A long-term survival case of unresectable intrahepatic cholangiocarcinoma treated with chemotherapy

An 83-year-old man commuting to our hospital with postoperative ascending colon cancer was pointed out an increase of CA19-9. CT scan revealed an intrahepatic cholangiocarcinoma in the left lobe. In May 2007, an operation was performed. We recognized a lymph node swelling in the hepatoduodenal ligament. Pathologically, it was moderately differentiated adenocarcinoma. Therefore, the operation did only the cholecystectomy. Gemcitabine was administered once a week for 3 weeks followed by a week rest. It was administered for about 20 months and the evaluation during the period was PR or SD. Afterwards, the tumor had increased gradually. Gemcitabine was changed to S-1. Then, S-1 was changed to gemcitabine again because the enlargement of the tumor and the rise of tumor markers were observed. Consequently, tumor markers decreased. Now, the patient is under an outpatient care maintaining ADL.     

A case of long-term survival of liver metastasis of breast cancer successfully treated with chemotherapy and endocrine therapy

A 42-year-old woman was diagnosed as having hepatic metastasis two years after radical mastectomy for breast cancer. She was initially treated with oophorectomy and cytotoxic chemotherapy, which resulted in complete regression of the lesion within two years after the start of the treatment. She remained free of the disease until the fifth year thereafter, when she again developed a metastatic lesions in her liver. Since then, she has been treated sequentially with various kinds of chemotherapy and endocrine therapy with a certain degree of response to each treatment. She has survived 12 years and three months after the development of liver metastasis. This patient is the longest survivor of hepatic metastasis from breast cancer in the Japaneses literature.     

A case of huge submandibular malignant tumor treated successfully with UFT chemotherapy

We report a patient with a huge submandibular malignant tumor showing an excellent response to chemotherapy with UFT. A 76-year-old woman complaining of a submandibular mass was referred to us. The mass had an irregular margin and measured 11 x 7 cm on CT scan. A left submandibular lymph node was enlarged slightly. Fine needle aspiration cytology of the mass indicated undifferentiated malignant tumor. We diagnosed her with unresectable malignant tumor. She was treated with oral UFT (600 mg/day), as she refused chemoradiotherapy. The malignant tumor became dramatically smaller in 4 weeks, and clinically disappeared in 6 weeks. Oral UFT was discontinued due to liver dysfunction. There has been no evidence of recurrence for 5 years after discontinuation of chemotherapy. The patient remains under observation.     

A case of unresectable advanced pancreatic tail cancer successfully treated with gemcitabine hydrochloride

We report a case of a 76-year-old female with unresectable advanced pancreatic tail cancer in whom systemic chemotherapy using gemcitabine hydrochloride was effective. The patient came to our hospital with a complaint of upper abdominal discomfort and was diagnosed as an advanced pancreatic tail cancer with severe vessel invasion. A curative operation was thought to be impossible, so gemcitabine hydrochloride was administered (800 mg/m2/week x 3/4 weeks). After 2 courses, the CEA, CA19-9 and SPan-1 value were decreased, and reduced tumor size was identified. Sixteen months after the first diagnosis, she died dissemination.     

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.     

A case of successfully treated unresectable multiple liver metastases from colon cancer by hepatic arterial infusion chemotherapy and systemic chemotherapy

Sigmoidectomy was performed for a 69-year-old man with sigmoid colon cancer and unresectable multiple liver metastases. The histological diagnosis was undifferentiated carcinoma of sigmoid colon. Hepatic arterial infusion chemotherapy with 5 FU and systemic chemotherapy with CPT-11 were performed after the operation. A complete response (CR) was achieved for liver metastases. The recurrent sign was not found at 23 months after the operation. This combination therapy is expected to be an alternative treatment of colorectal cancer with unresectable multiple liver metastases.     

