responding to TS-1/CDDP combination therapy

A 53-year-old man had consulted another physician regarding his epigastralgia and anorexia. Since gastric cancer was detected, he was referred to our department. An upper gastrointestinal endoscopy revealed a type-2 gastric cancer at the upper portion of the lesser curvature of the stomach, and an abdominal CT scan showed marked swelling of periaortic lymph nodes. Since a radical resection appeared impossible, we used preoperative chemotherapy with a combination of TS-1 and CDDP. The patient was administered TS-1 for 3 weeks at 120 mg/ day, received an intravenous drip infusion of 90 mg/body of CDDP on day 8, and then discontinued chemotherapy for 2 weeks, which was regarded as one course. After 2 courses of the chemotherapy, an upper gastrointestinal endoscopy showed that the primary tumor was reduced in size, the periphery of the tumor almost flattened, and an abdominal CT scan confirmed the loss of swelling in the periaortic lymph nodes. The responsive rate was evaluated as PR. Since a radical resection was considered possible, we performed a total gastrectomy with complete D3 extirpation combined with a splenectomy. Histological efficacy was evaluated as grade 2 in primary cancer, and grade 3 in lymph nodes. Regrettably, the patient died one year and 7 months postoperatively. However, we consider the TS-1 and CDDP in combination useful as preoperative chemotherapy for advanced gastric cancer with periaortic lymph node involvement.     

A case report--TS-1/CDDP combined chemotherapy found effective for metastatic recurrence after operation for colon cancer

A 68-year-old male with a history of gastric resection for gastric cancer underwent resection of the sigmoid colon for a sigmoid colon cancer in February, 2000. The cancer was classified as stage III b. After operation, l-LV + 5-FU therapy was administered, but metastases to the abdominal wall, right inguinal lymph node and spleen developed in succession, and resection was repeated. In October 2001, 1 year and 8 months after sigmoidectomy, however, multiple metastasis to the intraperitoneal lymph node had developed. As surgery was not indicated, TS-1/CDDP combined chemotherapy was started. TS-1 80 mg/day was administered for 4 weeks, the drug was withdrawn for 2 weeks and CDDP 80 mg was injected by intravenous drip at the 8th day of TS-1 administration, which was used as one course. From the second course after inception of the administration, CA19-9 decreased, and after the third course the upper intraperitoneal metastatic lesion disappeared on CT. CR has been continued for 4 months up to the present. Our results suggest a possibility that this therapy is effective not only for gastric cancer but also for colon cancer. This therapy can be administered at home. It is considered to be a useful therapy from the viewpoint of QOL as well. The high DPD activity of the tumor may have been one reason this treatment was effective. This case also seems significant from the viewpoint of attaining individualization of the drug selection in chemotherapy.     

A case of gastric cancer with paraaortic lymph node metastasis responding to TS-1/CDDP as neoadjuvant chemotherapy

A 64-year-old male visited our hospital with complaints of epigastric pain. Computed tomography (CT) showed gastric cancer with extensive paraaortic lymph node metastasis. We decided that a curative operation was impossible, and administered the following chemotherapy. After 120 mg/day of TS-1 was orally administered for 3 weeks followed by 2 drug-free weeks with 90 mg of CDDP was administered intravenously on day 8, CT showed a 90.6% reduction in the paraaortic lymph node metastasis. No serious adverse reaction was observed. After 2 courses of this chemotherapy, surgery was performed after informed consent was obtained from the patient. Histrogical result showed PR. The patient is now healthy and no sign of recurrence has been observed. TS-1/CDDP therapy is useful for advanced gastric cancer.     

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 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.     

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 advanced gastric cancer with giant lymph node metastasis responding to S-1/CDDP neoadjuvant chemotherapy

The patient was a 66-year-old man with advanced gastric cancer and bulky lymph node metastases. Since a radical resection appeared impossible, we tried neoadjuvant chemotherapy(NAC)with S-1/CDDP, expecting down staging of the tumor. S-1(120 mg/body)was orally administered for 21 days and CDDP(40 mg/body)was administered by intravenous drip on day 8, 15 and 22. Partial response(PR)was obtained after 2 courses, and distal gastrectomy with D2 lymph node dissection was performed. The histological diagnosis revealed complete disappearance of cancer cells in stomach and a few regional lymph node metastasis(3/30). The patient was administered S-1 for one year after operation, and he is well without recurrence at one year and four months postoperatively. We considered the S-1 and CDDP in combination useful as preoperative chemotherapy for advanced gastric cancer.     

