A case of advanced gastric cancer with Virchow's and paraaortic lymph node metastases successfully resected after combined chemotherapy of low-dose CDDP and 5-FU

The patient was a 61-year-old woman who had Stage IV advanced gastric cancer with Virchow's and paraaortic lymph node metastases. The lesions were considered surgically incurable, so she was placed on neoadjuvant chemotherapy consisting of low-dose CDDP and 5-FU. After 3 courses of chemotherapy, the tumor had decreased remarkably in size and Virchow's metastasis had disappeared. She was considered to have a partial response (PR) and underwent distal gastrectomy. Histopathological examination of the primary tumor revealed that almost all cancer cells existed in the mucosal and submucosal layers; few had infiltrated the serosa. A few paraaortic lymph nodes were positive for metastasis, but a curative resection (Cur B) was performed. The patient received another course of chemotherapy after the operation. Low-dose CDDP and 5-FU therapy was associated with few adverse events in this case, and thought to be effective against advanced gastric cancer.     

Successful treatment of advanced hypopharyngeal cancer with combination chemotherapy (VPCP regimen) followed by subsequent radiotherapy: a case report

This report concerns a 64-year-old male suffering from advanced hypopharyngeal cancer. This patient was treated with four courses of combination chemotherapy including VPCP (a combination of VCR, PEP, CDDP and PEP) regimen as neo-adjuvant chemotherapy. And radiotherapy was given as a secondary treatment; Linac. 60 Gy/6 weeks. He showed no tumor masses in the hypopharynx following this combination chemotherapy. No recurrence has been found under endoscopy for one year after the treatment with combination chemotherapy. It thus seems that neo-adjuvant chemotherapy prior to surgery and/or radiation including cisplatin, peplomycin and other agents is very useful as a multimodal treatment for cancer of the hypopharynx.     

A patient with recurrent gallbladder cancer responding to chemotherapy with CDDP/CPT-11 and gemcitabine

A 79-year-old female patient was referred to our hospital for treatment of a recurrent gallbladder cancer. Before admission, she had undergone expanded cholecystectomy and had been treated successfully with 5-FU for 3 years to suppress the tumor growth in intraperitoneal lymph nodes. The recurrence of the tumor in lymph nodes near the pancreas head was demonstrated by computer tomography. We tried a course of a combination chemotherapy consisting of CPT-11 and CDDP (40 mg CPT-11/body/day on day 1 and 10 mg CDDP/body/day on day 2-5) to reduce the size of the nodes. Then, we repeated a total of 8 courses of the therapy at 4-week intervals. The status of the nodes was not changed for a year. Then, the lymph node started to enlarge again and obstructive jaundice appeared. So, we substituted gemcitabine (1 g/body/day) for the combination chemotherapy with expandable metallic stent implantation to drain the bile. As a result, metastatic lymph nodes were reduced in size and the dilatation of the interhepatic bile duct disappeared. Thereafter, the patient was given an additional 20 courses of gemcitabine therapy at 2-week intervals as an outpatient. No change was observed in the size of the metastatic lymph nodes for a year. However, the patient died of liver metastasis 8 years after operation and 6 years after she started chemotherapy for the recurrence. She maintained a good quality of life during that time. The present case suggests that combination of chemotherapy protocols is effective for clinical management of gallbladder cancer recurrence, which is generally considered to be difficult to manage with chemotherapy.     

Successful treatment of mediastinal seminoma with combination chemotherapy of cis-diamminedichloroplatinum (CDDP), vinblastine (VBL), and bleomycin (BLM)

Complete response (CR) has been achieved in a case of advanced mediastinal seminoma using PVB therapy (CDDP, VBL, BLM). A 21-year-old man visited our department with the complaint of superior vena cava syndrome. Chest X-ray film, ultrasonography and CT scan revealed a large anterior mediastinal mass. Histological proof of mediastinal seminoma was obtained by needle biopsy. The patient was treated with a combination chemotherapy, consisting of CDDP, VBL and BLM according to Einhorn's PVB regimen. After three courses of this regimen, complete disappearance of the tumor was obtained. The patient underwent further radiation treatment (Linac: 4,000 rad), as a salvage therapy, at the anterior mediastinum, and has since been doing well without any sign of recurrence for a follow-up period of nine months.     