A case of unresectable pancreatic cancer showing tumor dormancy treated with gemcitabine

A 67-year-old woman visited our hospital with a chief complaint of epigastralgia. The patient was diagnosed as having unresectable pancreatic cancer because abdominal CT and angiography revealed a tumor that had invaded a common bile duct, portal vein and superior mesenteric vein. A palliative operation was performed because of obstructive jaundice. Peritoneal dissemination was observed and confirmed pathologically. The patient was treated with gemcitabine after the palliative operation. A gemcitabine 30 min i.v. infusion at a starting dose of 1,000 mg/m2 was administered once a week for 3 weeks with a 1-week rest. The patient experienced grade 2 leukocytopenia, so the dose of gemcitabine was reduced to continue the chemotherapy. The patient continued to undergo the palliative chemotherapy without severe adverse effects. As a result, the patient was in tumor dormancy for 15 months. It is important for the patient to induce an acceptable level of toxicity in clinical practice and to continue the chemotherapy.     

A long-term survival case of unresectable hepatohilar bile duct cancer treated with radiotherapy and hepatic arterial infusion chemotherapy

The patient, a 79-year-old woman, underwent distal gastrectomy for gastric cancer in November 2002. The lesion was judged to be T1 N0H0POM0 and fStage IA. A hepatohilar tumor was found 1 year after gastrectomy by CT scan. Radiological examinations revealed a presence of right portal vein stenosis and left portal vein obstruction due to hepatohilar bile duct cancer. Surgical treatment was considered to be difficult because of the consequence of the tumor involved in the right hepatic artery. We performed hepatic arterial infusion chemotherapy of 5-fluorouracil 1000 mg/body/week for 8 courses through the reservoir catheter. Radiation therapy was delivered concurrently with hepatic arterial infusion. The condition of the patient was good after receiving 40 Gy, Three months after the additional 20 Gy radiation, the tumor was markedly reduced in size, and was not detected 7 months thereafter. MRI showed no recurrence for three and a half years since chemo-radiation.     

A successfully resected case of colorectal cancer with multiple liver metastases treated with systemic chemotherapy

The patient was a-54-year-old man. Sigmoidectomy was performed for sigmoid colon cancer in 1991. Partial liver resection in 1992 and microwave coagulation therapy (MCT) in 1994 were carried out for liver metastasis. Complete remission of the metastasis was achieved. In June 2002, multiple liver and lung metastases were identified. 5-FU, CDDP therapy was applied as systemic chemotherapy. The liver metastasis was improved and the level of CEA was reduced. However, a new lesion appeared in the right lobe of the liver, followed by an increase of the CEA level. Although CPT-11, 5-FU, CDDP therapy was applied, it was not effective. The reason was considered to be from the decrease of drug delivery resulting from an unbalanced blood supply in the right lobe of the liver. Right lobectomy and radio-frequency ablation was performed on June 17, 2003. The level of CEA was dramatically decreased. Additionally, CPT-11, 5-FU, CDDP therapy was applied. The patient has survived for 11 years after liver metastasis was first detected.     

A case of unresectable gastric cancer successfully treated with combination chemotherapy of S-1 + CPT-11

A 70-year-old female, with type III gastric cancer underwent a staging laparoscopy in September 2004. Judging from the results of endoscopy, enhanced CT and staging laparoscopy, we finally diagnosed the patient with stage IV (T3N2MOHOP1CY1), and we started a combination chemotherapy of S-1 + CPT-11 (S-1: 80 mg/m2, day 1-21/35 days, CPT-11: 80 mg/m2, day 1, 15/35 days) from October 2005 to January 2007. Enhanced CT after 2 courses of the combination chemotherapy showed partial response (PR) in the primary lesion. PR continued up to the 13 courses. The CT and gastro fiberscope finally showed complete response (CR) with Group I in biopsy. During these procedures, the grade 3 of neutropenia, grade 1 of diarrhea and grade 1 of fatigue occurred as adverse events. In January 2007, Virchow and, abdominal lymph node metastases were detected, and that we judged the metastases as progressive disease (PD). Nevertheless, the second-line of paclitaxel chemotherapy (70 mg/m2, days 1, 8,15/28 days) has started and she was being judged PD after 2 courses, she died in April 2007.     

