Squamous cell carcinoma of the bladder: a patient treated successfully with a new combined chemotherapy regimen, intraarterial nedaplatin and pirarubicin plus intravenous methotrexate and vincristine

We report a case of squamous cell carcinoma (SCC) of the bladder treated successfully with intraarterial chemotherapy using nedaplatin. A 75-year-old woman was admitted to our hospital in March 2004 with gross hematuria. Cystoscopic examination showed tumors on the anterior bladder wall. Computed tomography (CT) scans and magnetic resonance imaging (MRI) revealed extravesical invasion of the tumors, and a clinical diagnosis of T3bN0M0 was made. Transurethral biopsy was performed, and histopathological examination revealed SCC, grade 2–3, invasive. The patient received a new combined chemotherapy, intraarterial nedaplatin and pirarubicin plus intravenous methotrexate and vincristine. After two courses of the chemotherapy, CT scans and MRI demonstrated no tumor in the bladder. Transurethral bladder-wall biopsy was performed in November 2004, and histopathological examination of the specimen revealed no definite tumors. The patient is alive without evidence of disease more than 1 year after the chemotherapy.     

A case of elderly advanced squamous cell lung carcinoma successfully treated with nedaplatin and S-1 combination chemotherapy

A 7 4-year-old male was referred to our hospital for an abnormal chest shadow pointed out by a medical examination. A chest computed tomography revealed a tumor shadow 39 X 32mm in size in his left upper lobe in January, 2010. Pathological examination of biopsy specimens showed squamous cell carcinoma of the lung. Although there was no distant metastasis, multiple metastases to mediastinal lymph nodes was noted. He was diagnosed as Stage III A(cT2aN2M0). Considering his age and the histology of the disease, systemic chemotherapy with nedaplatin and S-1 was performed. The diameter of the primary lesion was decreased from 39mm to 18mm after 4 courses of chemotherapy, and was considered as partial response (PR)according to the RECIST criteria. The adverse events were grade 2 appetite loss, grade 3 neutropenia, and grade 2 thrombocytopenia. Recently, various new agents for treating non-squamous cell lung carcinoma have been developed, but there has been little progress in the treatment of squamous cell lung carcinoma. We experienced a patient with advanced squamous cell lung carcinoma who responded with CDGP/S-1 combination chemotherapy. We are now conducting a phase I / II clinical study to verify the usefulness of this regimen against advanced squamous cell lung carcinoma.     

Two cases of plasmacytoid variant of urothelial carcinoma of urinary bladder: systemic chemotherapy might be of benefit

We report two cases of the plasmacytoid variant of urothelial carcinoma of urinary bladder in which systemic chemotherapy was effective. In the first case, a 76-year-old man presented with dysphasia. Magnetic resonance imaging (MRI) and computed tomography revealed a brain tumor and a bladder tumor. Resection of the brain tumor and transurethral resection of the bladder tumor were performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder with brain metastasis (pT1N0M1). Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy were performed. He has no evidence of recurrence 96 months after resection of brain metastasis. In the second case, a 76-year-old man presented with hematuria. MRI revealed a bladder tumor with abdominal wall invasion, and a transurethral biopsy was performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder (cT4bN0M0). After three cycles of neoadjuvant GC (gemcitabine and cisplatin) chemotherapy, MRI demonstrated a complete response. Radical cystectomy was performed, and the pathological diagnosis was pT0pN0. Although there was no evidence of recurrence 9 months after radical cystectomy, he died from other causes. Our two cases suggest that systemic chemotherapy might be effective for the plasmacytoid variant of urothelial carcinoma.     

A long-term survival case of unresectable malignant pancreatic endocrine tumor successfully treated with systemic chemotherapy

A 55-year-old man was admitted to our hospital because of high grade fever in October 1999. Computed tomography showed a solid tumor in the tail of the pancreas with multiple liver tumors. We diagnosed him as unresectable pancreatic tail cancer with multiple liver metastases at first, so systemic chemotherapy using UFT was performed. Gradually, liver metastases were slightly reduced, and tumor markers (CEA, CA19-9) decreased to the normal range. In April 2001, percutaneous transhepatic tumor biopsy was performed. Histopathological examination revealed a malignant pancreatic endocrine tumor. Long NC had continued by using the UFT regimen. But because tumors had gradually grown since October 2003, the chemotherapy with S-1 was followed by gemcitabine (GEM). The patient has now survived for 7.5 years while receiving the combined chemotherapy of S-1/GEM.     

