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 advanced gastric cancer showing a complete histological response after S-1/CDDP neoadjuvant chemotherapy

We experienced a case of advanced gastric cancer treated by curative operation after neoadjuvant chemotherapy with S-1/ CDDP. Gastric endoscopy was carried out on a 76-year-old man with epigastric discomfort and revealed a type 1 lesion in his stomach. Papillary adenocarcinoma was pathologically shown by endoscopic biopsy. The patient was initially treated by two courses of neoadjuvant chemotherapy with S-1/CDDP due to the large lymph node metastases around the lesser curvature of the stomach and celiac axis. Completion of chemotherapy resulted in a marked shrinkage of the primary lesion and a reduction of lymph node metastases. Later, total gastrectomy, splenectomy and D2 lymph node dissection were performed. Histopathological examination revealed no cancer cells in either the primary lesion of the stomach or dissected lymph nodes, confirming a pathologically complete response.     

A case of S-1/CDDP chemotherapy for inoperable advanced gastric cancer which led to gastrectomy with histological complete response

As the treatment for inoperable advanced gastric cancer, S-1/CDDP combination therapy (SP chemotherapy) has become a standard treatment. In our hospital, a second course of chemotherapy was performed on an outpatient basis in order to improve a traditional QOL. In this case, it showed remarkable effects in 15 months after starting chemotherapy. Then gastrectomy was performed. Histological findings of the resected specimens confirmed pCR in all tumors. We report on progress of this case and explain about the ingenuity of SP chemotherapy.     

A complete response after neoadjuvant chemotherapy for advanced gastric cancer with esophageal invasion

The patient was a 65-year-old woman with type 3 gastric cancer (por) in the upper third of the stomach invading esophagus. Because of No. 16 lymph node swelling on abdominal CT examination, she was treated with FLP (5-fluorouracil + Leucovorin + cisplatin) as a neoadjuvant chemotherapy (NAC). The activities of thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) in the primary tumors upon endoscopic examination were 2.72 pmol/g tissue and 129.1 pmol/mg/min, respectively. After the second course, we carried out lower esophagectomy and spleno-total gastrectomy with D3 including the No. 16 lymph nodes. Histopathological examination of resected specimens showed dense fibrosis and xanthogranulomatous inflammation with foamy cells and giant cells. No residual carcinoma was seen (complete response). The patient is still alive with no sign of recurrence 1 year after surgery. NAC by combination of FLP is thought to be effective for the treatment of highly advanced gastric cancer, especially in cases with locally advanced disease and lymph node metastasis such as the present. Although no relations were seen between NAC effects and TS, DPD activities and TSIR in primary tumors in 12 gastric cancer patients, the survival rate of a low DPD activity group was significantly better than a high group in 106 cases undergoing adjuvant chemotherapy including 5-FU after surgery.     

A case report of complete response by TS-1 and paclitaxel combination chemotherapy for advanced gastric cancer

We report a case in which combination chemotherapy of TS-1 and paclitaxel was effective for gastric cancer with malignant ascites, metastatic ovarian cancer and hydronephrosis. Judging from the above issue, the stage was IV and the type was Borrmann 4. The chemotherapy schedule was adjusted at the patient' s request without hindering her activities of daily living. The patient was a 53-year-old woman who suffered from gastric cancer as having malignant ascites and metastatic ovarian tumor. As an outpatient, she was treated with combination chemotherapy of TS-1 and paclitaxel for 2 cycles. The ascites had remarkably disappeared after 2 cycles. The adverse event was alopecia (grade 2), but she could continue the chemotherapy as an outpatient treatment. After completing 5 cycles of chemotherapy, we recognized the primary tumor as an endoscopic complete response.     

A case of advanced gastric cancer responding to paclitaxel/CDDP neoadjuvant chemotherapy leading to pathologically complete response

A 74-year-old male with advanced gastric cancer(cT3N1M0H0P0CY0, cStage III A)was treated with paclitaxel/ CDDP as neoadjuvant chemotherapy. Paclitaxel (80 mg/m(2)) and CDDP (25 mg/m(2)) were administered on days 1, 8 and 15 as one cycle. After the second course, a significant tumor reduction was obtained. Total gastrectomy, splenectomy, and D2 type nodal dissection were performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and all of the lymph nodes, a so-called pathologically complete response. The patient has now been in good health without any recurrence for 9 months after surgery. This case suggests that neoadjuvant chemotherapy with paclitaxel/CDDP is a potential regimen for advanced gastric cancer.     