A case of unresectable hilar cholangiocarcinoma successfully treated by gemcitabine and S-1 combination chemotherapy

A 52-year-old male was presented with obstructive jaundice and liver dysfunction. He was diagnosed as hilar cholangiocarcinoma involving the confluence of the right and left hepatic duct and bifurcation of the main portal vein trunk. Swollen lymph nodes in the hepatoduodenal ligament were also detected. ERBD tubes were placed in each B2, 3, and 5 branch. GEM and S-1 combination chemotherapy was carried out for four months. As a reduction in the primary tumor and lymph nodes was observed on CT scan surgical exploration was conducted, and an extended left hepatectomy with partial resection of the portal vein and regional lymph node dissection was achieved. The postoperative course was uneventful, and the patient remained free of recurrence, 34 months after the original diagnosis was made, and 29 months after surgical resection. Thus, GEM and S-1 combination chemotherapy is one of the options for the management of advanced hilar cholangiocarcinoma.     

A case of primary malignant lymphoma of the duodenum successfully treated with dose escalating chemotherapy

A 65-year-old woman with diabetes mellitus was hospitalized for heart failure and anemia in August 2001, and recovered with conservative treatment. An endoscopic examination revealed an ulcerative mass located in the duodenal bulb to the 2nd portion. Abdominal CT scan demonstrated tumor involvement in the pancreas head. The diagnosis of a diffuse large B-cell lymphoma, clinical stage IIE, was made by endoscopic biopsy. Although surgical resection of the localized intestinal tumor would have been a common choice for initial treatment, polychemotherapy was selected; the patient had diabetes mellitus and preferred polychemotherapy to surgical operation. Because of bulky intestinal mass, transmural disease and sensitive histological type, standard-dose chemotherapy was considered to include a high risk of intestinal perforation. We performed dose-escalating chemotherapy: A half dose of THP-COP (pirarubicin, cyclophosphamide, vincristine) was given at the start in October 2001, 60% THP-COP as the next cycle, 80% THP-COP as the 3rd cycle and thereafter. Without serious complications of the intestine, she received a total of 6 cycles of chemotherapy and subsequent involved field radiation. There has been no evidence of recurrence of disease 14 months from the start of chemotherapy. When conditions make surgical treatment difficult, dose-escalating chemotherapy in a treatment cycle may be considered as an alternative.     

A case of advanced pancreatic cancer treated successfully with self-expandable stent, PTEG and chemotherapy

A 52-year-old male admitted to our hospital for ileus was diagnosed with advanced pancreatic cancer. He was complicated with multiple alimentary tract stenosis (duodenal third portion, ascending portion and splenic-flexure portion of colon) due to intraabdominal spread of malignancies. The self-expandable metal stent was successfully placed in each stenotic portion with being effectively decompressed of his intestinal obstruction by the procedure of percutaneous transesophageal gastro-tubing (PTEG). These treatments improved his symptoms to ingest orally in addition to the tube feeding per PTEG. Furthermore, he has been receiving adjuvant chemotherapy with GEM, S-1, and CPT-11 for 9 months at outpatient department. We concluded a combined procedure of self-expandable stent and PTEG was useful palliative treatment in malignant gastrointestinal obstruction of advanced pancreatic cancer.     

A case of unresectable advanced gallbladder cancer treated by systemic chemotherapy combined with hepatic arterial infusion

A 53-year-old woman was revealed to have gallbladder cancer with liver metastases (H 1). Since a curative operation is impossible in this case, we started systemic chemotherapy employing S-1 combined with hepatic arterial infusion using epirubicin hydrochloride and mitomycin C. After three months, the primary lesion was reduced in size. The patient has been receiving systemic chemotherapy using S-1 only as an outpatient for 16 months. Although there is not enough evidence to support standard treatment, systemic chemotherapy combined with hepatic arterial infusion would improve the survival time without deterioration of quality of life in patients with advanced gallbladder cancer. This combined therapy should be considered one of the promising strategies for advanced gallbladder cancer.     