A case of advanced bladder cancer successfully treated with intraarterial chemotherapy

A 79-year-old Japanese male came to our hospital with complaints of protraction and macroscopic total hematuria. The medical imaging methods revealed a large papillary tumor in the left lateral wall of the bladder with the staging of T3N0M0. The pathological diagnosis was transitional cell carcinoma, G3. He received intraarterial chemotherapy with CDDP, ADM and MTX, which was called IA-MAC regimen. After two IA-MAC, no medical imaging method could reveal the tumor. The biopsied specimen, which was taken using the transurethral resection of the bladder mucosa, demonstrated no malignant cells. The new chemotherapeutic regimen "IA-MAC" is useful for the treatment of localized advanced bladder cancer in clinical use and enables one to preserve the organ.     

Successfully resected stage IIIA non-small cell lung cancer with mediastinal lymphnode metastasis after chemotherapy of cisplatin and docetaxel combined with concurrent radiation

A 47-year-old man with no symptoms was admitted to our hospital for the treatment of NSCLC, which was incidentally detected by an X-ray examination at the mass screening. Computed tomography (CT) of the chest and FDG-PET revealed a 3.6 cm tumor in the right upper lobe with multiple lymphadenopathy in the right mediastinum. Based on these clinical findings, we classified this case as a T2N2M0, stage IIIA NSCLC. The patient consented to and received 2 courses of systemic chemotherapy consisting of cisplatin (CDDP 40 mg/m(2); day 1, 8) and docetaxel (DOC 40 mg/m(2); day 1, 8) combined with concurrent radiation (2 Gy/day; total 46 Gy) with no severe adverse events. His tumors responded well to the treatment, and restaging chest CT showed marked regression of mediastinal lymphadenopathy, and partial response to the lung tumor. Then, acurative surgical resection was performed. Finally, the case was diagnosed as a T1N1M0, stage IIA NSCLC pathologically. Our chemotherapy regimen consisting of CDDP and DOC combined with concurrent radiation might be as potent as neo-adjuvant therapy for clinical stage III NSCLC.     

保留膀胱手术联合动脉化疗治疗浸润性膀胱癌的临床研究

目的 评价保留膀胱手术联合动脉化疗治疗浸润性膀胱癌的临床疗效.方法 2003年4月～2006年12月,对35例浸润性膀胱癌患者采用经尿道膀胱肿瘤电切或膀胱部分切除术联合GC(吉西他滨 顺铂)方案动脉化疗治疗,总结分析肿瘤控制情况、膀胱保存率和患者的生存率.结果 33例患者获随访,2例失访,平均随访24.3个月(3～45个月).27例无瘤生存,2例带瘤生存,4例死于肿瘤转移,2年生存率为88.8%;19例无复发及转移,5例浅表性复发,3例浸润性复发,6例转移;25例保留膀胱生存,4例行挽救性全膀胱切除,4例死亡,2年膀胱保存率为74.1%.全部患者对动脉化疗耐受良好,无严重全身和局部不良反应.结论 保留膀胱手术联合GC方案动脉化疗治疗浸润性膀胱移行细胞癌近期疗效满意,毒副作用轻,值得临床进一步观察研究.     

A case of gastric neuroendocrine cell carcinoma successfully treated by neoadjuvant chemotherapy

A 74-year-old man, whose chief complaint was epigastralgia, was referred to our hospital and diagnosed gastric cancer with liver metastasis. Gastrointestinal endoscopy showed a tumor on the lesser curvature of cardia of stomach. He was diagnosed as neuroendocrine cell carcinoma by biopsy specimens. He was treated by combined chemotherapy of CPT-11 and CDDP. After 11 courses, endoscopic examination revealed a complete disappearance of the primary tumor. CT-scan and MRI showed that the liver metastasis had been disappeared. We diagnosed as clinical CR and performed total gastrectomy with lymph node dissection and partial hepatectomy. Histological findings revealed a few cells in stomach and no cancer cells in the liver. He was treated with adjuvant chemotherapy of S-1. After 3-course, he suffered from anemia of grade 3, thus we interrupted chemotherapy. The patient remains alive for 28 months without recurrence. We conclude that chemotherapy was effective for neuroendocrine cell carcinoma of the stomach, which was to be considered of poor prognosis, and that liver resectomy was often effective.     

