Seven patients with stage IVb advanced gastric cancer who were treated with preoperative chemotherapy

We examined the usefulness of preoperative chemotherapy using 5-FU and low-dose CDDP in patients with stage IVb gastric cancer. Between 1996 and 1998, seven patients with stage IVb gastric cancer who received preoperative chemotherapy achieved complete or partial response. One course of the chemotherapy was as follows: arterial or venous infusion of 5-FU (500 or 250 mg/day on day 1-5) and low-dose CDDP (5-10 mg/day on day 1-5) for three weeks. In addition to preoperative chemotherapy, biological response modifiers such as OK-432 and lentinan were used. We evaluated the response with abdominal or chest CT and tumor markers. Although preoperative chemotherapy did not improve the survival rate significantly, the prognosis of these patients seemed to be relatively good. Only slight side effects were found. These results suggest that preoperative chemotherapy using 5-FU and low-dose CDDP may be useful for patients with stage IVb gastric cancer.     

Effective chemotherapy for small cell carcinoma of the esophagus

This article documents the use of chemotherapy in a case of small cell carcinoma of the esophagus with multiple liver and lymph node metastases. A multi-drug regimen was used and included cis-dichlorodiamine platinum (CDDP), VP-16, vincristine (VCR), adriamycin (ADM), and cyclophosphamide (CPA). After chemotherapy, the esophageal tumor disappeared, and liver masses reduced in number and degenerated. Nine months later, however, the patient died of brain metastases. It was concluded that radiotherapy should be given to the brain for the prophylaxis of tumor relapse.     

Local and systemic treatment in small cell carcinoma of the esophagus

Primary small cell carcinoma of the esophagus is a rare and aggressive disease. We report on our experience with two patients having a small cell cancer of the esophagus, being treated with photodynamic therapy combined with irradiation and induction-chemotherapy as well as a review of literature. Both patients were admitted with severe dysphagia, weight loss and a Karnovsky performance status of 90. Diagnostic work-up revealed tumor-stenosis in the proximal third in one and in the distal third in the other case. Clinical staging showed T4N2M0 and T3N2M0, pure small cell carcinoma. Due to dysphagia and lymph node enlargement, local and systemic therapy were considered as first-line treatment. Restaging after three cycles of induction-chemotherapy revealed partial response in both cases. Esophagectomy as a second-line treatment was considered. However, in the preoperative period, one patient developed motorical aphasia. The CT-scan of the brain showed multiple brain metastases. External beam irradiation and further chemotherapy was initiated. The patient died 12 months after admission. The other patient revealed anatomical inoperability at the staging laparoscopy. External beam irradiation and a second session of PDT was performed. The patient is still alive, 12 months after his first admission. The biological behavior of this aggressive disease and metastases in about 50% of patients at admission, as well as significant dysphagia makes combined systemic and local treatment necessary. Nevertheless, after reviewing the literature, esophagectomy and adjuvant chemotherapy may have an advantage pertaining to survival time when anatomical and functional operability is given.     

A patient with small-cell carcinoma of the esophagus with synchronous liver metastasis surviving 48 months after surgery]

Small-cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent and early systemic metastasis. Recently, several reports have described small-cell carcinoma satisfactorily treated by chemotherapy and radiation therapy combined with surgery. We herein report a patient with small-cell carcinoma of esophagus with synchronous multiple liver metastasis who survived 44 months after surgery. A 70-year-old man was found to have a polypoid lesion at the abdominal esophagus by upper gastrointestinal endoscopy. A biopsy specimen of the lower esophagus demonstrated undifferentiated carcinoma of the esophagus. Ultrasonographic investigation demonstrated solitary SOL in the liver. The patient underwent a total gastrectomy and lower esophagectomy by an abdominal approach. As ultrasonographic evaluation during laparotomy revealed multiple liver metastases, a hepatic artery infusion catheter was inserted into the proper hepatic artery. A pathological study of the resected esophagus and a biopsy specimen of the liver revealed undifferentiated cell carcinoma of the esophagus (small-cell type). During hospitalization, hepatic artery infusion therapy (CDDP 20 mg/4 h and 5-FU 750 mg/5 h) was given for 4 days starting on days 14 and 28. After chemotherapy, liver metastasis could not be detected by ultrasonographic investigation. At the outpatient clinic bi-weekly hepatic artery infusion of 5-FU (1,500 mg/body/5 h) was continued for 30 months. The patient is alive 48 months after surgery without any evidence of recurrence.     