A case of advanced gastric cancer with long-term survival treated by S-1/paclitaxel as neo-adjuvant chemotherapy

A 61-year-old male presented with advanced gastric cancer with lymph node swelling around the root of superior mesenteric artery lymph nodes and invasion of pancreas. We thought a complete resection would be difficult, so he was given neo-adjuvant chemotherapy in combination with S-11 20 mg/body/day (3 weeks administration and 1 week rest) and paclitaxel (PTX) 80 mg/m(2) (day 1, 8, 15). After 2 courses of this neo-adjuvant chemotherapy, the tumor and lymph node swelling decreased in size. Total gastrectomy, Roux-en Y and D1+beta type nodal dissection were performed. Intraoperative findings included tumor exposure on the serous membrane and enlarged lymph nodes on the lesser curvature; however, no marked pancreatic invasion was observed and the lymph nodes had become scarred. The changes with neo-adjuvant chemotherapy were judged to be grade 2. After the operation, there was no side effect, though he received the same chemotherapy as an outpatient in three courses. Five years passed from the first medical examination. The patient remains alive, and the neo-adjuvant chemotherapy proved effective.     

A case of a patient with stage IVa esophageal cancer surviving over 4 years by combination chemotherapy with docetaxel,5 -FU and cisplatin, without operation

A male patient in his 50s was found to have lower thoracic advanced esophageal squamous cell carcinoma by upper gastrointestinal endoscopy with the chief complaint of dysphagia in July 2006. CT revealed supraclavicular lymph node metastasis, and he was diagnosed as clinical stage IVa. He underwent two courses of combination chemotherapy with docetaxel, 5-FU and cisplatin(DFP therapy: docetaxel at 25mg/m / / 2 on day 1, 5-FU at 370 mg/m2 on days 1-5, and cisplatin at 7 mg/m2 on days 1-5 were repeated weekly for 4 weeks). The primary tumor disappeared and the lymph node was reduced as observed by upper gastrointestinal endoscopy and CT. After 2 courses of DFP therapy, PET-CT revealed that the primary tumor and lymph node had no new accumulation. Because he refused both operation and chemoradiotherapy, the patient underwent oral chemotherapy. In January 2010, PET-CT and upper gastrointestinal endoscopy revealed that the primary tumor relapsed. DFP therapy was performed and was effective once again. He has survived for over 4 years and 4 months without operation.     

A case of gastric adenosquamous carcinoma with abdominal paraaortic lymph node metastases successfully treated by TS-1 plus CDDP neoadjuvant chemotherapy

A 62-year-old woman was admitted for anemia. An endoscopic examination revealed type 2 cancer from the upper body of the stomach to the antrum, and abdominal CT scan demonstrated enlarged abdominal paraaortic lymph nodes. The preoperative diagnosis was cStage IV gastric cancer (cT 3, cN 3, cH 0, cP 0, cM 0). Since a curative operation was deemed impossible, we conducted neoadjuvant chemotherapy using TS-1 plus cisplatin (CDDP) for downstaging. TS-1( 100 mg/day) was orally administered for 3 weeks,and CDDP (60 mg/m2) was given intravenously on day 8. Appetite loss of grade 3 and erythropenia of grade 1 were observed. After two courses of chemotherapy the primary lesion and the paraaortic lymph nodes were significantly reduced in size. She was judged as clinical PR, followed by distal gastrectomy and lymph node dissection, resulting in curability A. Histopathologically, the tumor was diagnosed as adenosquamous carcinoma of the stomach with lymph node metastasis at only No.3. This case suggests that neoadjuvant chemotherapy using TS-1 plus CDDP is effective for advanced gastric adenosquamous carcinoma with massive lymph node metastases.