A long-term survival case of hepatocellular carcinoma with bone metastasis and inferior vena cava tumor thrombus successfully treated with multidisciplinary therapy

A 54-year-old man was diagnosed as hepatitis B in 1987 and observed. In January 2007, he was detected a 7 cm mass in the posterior segment of the liver with inferior vena cava tumor thrombus (Vv3), a 4.5 cm mass and multiple small nodules in the liver by computed tomography. Moreover, his right pubic bone has solitary small osteolytic change in x-ray and abnormal up take on bone scintigram. We diagnosed it having a highly advanced hepatocellular carcinoma (HCC) with bone metastasis. We started to treat with multidisciplinary therapy. We performed Transarterial chemoembolization (TACE) twice for intrahepatic lesions and radiotherapy for bone metastasis. Interferon-α and S-1 combination therapy were performed for three months. A new lesion in the liver was appeared advanced slowly 16 months after the last TACE, and caused to increase PIVKA-II. He received TACE for this lesion. Three years after the diagnosis, and he is alive in good condition without a new extrahepatic metastasis. This case suggests that some patients with highly progressive HCC involving inferior vena cava tumor thrombus (Vv3) and bone metastasis can gain a long-term survival by multidisciplinary therapy including TACE and Interferon-α and S-1.     

A 6-year survival case of locally advanced unresectable pancreatic tail cancer treated with chemo-radiation therapy

We report a case of locally advanced unresectable pancreatic tail cancer patient who survived over 6 years by chemo-radiation therapy (CRT). A 61-year-old male was pointed out by CT to have pancreatic tail cancer of 5.6 cm in diameter that invaded to the stomach, left kidney and adrenal gland, nerve plexus of celiac and superior mesenteric artery, was diagnosed as locally advanced unresectable pancreatic tail cancer. CRT of gemcitabine (GEM) with RT to a primary lesion was successful. After two years and 11 months, Schnitzler's metastasis appeared and RT was effective to recover from rectal stricture. At three years and 3 months, GEM was converted to S-1. After 4 years and 5 months, paraaortic lymph node metastasis was enlarged, so chemotherapy was changed to combination of GEM + S-1. After 4 years and 10 months, upper mediastinal lymph node metastasis appeared. At 6 years and 1 month, RT to upper mediastinum for pain control was performed. Finally, 6 years and 6 months after the first diagnosis, he died of pancreatic cancer. A long-term survival of locally advanced unresectable pancreatic cancer is very rare. In the case of pancreatic cancer that CRT is effective to the remission of primary lesion, CRT is potentially useful to perform for the control of metastatic lesion or palliative therapy.     

A case of vulval extramammary Paget's disease associated with pancreatic cancer that was successfully treated with chemotherapy

We report the case of an 84-year-old woman with vulval extramammary Paget's disease associated with pancreatic cancer who was successfully treated. At first, biweekly low-dose FP (cisplatin 10 mg/body, 5-fluorouracil 250 mg/body) was administered by intravenous infusion. Next, we attempted a regimen of gemcitabine (1,000 mg/body) was administered weekly by intravenous infusion. As a result, the size of the pruritic lesion of the vulva was reduced more than 50%, and the serum level of CA19-9 decreased clearly. These treatments would be a valid option in certain cases of pancreas cancer and extramammary Paget's disease.     

A case of unresectable liver metastasis from leiomyosarcoma of the stomach successfully treated by intra hepato-arterial chemotherapy with Infuse-A-Port

This report describes a 55-year-old man who had a curative operation for leiomyosarcoma of the stomach 6 years ago. Unresectable liver metastases was discovered during the second laparotomy and successfully treated by intra hepato-arterial chemotherapy, which included MMC, ADM and Therarubicin with Infuse-A-Port. He remains well presently with a decrease in the size of the liver metastases and no metastasis to any other organs upon investigation by an abdominal CT 2 years and 2 months after the second laparotomy.     

A case of long-term survival with TAE resistant multiple recurrence HCC successfully treated by hepatic resection

A 55-year-old female was admitted to our hospital for a third recurrence of hepatoma. She was treated with transcatheter arterial embolization (TAE) in April and November 1996. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple tumors of S4/S8 and S7 in the liver. After the third TAE using SMANCS, Lipiodol and Spongel, abdominal CT revealed insufficient Lipiodol retention and the in efficacy of this treatment. A right lobectomy of the liver was performed for the TAE resistant multiple recurrence of HCC. After the surgery, the patient survived for over 5 years with no recurrence. It appears that this surgery may be a useful modality for TAE resistant multiple recurrence hepatoma in cases of good liver function and lesions limited to the hemi lobe.