A case of synchronous multiple liver metastasis of sigmoid colon cancer with a pathological complete response to combination chemotherapy of 5-FU/LV and bevacizumab

A 73-year-old man was referred to our hospital with sigmoid colon cancer in July 2009. CT and MRI showed synchronous multiple liver metastasis. After a sigmoid colon resection in August, he received convergent chemotherapy in combination with 5-fluorouracil(5-FU)/Leucovorin(LV)(RPMI regimen)and bevacizumab for liver metastasis. After two courses without any major adverse effects, liver metastasis remarkably reduced on CT and MRI examination. We thus performed a liver resection, and pathological examination revealed a complete response in liver. Combination chemotherapy of 5-FU/LV and bevacizumab can be expected to provide safe and effective treatment for liver metastasis of colon cancer.     

A case of small cell carcinoma in the urinary bladder responding to gemcitabine/cisplatin combination therapy as neoadjuvant chemotherapy

We report a case of primary small cell carcinoma of the urinary bladder. A 79-year-old man with the chief complaints of macrohematuria and pollakisuria was admitted to our hospital. Cystoscopy and computed tomography (CT) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was small cell carcinoma of the urinary bladder, and he underwent 3 courses of neoadjuvant chemotherapy including gemcitabine and cisplatin with a preoperative diagnosis of cT3bN0M0. After the chemotherapy, cystoscopy and CT showed complete remission. Total cystectomy with ileal conduit was performed following 3 courses of chemotherapy. Microscopic examination revealed that the small cell carcinoma had disappeared and the converted squamous cell carcinoma remained only in a small part of the specimens. The patient was carefully followed for 10 months after operation, with no tumor recurrence.     

A case of advanced esophageal carcinoma with nephrotic syndrome completely responding to chemotherapy of docetaxel, nedaplatin and 5-fluorouracil

A 78-year-old male was admitted to our hospital because of dysphagia. He had been diagnosed as nephritic syndrome at 30 years of age and had been treated with prednisolone 10 mg/day. Blood examination revealed renal dysfunction; BUN 25 mg/dL, Cr 1. 9 mg/dL, and glomerular filtration rate(GFR)47. 4 mL/min. Endoscopy showed a type 2 tumor at the middle thoracic esophagus, and the biopsy specimen revealed moderately differentiated squamous cell carcinoma pathologically. Computed tomography (CT) of the chest and abdomen showed no metastases at distant regions and lymph nodes. Clinical staging was Stage II (cT2cN0cM0). Because of old age and renal function, we chose chemotherapy using docetaxel, nedaplatin and 5-fluorouracil. The adverse event was grade 2 in leucopenia and grade 1 in inappetence, but the renal function did not progress. Repeated endoscopic examinations after chemotherapy revealed that the esophageal cancer was significantly reduced in size, and no cancer cells were pathologically detected by endoscopic biopsy, resulting in a complete response(CR). This chemotherapy of docetaxel, nedaplatin and 5-fluorouracil might be effective and tolerable for patients with renal dys- function due to nephritic syndrome.     

Type 4 advanced gastric cancer responding to histological complete response after neoadjuvant S-1 combined with CDDP therapy-report of a case

A 75-year-old man with type 4 advanced gastric cancer was referred to our hospital. We diagnosed the tumor as cStage III B(cT4a, cN2, cM0)gastric cancer. We selected neoadjuvant S-1 combined with CDDP therapy for him. After 2 courses of chemotherapy, the extension of the gastric wall improved. After an additional 2 courses of chemotherapy, the primary tumor revealed a partial response(PR), judged from a barium meal study and upper GI endoscopic findings, and a total gastrectomy with lymph node dissection was performed. The pathological specimens showed no cancer cells in the gastric wall and lymph nodes, so the histological effect was judged as Grade 3.     

A resected case of squamous cell carcinoma of the breast successfully treated by FU plus cisplatin (CDDP) adjuvant therapy against recurrent metastases

A resected case of squamous cell carcinoma associated with ductal carcinoma in the hemilateral breast successfully treated by FU plus cisplatin (CDDP) adjuvant therapy against recurrent metastases is reported with some discussion. A 42-year-old woman was admitted to our hospital because of right breast tumor. By physical examination, mammography, ultrasound examination and aspirated cytology, we diagnosed squamous cell carcinoma of the right breast. Before operation SCC antigen was elevated. Standard mastectomy was performed, and SCC antigen was decreased within normal range. Then, a standard regimen of chemotherapy using docetaxel with anti-hormonal therapy by LH-RH analog and tamoxifen was done as first-line adjuvant therapy. Four months after operation the SCC antigen level was elevated again, and recurrence of cancer (skin and liver metastases) was recognized. Next, we tried 5-FU/UFT plus CDDP for squamous cell carcinoma of other organs such as the esophagus. These anti-tumor drugs proved effective, and no metastasis of the skin was detected thereafter, and liver metastatic lesion was decreased in ten months. The SCC antigen level was within the normal range again. Additionally, when metastases redeveloped, TS-1 plus CDDP controlled growth of tumors in seven months. Based on the present findings,we recommend adjuvant chemotherapy by FU plus CDDP for squamous cell carcinoma of the breast.     