A case of advanced gastric cancer that responded to docetaxel with low-dose 5-FU and cisplatin combination chemotherapy after becoming chemoresistant to M-FLP

We report a case of advanced gastric cancer that responded to docetaxel with low-dose 5-FU and cisplatin combination chemotherapy after becoming chemoresistant to M-FLP. A 52-year-old male was diagnosed with type 3 gastric cancer of angulus (poorly differentiated adenocarcinoma) with left neck, Virchow, mediastinal and abdominal lymph nodes metastases. The patient was treated with 5 courses of M-FLP (MTX + 5-FU + LV + CDDP), and the effect of this therapy was PR, but the tumor was chemoresistant to the sixth course of this therapy. After 7 courses of M-FLP, docetaxel (TXT) with low-dose FP (5-FU + CDDP) was administered to the patient as second-line chemotherapy. After 2 courses of TXT with low-dose FP, the gastric cancer and metastatic lymph nodes were remarkably reduced and the effect of this therapy was PR. The toxic events were anemia (grade 2) and leukopenia (grade 3), which were treated with G-CSF. CDDP and 5-FU based regimens are considered as the first-line chemotherapy for metastatic advanced gastric cancer in Japan; however, a second-line chemotherapy has not been established. As in this case, a TXT based regimen is effective and well tolerated therapy as a second-line chemotherapy for metastatic gastric cancer after prior exposure to CDDP and 5-FU.     

A case of gastric cancer with liver metastasis responding to low-dose CDDP/5-FU combination chemotherapy

We reported a case of a 62-year-old female with gastric cancer accompanied by liver, Virchow and paraaortic lymph nodes, and bone metastasis (taken low-dose cisplatin (CDDP)/5-fluorouracil (5-FU) combination chemotherapy). CDDP (10 mg/body/day) was injected on 1-5 days i.v. and 5-FU (500 mg/body/day) was injected i.v. continuously on 1-7 days. This treatment cycle was repeated for 4 weeks. After 4 cycles, liver metastasis disappeared without severe side effects. Primary lesion and Virchow's lymph nodes metastasis were reduced. However, bone and paraaortic lymph node metastasis showed no response. It was considered that low-dose CDDP/5-FU combination chemotherapy was effective for liver and lymph nodes metastasis of gastric cancer in this case.     

Refractory non-small-cell lung cancer responding to combination chemotherapy with gemcitabine and cisplatin

The patient was a 60-year-old female with adenocarcinoma of the lung. An effective radiation therapy was performed for cervical lymph node metastases found 19 months after the operation. A right adrenal metastasis and abdominal paraaortic lymph node metastases were detected 11 months later, and chemotherapy with cisplatin (CDDP) was administered. Although a temporary partial response was obtained, the metastatic lesion was refractory to CDDP. The patient was treated with gemcitabine (GEM) and CDDP, which resulted in near complete response continued for 3 months. The combination therapy of GEM and CDDP may be effective for recurrent non-small-cell lung cancer refractory to other regimens.     

A case of recurrent gastric cancer that responded dramatically to docetaxel and 5'-DFUR combination chemotherapy

A 54-year-old man suffering from Borrmann type 4 advanced gastric cancer with pancreatic invasion and paraaortic lymph node metastases underwent a total gastrectomy, which was a radical C operation. From postoperative month 4, he visited our hospital with multiple liver metastases and increased lymph node metastases. After chemotherapy with CDDP and 5-FU, CDDP and UFT was administered on an outpatient basis. The effect of this therapy was PD, therefore, docetaxel and 5'-DFUR combination chemotherapy was performed as second line therapy. After 2 courses of this therapy, the size of liver and lymph node metastases was reduced and the effect of this therapy was PR. The patient has undergone 4 courses of this therapy and is maintaining a clinical PR. It is conceivable that docetaxel and 5'-DFUR combination chemotherapy is useful for patients with advanced and recurrent gastric cancer, even if they had been treated with 5-FU administration as first line therapy.     

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 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.     

Combination of operation, chemotherapy and radiation for AFP producing gastric cancer--a case report

We report a case of AFP producing gastric cancer after a combination of operation, chemotherapy and radiation. A 70-year-old man was admitted complaining of abdominal fullness. He was diagnosed as having type 3 advanced gastric cancer with multiple lymph node metastasis, including No. 8p lymph node, by endoscopy and computed tomography. Distal gastrectomy and D2 lymph node dissection were performed after chemotherapy using S-1, low-dose CDDP and CPT-11. Histopathological study showed moderately differentiated adenocarcinoma, and immunohistochemical study revealed a few AFP-positive tumor cells. Postoperatively, radiation (50 Gy) was performed for paraaortic lymph node metastasis and right hepatic lobectomy for liver metastasis. However, about 2 months after hepatic lobectomy, liver metastasis was diagnosed again by computed tomography, and radiation (30 Gy) was performed. He died 13 months after first surgery.     