A case of squamous cell carcinoma of esophagus with mediastinal lymph node recurrence after surgical resection treated with systemic chemotherapy and chemoradiotherapy

The patient was a 58-year-old man with a mediastinal lymph node recurrence 26 months after surgical resection of squamous cell carcinoma of esophagus. We started a treatment with systemic chemotherapy (FAP chemotherapy) on the supposition of systemic recurrence. Next, chemoradiotherapy with docetaxel (DOC) was chosen for the expectation of powerful local control. Then bi-weekly DOC chemotherapy was chosen for the third-line therapy at an outpatient clinic. A complete response (CR) was observed after the sixth course and the treatment was finished at the twelfth course. CT showed CR after the treatment for six months. The prognosis of the cases with post-operative recurrences was poor, and its formation of recurrence varied. The strategy of the treatment should be considered a case-by-case.     

TS-1 was prescribed for a patient with stomach cancer with peritoneal dissemination who survived for 3 years and 2 months

A 42-year-old female patient underwent total gastrectomy for gastric cancer (Borrmann's Type 3). Many rice-grain sized peritoneal metastases were observed in the transverse colon and mesenterium. The lesion was diagnosed as stage IV cancer and the degree of radical cure was determined to be C. Chemotherapy with TS-1 was administered postoperatively. In each cycle, the drug was administered at a daily dose of 100 mg for 4 weeks, followed by a drug-free period of 2 weeks. The adverse reactions were mild, and she underwent the 2nd and further courses of therapy on an outpatient basis. Since she had acute cholecystitis during the 12th course, the drug was withdrawn for 2 months. Thereafter, the drug was started again after resolution of the cholecystitis. At present, ie, 3 years and 2 months after the surgery, the patient is receiving the 23rd course of chemotherapy on an outpatient basis, and abdominal CT shows no evidence of increase in the peritoneal metastases, enlargement of the intraperitoneal lymph nodes, or ascites.     

A case of small cell carcinoma of the esophagus

The case of a 51-year-old man, complaining of a sense of pressure on his chest, is reported. Tests led to a diagnosis of a cancer in the midesophagus and a subtotal esophagectomy was performed. The tumor was found to be a protruded type, 8.5 X 7.0 cm in size. A histologic diagnosis revealed it to be a small cell anaplastic carcinoma. The tumor cells were found negative in a Grimelius staining and did not contain hormones such as ACTH. Some cytokeratins, however, were detected by an immunohistochemical examination, Cancer invasion into the adventitia was seen, though no lymph node metastasis or a distant metastasis was shown. Six months after operation, a recurrence in the mediastinum and in the distant lymph nodes was found. Chemotherapy and irradiation were found to be useful, and the postoperative survival period was 25 months.     

A case of small cell carcinoma of the esophagus

A small cell carcinoma of the esophagus is a rare entity; only 101 cases have been reported in the world literature. In a 59-year-old man, complaining of dysphagia, a tumorous lesion was detected in the esophagus at the upper GI series. The histologic diagnosis of biopsy revealed an undifferentiated carcinoma or a malignant lymphoma. Preoperative radiotherapy was carried out, effectively decreasing the large tumorous lesion in size. Thereafter an esophagectomy and an esophagogastric anastomosis were done. The histologic diagnosis of the resected specimen revealed a small cell carcinoma of an intermediate cell type. The tumor cells failed to show cytoplasmic argyrophilia and an ultrastructural examination did not display any cells containing membrane-bound neurosecretory granules.     

局限期小细胞肺癌的放化疗

肺癌是引起肿瘤相关死亡的首要原因之一,其中15%～20%的患者为小细胞肺癌。小细胞肺癌的恶性程度高,易于远处转移,常至骨、肝、脑及肾上腺,并迅速导致患者死亡。目前大约25%～30%的小细胞肺癌患者确诊时尚为局限期,行放疗及化疗的联合治疗是目前此类患者的标准治疗措施。通常所选择的化疗方案为EP或EC,共4个周期,放疗常采取1f/d的胸部放射治疗,范围包括病变区及纵膈,总剂量在50～60Gy之间,并需要早期同步参与化疗。为提高放疗的生物学效应,关于超分割放疗的临床试验正进一步被评价。本文简要的阐述了局限期小细胞肺癌的治疗策略,也会进一步探讨放化疗时序的重要性。     

Three months treatment with chemotherapy and radiotherapy for small cell lung cancer.

Fifty-five patients with inoperable but limited stage small cell carcinoma of the bronchus and a further 15 patients with contra lateral neck nodes, pleural effusions and marrow involvement were entered into the study and treated. The 3 month treatment regimen comprised 3 courses of etoposide with cyclophosphamide at 2.5 gm-2 followed by methotrexate and radiotherapy, no maintenance treatment was given. The complete response rate in the total patient group was 54% and the partial response rate 21%. The median survival was 11 months for the 70 patients, 15 months for the complete responders, and those patients with a bronchoscopically confirmed complete response survived significantly longer. There was no significant difference between the patients with strictly limited stage disease and those in the broader category. Eight patients are tumour free and alive one year or more after the end of treatment. The median followup is 17 months. Twenty-four patients were delayed 1-2 weeks during treatment because of chemotherapy induced toxicity. Six patients died probably of infection associated with leucopaenia. The majority of the patients'' Karnofsky performance improved with the treatment as did their breathlessness assessed on a respiratory score. The short intensive chemotherapy regimen of 3 months produced similar results to those following more prolonged treatment regimens.     