Pathologically complete response for unresectable stage IV rectal cancer using systemic chemotherapy with panitumumab - a case report

We report a case of rectal cancer resulting in a pathologically complete response of the primary tumor by systemic chemotherapy with panitumumab, a new endothelial growth factor receptor(EGFR)antibody. A 56-year-old man was diagnosed as having unresectable Stage IV rectal cancer with local invasion and lung metastasis, and underwent systemic chemotherapy by FOLFOX, combined with panitumumab as a first-line therapy. After 3 courses of FOLFOX and 3 courses of FOLFOX with panitumumab, the treatment regimen was changed to FOLFIRI with panitumumab to prevent peripheral neuropathy. After 5 courses of FOLFIRI with panitumumab, pelvic computed tomography(CT)revealed that the primary tumor was markedly reduced, and the intrapelvic direct invasion was resolved. On the post-treatment chest CT, lung metastasis had disappeared. A low anterior resection preserving the automatic nerves, the colonic J-pouch and anal anastomosis, was performed 20 days after the last chemotherapy. Although the whole tumor-like lesion of the specimen was sectioned macroscopically at 5-mm intervals, no vivid tumor cells were detected at the pathological examination. The patient's postoperative course was uneventful, and no recurrence occurred 5 months after the operation. The EGFR receptor antibody is reported to have a significant anti-cancer effect for colorectal cancer without the KRAS gene mutation. In cases with relatively large tumors especially, EGFR antibody can be an effective first-line treatment.     

Alpha-fetoprotein (AFP)-producing ovarian tumor in an elderly woman

Apart from typical yolk sac tumors, ovarian tumors with elevated alfa-fetoprotein (AFP) are uncommon and the differential diagnosis needs to consider the hepatoid pattern of a yolk sac tumor, hepatocellular carcinoma metastatic to the ovary, hepatoid carcinoma, and other epithelial ovarian tumors. We report here an AFP-producing ovarian tumor with uncertain pathological diagnosis, which was extremely responsive to chemotherapy. A 59-year-old Japanese woman presented with lower abdominal distension and was found to have a left ovarian mass on pelvic examination and magnetic resonance imaging (MRI) scan. Laboratory tests showed serum AFP, 73 687 ng/ml; carbohydrate antigen 125 (CA125), 1599 U/ml; and carcinoembryonic antigen (CEA), 13.9 ng/ml. Total hysterectomy with bilateral salpingo-oophorectomy, partial omentectomy, and low anterior resection of the rectum was performed, without any residual macroscopic tumor. Microscopically, the tumor was characterized by a hepatoid carcinomatous component composed of solid sheets of large eosinophilic cells with pleomorphic nuclei. The pathological stage was pT2N0M0. Tumor cells were diffusely immunoreactive for AFP and cytokeratin (CAM5.2), but monoclonal CEA and CA19-9 were focally positive in the cytoplasm, while CA125 was negative. The patient was treated postoperatively with three cycles of chemotherapy consisting of bleomycin, etoposide, and cisplatin; with this regimen, serum AFP decreased to 16 ng/ml from 12 600 ng/ml just before the initiation of chemotherapy. The patient received secondary cytoreductive surgery of systemic lymphadenectomy, which revealed no evidence of residual tumor.     

低剂量吉西他滨联合奈达铂方案在膀胱尿路上皮癌化疗中的疗效和安全性分析

目的 探讨低剂量吉西他滨联合奈达铂方案治疗膀胱尿路上皮癌的疗效和安全性.方法 回顾性分析27例膀胱尿路上皮癌患者的临床诊治资料,均采取低剂量吉西他滨联合奈达铂方案化疗.结果 27例患者中,CR 2例,PR 12例,SD 9例,PD 4例,总有效率为51.8%,疾病控制率为85.1%.主要化疗不良反应为血白细胞减少、血小板减少,且化疗停止并对症治疗后很快缓解,未发生化疗相关死亡病例.结论 低剂量吉西他滨联合奈达铂方案治疗膀胱尿路上皮癌安全有效.     