A case of advanced gastric cancer with recurrence-free long survival showing disappearance of distant lymph node metastases by S-1/docetaxel therapy followed by curative resection

A screening CT of a 78-year-old man suffering from a laryngeal foreign body revealed multiple lymph nodes swelling at the left subclavicular, mediastinal, perigastric, and paraaortic space. He was diagnosed as advanced gastric cancer. After five courses of S-1/docetaxel therapy, the primary tumor became flat and lymph nodes became undetectable. After seven courses, he received operation(total gastrectomy and D2 lymph nodes dissection)because of tumor bleeding and severe adverse effects. The pathological chemotherapeutic effect was Grade 1b for the primary tumor and Grade 3 for lymph nodes. He received S-1 maintenance therapy for three years afterward, and is now still in good condition without recurrence 53 months after the first administration. S-1/docetaxel therapy was thought to be a useful optional regimen for highly advanced gastric cancer.     

A case report of a three-year survivor with advanced non-small cell lung cancer producing alpha-fetoprotein

An 80-year-old patient with poorly differentiated adenocarcinoma of the left lung with metastasis to both lungs and supraclavicular lymph nodes, stage III M1 (T2N2M1), was treated with cisplatin (cis-diamminedichloroplatinum, CDDP) at a dose of 80 mg/m2 intravenously. He achieved a partial response, however, he could not continue therapy with CDDP because of its renal toxicity. He was then given etoposide and vindesine as a single chemotherapeutic agent, but no response was observed. Therefore, CDDP was administered again in a fractionated regimen, the first course of treatment achieved a minor response, but the second course resulted in stable disease. He therefore received combination chemotherapy consisting of mitomycin, vindesine and CDDP, and tumor regression of more than 30% was observed after one course of this combination chemotherapy. After three years from the initiation of chemotherapy, he had no symptoms except for hoarseness, and has been followed up on an ambulatory basis. In addition, the tumor was producing alpha-fetoprotein (AFP), which was shown by immunohistochemical staining with polyclonal antibody against AFP. The changes in serum AFP level correlated well with the disease status.     

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.     

Pathological complete response in advanced gastric carcinoma by S-1/CDDP combination chemotherapy

A59 -year-old woman was referred to our hospital for a close examination and treatment of an advanced gastric carcinoma. A physical examination and CT scan showed that the right cervical and axillar lymph nodes were swelling, and a histopathological examination of the axillar lymph node revealed metastatic growth of the gastric carcinoma (Stage IV). Then, we started S-1/CDDP combination chemotherapy. S-1 (80 mg/m2/day)was orally administered for 3 weeks followed by 2 weeks of rest, and CDDP (60 mg/m2) was administered by drip on day 8. Since the distant metastases were greatly reduced after 6 courses of combination therapy, a distal gastrectomy with lymph nodes dissection (D2) was performed. Histopathological examination of the resected tissues revealed no residual cancer cells, suggesting a pathologically complete response. The clinical course after the operation went well without any complications, and the patient is alive with no evidence of recurrence 1 year after surgery. S-1/CDDP combination chemotherapy appears to be one of the effective treatments for advanced gastric carcinoma.     

A case of rectal cancer with distant lymph node metastases completely responding to postoperative chemotherapy with levofolinate combined with 5-fluorouracil

The patient was a 58-year-old female who had a cancer of the rectum with multiple lymph node metastases including paraaortic lymph nodes and Virchow lymph nodes. Abdominoperineal resection was performed palliatively. After the operation, weekly bolus of 5-fluorouracil combined with levofolinate was carried out. After 2 courses of chemotherapy, metastases of paraaortic lymph nodes and Virchow lymph nodes completely disappeared upon CT examination. Chemotherapy has continued for 14 months, and she is well and has maintained a complete response for more than 1 year. This case suggests that this combination chemotherapy of LV/5-FU, admitted in Japan, is effective against advanced colorectal cancer.     