A case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy

We present a case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy. A 73-year-old woman visited our hospital with complaints of neck mass and discomfort during swallowing. Upper gastrointestinal endoscopy revealed a type 3 tumor in the middle portion of the esophagus, which was pathologically diagnosed as small cell carcinoma. A computed tomography showed lymph node swelling from neck to mediastinum. Then she was administered chemotherapy with CDDP plus CPT-11 and radiotherapy. The main tumor and lymph node swelling was remarkably reduced by chemoradiotherapy. The prognosis of small cell carcinoma of the esophagus is extremely poor because it may cause a general metastasis in early stage. This case was for long-term survival with chemoradiotherapy, and we report our case with the literature cited.     

局限期小细胞肺癌局部放疗联合化疗预后影响因素分析

目的:探讨局部放疗联合全身化疗治疗局限期小细胞肺癌(limited-stage small cell lung cancer,LS-SCLC)的预后及相关因素分析。方法:回顾性分析107例LS-SCLC患者临床资料,统计各临床因素及物理参数。采用χ2检验进行近期疗效影响因素分析。采用Kaplan-Meier法计算生存率,Log-rank法进行单因素分析,采用Cox比例风险模型进行多因素分析。结果:107例患者治疗后总有效率(CR+PR)为87.9%(94/107),1年生存率为73.8%,2年为38.8%,3年为27.6%,中位生存期19个月。接受全身化疗患者的有效率为89.9%(89/99),高于未接受化疗的5/8,差异有统计学意义,χ2=5.206,P=0.023。单因素分析结果显示,肿瘤体积≤135.0cm3、治疗后达CR及PR、接受全身化疗和PTVD95>51.0Gy的患者预后较好,P<0.05;多因素分析结果证实,肿瘤体积、化疗、放疗范围、放疗剂量、GTV HI和PTVD95是影响患者预后的独立因素,P<0.05。结论:对接受放化综合治疗的LS-SCLC患者,肿瘤体积较小、接受全身化疗、对累及肿瘤照射同时对原受累区预防照射、放疗剂量>56.0Gy、GTV HI≤1.05和PTV D95>51.0Gy是影响预后的临床和物理因素。     

奥沙利铂在晚期非小细胞肺癌化疗中的应用

奥沙利铂是第3代铂类抗肿瘤药。前期临床研究结果显示，其治疗晚期非小细胞肺癌（NSCLC）有效，耐受性良好，且使用方便，有应用前景，但诸多方面仍须进一步研究。     

局限期小细胞肺癌患者化疗前后记忆力的调查分析

探讨局限期小细胞肺癌(small cell lung cancer, SCLC)患者化疗前后的记忆功能变化,对36例局限期SCLC患者在化疗前、后分别采用韦氏记忆量表(WMS)测评,比较化疗前后记忆力的变化.患者化疗前记忆商数MQ=94.20±9.63,化疗后MQ=92.71±8.20,化疗前后比较差异无统计学意义,t=1.462,P>0.05;在10分测验中,有3个分测验即图片回忆、再认和联想学习的量表分化疗后比化疗前降低(8.58±2.52 vs 9.38±2.37,7.63±2.33 vs 8.45±2.41, 7.57±3.50 vs 8.50±3.31), 差异均有统计学意义,P<0.05.本研究结果提示,化疗对SCLC患者的总体记忆力无显著损害,但化疗可能损害了患者记忆的某些成分如短时记忆.     

Immunologic monitoring of patients with small cell anaplastic carcinoma who are treated with chemotherapy and radiotherapy

From January to October 1978 the diagnosis of small cell anaplastic carcinoma was made in 12 patients. Patients were treated with chemotherapy and radiotherapy and were followed for 13 months. Before treatment lymphocyte stimulation (L.S.) and blood T and B lymphocytes were within normal range. Positive skin tests were observed in patients who had a large weight loss. After treatment, the number of lymphocytes dropped, but the T/B radio did not change. T lymphocyte function was impaired (decrease of LS with phytohemagglutinine but B lymphocyte function was normal (normal LS with Pockeweed Mitogen). The skin tests became negative after radiotherapy or when patients had a loss of body weight of more than 10%. In spite of its imprecision, skin tests appear to be the best to follow immunological Status. More sophisticated tests gave no supplementary information. Immunological status could not be related to prognosis.     