A case report of advanced rectal cancer showing a pathological complete response by neo-adjuvant FOLFOX chemotherapy

A 72-year-old man was admitted with melena. Colonoscopy detected an advanced rectal cancer. CT scan revealed the prostate was invaded. We decided to start a systemic chemotherapy (mFOLFOX6). The chemotherapy (mFOLFOX6) was performed six times. After the treatment with chemotherapy, the tumor shrunk. Abdominoperineal resection of rectum was done, and a final pathological examination revealed a complete response of the main tumor.     

A case of complete response after neoadjuvant chemotherapy for advanced esophageal cancer with low-dose FP therapy

The patient was a 58-year-old man complaining of vomit and body-weight loss of 10 kg with advanced lower thoraco-abdominal esophageal cancer, which was 9 cm in length and with a maximum diameter of 5.5 cm on thoracic CT examination. Moderately differentiated squamous cell carcinoma diagnosed by pre-operative endoscopic biopsy. Low-dose FP therapy (continuous 5-FU div of 500 mg/day with intermittent CDDP div of 5 mg/day) was performed during 4 weeks as neoadjuvant chemotherapy. The side effect was little, and the tumor size was remarkably reduced. A histological complete response was diagnosed with no carcinoma cells evident in the resected specimen. The patient is alive and healthy with no relapse of the carcinoma 30 months after operation. We are first planning neoadjuvant chemotherapy, and then considering the additional radiotherapy after estimating the effect of chemotherapy. Low-dose FP therapy with low-dose cisplatin as a modulator does not show much side effect and is useful for esophageal cancer. We consider that the chemotherapy is more effective preoperatively than postoperatively because it preserves the feeding vessels for transporting the medicine to the focus of the disease.     

A case of stage IV advanced gastric cancer responding to TS-1/CDDP neoadjuvant chemotherapy which leads to a pathological complete response

A 72-year-old male with advanced gastric cancer (cT3N2M0H0P0CY1, cStage IV) was treated with TS-1/CDDP as neoadjuvant chemotherapy. TS-1 (60 mg/m(2)/day) was orally administered for 3 weeks followed by 2 drug free weeks as a course, and CDDP (60 mg/m(2)) was administered by intravenous drip on day 8. After the fourth course,a significant tumor reduction was obtained. Total gastrectomy, splenectomy, and D 2 type nodal dissection were performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and all of the lymph nodes, which is a so-called pathological complete response. The patient has now been in good health without a recurrence for 24 months after surgery. This case suggests that neoadjuvant chemotherapy with TS-1/CDDP is a potential regimen for advanced gastric cancer.     

A case report of advanced cardiac cancer showing a complete response to TS-1 as neoadjuvant chemotherapy

A 69-year-old female had complaints of vomiting, appetite loss and feeling of pharyngeal obstruction. She was diagnosed with a 3'-shaped advanced cardiac cancer with esophageal invasion. A biopsy revealed poorly differentiated adenocarcinoma. The tumor was T3 (SE) N2, Stage IIIB indicating a poor prognosis. After informed consent, TS-1 was administrated as preoperative chemotherapy. Chemotherapy with TS-1 was very effective, and the tumor noticeably decreased. Next, total gastrectomy was performed. Histopathological findings revealed that the primary tumor and lymph node had become scarred and fibrous, indicating a complete response (Grade 3). In the future, TS-1 can be expected to display efficacy in neoadjuvant chemotherapy for patients with advanced gastric cancer who have poor prognoses.     

A case of advanced gastric cancer which disappeared histopathologically after short-time chemotherapy

Poorly differentiated adenocarcinoma was confirmed by endoscopic biopsy. Anticancer therapy was performed preoperatively, but was discontinued after the second intravenous administration of MFC because she developed nausea, vomiting and pancytopenia. On Jan. 18, 1980, gastrectomy with extended lymph node dissection was performed. Histologically, the excised stomach showed non-specific active ulcer (ul-IV) at the side of the tumor without evidence of residual cancer cells. The cause for the disappearance of the advanced carcinoma remains unknown. Although the dosage of the anticancer chemotherapy was quite small, this treatment may have promoted the regression of the tumor in conjunction with activated antitumor immunity of the host.     