A clinical case of lymph node recurrence after resection of gastric cancer successfully treated by combination chemotherapy with irinotecan and cisplatin

A 60-year-old female who was diagnosed as gastric cancer underwent distal gastrectomy and received adjuvant chemotherapy (S-1 therapy). After 6 months, the tumor marker (CEA) was elevated. CT revealed para-aortic lymph nodes enlargement. Lymph node metastasis was confirmed. The patient was administered combination chemotherapy with irinotecan (CPT-11) and cisplatin (CDDP) Seven months later, CT revealed lymph node metastasis had disappeared. After judgment of complete response (CR), we continued the treatment for 22 months. The patient was followed without any recurrence in May 2010.     

A partial response to combined TS-1 and docetaxel chemotherapy enabling a curative resection after the failure of combined TS-1 and CDDP chemotherapy in a patient with unresectable gastric cancer

A 60-year-old man visited our hospital complaining of epigastric pain. Gastrofiberscopy revealed an advanced gastric cancer located on the anterior wall of the antrum. Abdominal computed tomography (CT) revealed metastases to the paraaortic lymph nodes. The patient subsequently underwent combined chemotherapy consisting of TS-1 and low-dose CDDP for the treatment of unresectable gastric cancer. No reductions in the paraaortic lymph node metastases were noted after one cycle. The patient was then treated with TS-1 combined with docetaxel as a second-line chemotherapy. TS-1 (80 mg/m2) was orally administered for 2 weeks followed by a 2 week interval, while docetaxel (25 mg/m2) was simultaneously administered weekly (days 1, 8, and 15). One cycle of chemotherapy was 28 days. An abdominal CT revealed a partial response after 3 cycles. The patient experienced grade 2 leukocytopenia and grade 3 neutropenia. We decided that the patient could undergo a curative resection, and a distal gastrectomy with D2+para-aortic LN dissection was performed. The pathological efficacy was Grade 2. The patient is presently alive with no sign of recurrence after 20 months. Combined TS-1 and docetaxel chemotherapy is a promising second-line regimen for the treatment of unresectable gastric cancer, after treatment with TS 1 combined with CDDP has failed.     

A case of advanced small intestinal cancer treated with S-1 plus cisplatin

A66 -year-old woman was referred to our hospital because of abdominal pain in 2005. Computed tomography(CT) showed severe wall thickening of the proximal part of the jejunum and extensive intraperitoneal lymph node swelling. Therefore she was diagnosed with primary advanced small intestinal cancer. Surgery was performed to prevent the gastrointestinal obstruction and bleeding. Extensive lymph node metastases, including those in the paraaortic area, were observed. Because a curative resection seemed impossible, only a partial resection of jejunum was performed. After the operation, a regimen of chemotherapy with S-1(80mg/body, alternate-day dosage)and CDDP(100mg/body), was administered once every 5 weeks. At the end of the 4th course, the tumor marker was normalized and CT showed a marked decrease in the size lymph nodes; a complete response(CR)was achieved. But when a total 9 courses of chemotherapy was completed during the 17- month follow-up period after the operation, the tumor marker re-rose, and CT showed extensive intraperitoneal lymph node swelling again, so it was diagnosed the recurrence of as a disease. Chemotherapy was administered again, but was not effective. The patient died 29 months after the operation.     

Preoperative combination chemotherapy with TS-1 is effective in a case gastric cancer with peritoneal dissemination

We report a case of peritoneal cancer dissemination with Type 4 gastric cancer, successfully treated with combination chemotherapy with TS-1. The patient was a 59-year-old female, who complained of abdominal distension with pain, weight loss, and poor appetite. She was diagnosed as unresectable Type 4 gastric cancer, T3N2MOHOP1CY1M0, Stage IV with massive ascites (cytology: Class V). After 2 courses of combined chemotherapy with TS-1 and cisplatin (CDDP), primary tumor reduction was confirmed and no cancer cells were detected from a pathological investigation with biopsied specimens by endoscopy. As additional therapy for remained ascites, intraperitoneal administration of paclitaxel and docetaxel was performed, resulting in a remarkable decrease of ascites with cytological disappearance of cancer cells. The patients underwent total gastrectomy with lymph node dissection, pathological diagnosis of primary site and lymph nodes showed grade 2 effect, and no cancer cells were detected in ascites and peritoneum, microscopically. While she died of peritoneal recurrence after the surgery, the case suggested the clinical advantage of controlling the advanced cancer-bearing state by combination chemotherapy with TS-1, instead of surgery.