467例Ⅱ期胸段食管鳞癌切除术后患者的生存分析

背景与目的:食管癌是我国常见恶性肿瘤之一,多数患者就诊时已是局部晚期。迄今为止,手术切除仍是其最主要的治疗方法。本研究旨在探讨影响Ⅱ期胸段食管鳞癌术后生存的因素。方法:回顾性分析中山大学肿瘤防治中心1990年1月至1998年12月收治的467例Ⅱ期胸段食管癌患者的临床资料,应用Kaplan-Meier法进行生存分析,组间比较用log-rank检验,多因素分析采用Cox模型。结果:全组总的1、3、5和10年生存率分别为87.1%、54.6%、43.0%和32.3%,ⅡA期和ⅡB期患者的5年生存率分别为51.0%和19.9%。81例(17.3%)术后复发,其中有70例(86.4%)在术后3年内复发。单因素分析表明患者的性别、肿瘤浸润深度、淋巴结转移、病理分期、淋巴结转移区域数、组织分化、切缘阳性和肿瘤复发均为预后影响因素。Cox回归分析显示性别、肿瘤浸润深度、病理分期、淋巴结转移区域数、切缘阳性和肿瘤复发是食管癌预后的独立影响因素。结论:影响Ⅱ期胸段食管癌患者术后生存的独立因素有性别、肿瘤浸润深度、病理分期、淋巴结转移区域数、切缘阳性和肿瘤复发。外科手术仍是ⅡA期患者的主要治疗方法,但对于ⅡB期患者应采取以手术为主的综合治疗。     

联合化疗加放射治疗局限期小细胞肺癌

回顾性分析局限期小细胞肺癌６０例，ＡＤＭ、ＤＤＰ、ＶＰ－１６、ＣＴＸ联合化疗加胸部（６０）Ｃｏ放疗，ＤＴ５０～６０ＧＹ／６～７周。放疗结束后２个月左右复查，将获得ＣＲ的４９例，采用随机分组分为预防性全脑照射组（ＰＣＩ）２５例及对照组２４例。结果为生存时间与ＫＰＳ计分和ＣＥＡ值明显相关，而与是否行脑预防照射无明显差异。     

食管小细胞癌的临床分析

背景与目的：世界范围内食管癌每年发病约40万例，其中食管小细胞癌（small cell esophageal carcinoma SCEC）发病率较低，国内外治疗方法尚未达成一致，我们对国内21家医院1998-2005年公开发表文献中的676例SCEC和我院收治67例SCEC（共743例）进行回顾性分析，探讨SCEC的临床特点、治疗方法及相应的预后。方法：共收集在不同级别的21家医院诊治的共743例SCEC患者的临床资料，收集年度从1961-2003年，最长39年，最短7年，平均16年：743例SCEC约占同期食管恶性肿瘤中的1．38％，平均发病年龄56．8岁（范围51～66岁），其中男性511例，女性232例，男女之比为2．2：1：743例SCEC发病部位：颈段2例，胸上段68例，胸中段420例，胸下段252例，全食管1例；病变长度平均值5．7cm病变范围1．5～22cm。在阐明病理分期的文献中，Ⅰ期17例，Ⅱ期199例，Ⅲ期204例，Ⅳ期37例。在阐明治疗方法的文献中，单纯手术88例，单纯化疗24例，单纯放射治疗23例，手术＋化疗135例，手术＋放疗26例，放射治疗＋化疗54例，手术＋化疗＋放射治疗37例。结果：单纯手术、放疗、化疗的中位生存期分别为10．8、6．2、6．6个月，而放疗＋化疗、手术＋化疗、手术＋放疗和手术＋放疗＋化疗的中位生存期分别为12．3、16．1、14．7、16．2个月。743例SCEC患者总1、2、3、4、5年平均生存率分别为56．4％、27％、19．3％、11．1ck、9．7％。结论：对于食管小细胞未分化癌，有计划的综合治疗，尤其是早期食管小细胞未分化癌的手术与化疗对患者的治疗更有意义，可以提高远期疗效，延长患者的生存期。     

A cytologic study on small cell carcinoma of the esophagus.

The cytologic picture of small cell carcinoma primarily arising from the esophagus was studied with 7 cases which were confirmed by histologic examination. Cytomorphologic characteristics of small cell carcinoma of the esophagus are as follows: the arrangement of groups of tumor cells is irregular and overlapping with indistinct cell boundaries. The cytoplasm is small, or sometimes absent. The nuclei are round, oval or occasionally spindle shaped. Nuclear borders are thin. The chromatin of finely granular pattern has increased and is evenly distributed.