A case of occult breast cancer successfully treated by capecitabine in combination with weekly paclitaxel followed by FEC (75)

A 78-year-old woman was referred to our hospital complaining of a hard nodule on the left side of her neck. Histological examination of this nodule showed metastatic carcinoma from breast cancer. Further examination revealed paraaortic lymph node swelling and no breast tumors. We diagnosed her tumors as occult breast cancer and its metastasis to lymph nodes (cT0N3cM1, Stage IV). We used weekly paclitaxel followed by a FEC75 regimen. The neck nodule size did not change after administration twice. We added capecitabine to the weekly paclitaxel, which had decreased the size of the nodule immediately. After this chemotherapy, PET-CT revealed that the lymph node metastasis had disappeared completely. It was considered that the addition of capecitabine in the early phase of the regimen was useful for this case.     

A case of complete response treated by gastrectomy with lymphadenectomy and combined chemotherapy of peroral S-1 and CDDP by arterial infusion for gastric cancer with multiple liver metastasis

A 70-year-old female was admitted to our hospital with high fever about 5 days before this writing, along with anemia and hyperglycemia. Upper gastrointestinal series and endoscopy revealed type 1 gastric cancer in the greater curvature. CT and MRI showed multiple liver metastasis in the right lobe. Distal partial gastrectomy with lymphadenectomy and cannulation of hepatic artery was performed. The pathological findings revealed moderately-differentiated adenocarcinoma, T2, N0, H1, M0, stage IV. The postoperative chemotherapy with S-1 (80 mg/day) was administered for 4 weeks followed by 1 week rest and CDDP (50 mg) administered once every 4 weeks by arterial infusion. Two months after operation the tumor marker values have become normal, and CT can hardly detect the metastatic liver tumors. At 8 months after operation, CT and MRI revealed complete disappearance of these tumors. Then, 12 months after operation, FDG-PET revealed no accumulation. Now, at 18 months, the CR stage has been maintained. Combined use of peroral S-1 and CDDP by arterial infusion is effective for multiple liver metastasis after gastrectomy in gastric cancer.     

新辅助化疗对进展期食管鳞癌的近期疗效观察

【摘要】目的探讨新辅助化疗(奈达铂+多西他赛)治疗进展期食管鳞癌的近期疗效及安全性。方法选取2016年8月至2018年2月川北医学院附属医院胸外科同一治疗组收治的食管鳞癌患者44例,术前行2周期新辅助化疗,化疗方案为奈达铂(80 mg／m2,第3天)+多西他赛(75 mg／m2,第1天),每个周期21 d。记录每个周期化疗后患者的肿瘤长度(肿瘤最长径),计算肿瘤长度缩减率=(术前肿瘤长度-完成该周期化疗后肿瘤长度)／术前肿瘤长度,观察并记录术后病理缓解率及术后并发症情况。结果44例接受新辅助化疗患者第1、2周期化疗有效率分别为25.0％、59.1％。术前、第1次化疗和第2次化疗后食管肿瘤长度分别为(5.76±1.41)cm、(4.56±1.21)cm和(3.42±1.63)cm,术前<第1次化疗<第2次化疗(P<0.05)。第2次化疗后肿瘤长度缩减率为(40.6±27.0)％,明显高于第1次的(19.9±14.1)％(P<0.05)。44例患者中接受手术40例,术后病理完全缓解3例(7.5％)。不同cN分期、cTNM分期、病理T分期和ypTNM分期(新辅助治疗后分期)患者的肿瘤长度缩减率差异有统计学意义(P<0.05),分期较早的患者(cN0、cⅡ、pT0～2、ypⅠ～Ⅱ)肿瘤长度缩减率优于分期较晚者(cN1～2、cⅢ～Ⅳa、pT3～4、ypⅢA～ⅢB);不同术后pN分期(pN0和pN1～2)患者的肿瘤长度缩减率差异无统计学意义(P>0.05)。结论新辅助化疗（奈达铂+多西他赛）2周期治疗进展期食管鳞癌有利于缩减肿瘤长度,近期疗效及安全性较好。     

Recurrent retroperitoneal malignant nerve sheath tumor associated with neurofibromatosis type 1 responding to carboplatin and etoposide combined chemotherapy

A 25-year-old man was referred to our hospital with left flank pain, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed large retroperitoneal masses. Physical examination revealed many café-au-lait spots and superficial neurofibromas, and a diagnosis of neurofibromatosis type 1 (von Recklinghausen's disease) was made. The tumor was resected, and the pathological diagnosis was malignant peripheral nerve sheath tumor (MPNST). Six months after the operation, lung metastases were detected. Surgical resection was incomplete, as there were too many lesions. He received four courses of chemotherapy with carboplatin and etoposide, and the metastatic lung lesions were markedly decreased. After chemotherapy, complete resection of the remaining lung lesions was performed, and there has been no recurrence to date.