Histological complete response in a case of advanced gastric cancer treated by chemotherapy with S-1 plus low-dose cisplatin and radiation

A 76-year-old male was diagnosed with stage IV (cT4, cN2, cP0, cH0, cM0) gastric carcinoma with a type 3 tumor in the cardia with lymph node metastases, determined by gastrofiberscope and abdominal computed tomography (CT). The patient was treated with chemotherapy consisting of S-1 and low-dose cisplatin (CDDP) during the first cycle (3 weeks). S-1 was orally administered at a dose of 100 mg/day (60 mg/m(2)/day) on days 1-21. CDDP was infused at a dose of 10 mg/day (6 mg/m(2)/day) on days 1-5, 8-12 and 15-19. After this cycle, the clinical response was evaluated as no change (NC). In the second cycle, radiation therapy (2 Gy/day for 5 days/week) was initiated along with the chemotherapy. The CDDP dose was decreased to 7.5 mg/day because of the grade 3 thrombocytopenia and grade 2 leukocytopenia that occurred during the first cycle. The second cycle was stopped at a total radiation dose of 48 Gy due to grade 3 thrombocytopenia and grade 2 leukocytopenia. Examination after this treatment showed remarkable reduction of tumor volume in the primary lesion and lymph nodes, which was defined as a partial response (PR). The patient then underwent total gastrectomy with D1 lymph node dissection. The postoperative course was uneventful without surgical complications. At this time, no gastric cancer cells were detected in the resected specimen, including the primary lesion and lymph nodes, confirming a pathological complete response (CR grade 3). Thus, the chemo-radiation treatment regimen described here may be a potent tool to control advanced gastric carcinoma.     

A case of advanced esophageal cancer showing a long-term complete response with chemotherapy with nedaplatin alone

We describe a case of advanced esophageal cancer treated successfully by chemotherapy with nedaplatin alone. A 60-year-old male with type 2 advanced esophageal cancer, which was located in the upper part of the esophagus and had invaded adjacent organs, was treated with nedaplatin 150 mg/body (100 mg/m2) given intravenously every 4 weeks from January 6, 1991. He achieved a partial response (PR) and was discharged in March 1991. Subsequently, he received nedaplatin 75 mg/body in an out-patient setting almost every month until August 1992. Toxicities were tolerable and included mild thrombocytopenia and nausea/vomiting. From serial evaluation in October 1993, the esophageal tumor was not observed. After 7 years since initial chemotherapy was administered, he still survives without the disease.     

Duration of complete response to chemotherapy in advanced breast cancer

Twenty-seven patients with advanced breast cancer with complete response (CR) to chemotherapy have been analysed and observed for up to 8 years. Median time to attainment of CR was 8.1 months (range, 1–19.5) and median duration of CR was 27.5 months (1–97 + months). Most (16) recurrences occurred in the first 2 years. In 12 patients (63%) relapse was at sites initially involved. No clear relationship between the duration of CR and a variety of prognostic factors or the dose of cytotoxic drugs given was found, although there was a tendency to longer duration of CR when fewer sites were involved. The presence of visceral disease did not preclude a prolonged CR. It seems that despite some patients surviving many years, relapse is inevitable and cure of the disease is unlikely with presently available chemotherapy.     

A case of advanced gastric cancer responding to S-1 therapy, leading to pathologically complete response

Our patient was a 74-year-old man with abdominal pain. A gastrofiberscope revealed type 2 advanced gastric cancer. An abdominal computed tomography(CT)demonstrated liver and lymph node metastases. The No. 8a lymph node was 7 cm in diameter, and it invaded the head of the pancreas. Since a curative operation was deemed impossible, S-1 was administered orally for 28 consecutive days with a 14-day interval. After 2 courses of monotherapy, CT showed that metastatic lymph nodes were reduced and that liver metastases had mostly disappeared. After 8 courses, the primary lesion was scarred and the lymph node metastases were remarkably reduced. Therefore, we conducted distal gastrectomy and lymph node resection (D2). Histological findings revealed that there were no cancer cells in either the primary tumor or the lymph nodes, meaning that the resected lesions were Grade 3 in pathology. This rare case showed that S-1 monotherapy enabled curative surgery of unresectable gastric cancer with pathological CR.     

Histological complete response in advanced gastric cancer after 2 weeks of S-1 administration as neoadjuvant chemotherapy

Single-agent or combined chemotherapy with the novel oral fluoropyrimidine anticancer drug, S-1 (TS-1), has been reported to be useful for the treatment of advanced gastric cancer. Here, we report a patient with advanced gastric cancer achieving a complete response (CR) after 2 weeks of administration of S-1 as neoadjuvant chemotherapy. A 78-year-old woman with epigastric pain was diagnosed as having advanced gastric cancer. S-1 was administered orally, at a dose of 50 mg twice a day every day for 2 weeks, followed by a 2-week drug-free period. No obvious adverse reactions occurred. Subsequently, the patient underwent distal partial gastrectomy with D2 lymph node dissection. Pathological examination indicated no remnant signet-ring cells in the excised specimen, no lymph node metastasis, and unnatural fibrosis in one of the No. 3 lymph nodes. The neoadjuvant chemotherapy induced a CR according to the Japanese classification of gastric carcinoma.     

A case of unresectable advanced gastric cancer successfully treated with chemotherapy after gastrojejunostomy

We report a patient with unresectable advanced gastric cancer who was successfully treated with chemotherapy after gastrojejunostomy. A 64-year-old man was admitted to our hospital complaining of appetite loss and body weight loss. Abdominal enhanced CT revealed a gastric wall thickening and swelling of lymph nodes in the lesser curvature. Upper gastrointestinal endoscopy showed a gastric cancer in the antrum of the stomach. He underwent laparotomy, which revealed a T4 tumor invading the pancreas. Gastrojejunostomy was performed. After the operation, intake therapy of 80-100 mg S-1 was started for four weeks followed by two weeks rest as one course. After 2 courses of the therapy, abdominal enhanced CT showed a partial response of the lymph nodes. He is alive for 19 months after the operation. Abdominal enhanced CT showed a stable disease. This case suggested that S-1 chemotherapy after gastrojejunostomy was effective for unresectable advanced gastric cancer because of the long-term survival and an improvement of the patient's quality of life.     

Long-term survival outcome of locally advanced gastric cancer patients who achieved a pathological complete response to neoadjuvant chemotherapy

International Journal of Clinical Oncology - Long-term outcome of patients with locally advanced gastric cancer (LAGC) who achieved a pathological complete response (pCR) was scarcely discussed,...     

A case of stage III B advanced gastric cancer with psoriasis vulgaris responding to S-1/CDDP neoadjuvant chemotherapy leading to a pathologically complete response

A 39-year-old man with psoriasis vulgaris who complained of severe anemia was examined and diagnosed with advanced gastric cancer (UM, Type 3, cT3 cN2 cH0 cP0 cM0, cStage III B). He was treated with S-1/CDDP as neoadjuvant chemotherapy. S-1 (120mg/day) was administered orally for 14 days, followed by 7 drug-free days as a course, and CDDP (100mg/ body) was administered by intravenous drip on day 8. After the third course, a significant tumor reduction was obtained. Total gastrectomy and lymph node dissection (D2) were performed. The histological diagnosis revealed a complete disappearance of cancer cells in the stomach and all of the lymph nodes. He has been doing well without any recurrence for 9 months since the start of treatment.     

进展期胃癌新辅助化疗原发灶病理完全缓解5 例报告及文献复习*

进展期胃癌不可切除率及术后复发率较高,新辅助化疗联合手术切除是最常见的胃癌多学科综合治疗方法之一,具有以下优点：使肿瘤降期,提高R 0 切除率;对于高强度化疗的耐受性较辅助化疗好,化疗完成率较辅助化疗高;提供活体药敏检测从而避免不必要的手术。虽然高强度化疗产生更高的客观反应率,但是进展期胃癌经新辅助化疗获得病理完全缓解的仍然较少,且缺乏相关诊治规范。现介绍在广西医科大学附属肿瘤医院胃肠外科予新辅助化疗后获得病理完全缓解的5 例进展期胃癌,以探讨该类患者的临床病理特征、合理的综合治疗决策及预后的相关因素,使临床诊疗更加规范,患者更多获益。