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 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.     

A case of advanced gastric cancer successfully treated by surgery after chemotherapy with S-1/CDDP

A-46-year-old male with advanced-stage IV multicentric gastric cancer was treated with S-1/CDDP as neoadjuvant chemotherapy. S-1(initially 100 mg/day, up to 120 mg/day)was orally administered for 3 weeks(day 1-21)followed by 1 drug-free week as a course, and CDDP(initially 60 mg/day, up to 100 mg/day)was administered by intravenous drip on day 8. After the fourth course, a significant tumor reduction was obtained and curative surgery was performed. Thereafter, S-1 therapy was continued. There has not been any recurrence for 19 months postoperatively.     

A case of advanced gastric cancer with hepatic metastasis successfully treated by combined chemotherapy with UFT and lentinan

We have experienced successful treatment of a hepatic metastasis of gastric cancer with UFT and lentinan. The patient was a 65-year-old male, who underwent distal gastrectomy for gastric cancer with hepatic and lymphatic metastases. After operation, administrations of UFT 300 mg/day and lentinan 2 mg/2 weeks were given, and the hepatic metastasis disappeared by 17 months. We performed a resection of the residual stomach and lymphatic metastasis at 52 months after operation. For over 5 years the patient has shown no evidence of a recurrence of the hepatic metastasis. This chemotherapy regimen was very effective and improved the patients quality of life.     

A case of advanced gastric cancer successfully treated with TS-1

A patient with advanced gastric cancer complicated with liver and lymph node metastases was successfully treated with a novel oral anticancer drug, TS-1, TS-1 was administered at a dose of 100 mg/day. One course consisted of consecutive administration of TS-1 for 28 days and withdrawal for 14 days. At the end of 3 courses a partial response of the liver metastases was achieved. Although the patient has had complications with ascites collection due to hypoalbuminemia, he has been well without regrowth of any metastases for over 8 months.     

A case of carcinomatous enterodermal fistula successfully treated with arterial infusion chemotherapy

We report a 74-year-old male patient with a carcinomatous enterodermal fistula after residual gastrectomy, who responded to arterial infusion chemotherapy. The patient was administered 10 mg/body cisplatin (CDDP) and 1,000 mg/body 5-fluorouracil (5-FU) through an injection port every week. After 13 weeks, the fistula was closed and viable cancer cells had disappeared without any side effects. After 1 month, however, the fistula re-opened and viable cancer cells appeared again.     

A case of advanced mullerian cancer successfully treated with S-1 chemotherapy

A 79-year-old woman was referred to our hospital with complaints of dyspnea. She was diagnosed with massive pleural effusion and cytology demonstrated the presence of adenocarcinoma, but no solid tumors were found in the systemic examination. Her serum CYFRA and CA125 level were increased. She was diagnosed with an effusion type of lung cancer or a cancer of unknown origin. S-1/CDDP was the chemotherapy of choice. After 2 courses of the treatment, her serum CYFRA level and CA125 level were normalized, and a chest CT detected no pleural effusion. Two years and 3 months after the first treatment, her CA125 level was increased. We found an FDG accumulation in her pelvic lesion by PET examination. To identify the FDG accumulated lesion in her pelvis, an operation was performed. Histopathological examination of the right ovary demonstrated the presence of an adenocarcinoma. Postoperatively, we administered 2 courses of paclitaxel/carboplatin combination treatment, considering the right ovarian tumor was the primary lesion. The patient remained alive and in good condition without any signs of recurrence 2 years after second treatment. This case suggests that S-1 therapy may be effective for patients with mullerian cancer.     

A case of advanced gastric cancer with obstructive jaundice due to liver metastases successfully treated with chemotherapy

We report a successful case of chemotherapy for primary far-advanced gastric cancer accompanied with poor general condition related to jaundice due to hepatic metastasis. A 54-year-old man, who had been admitted to another hospital in October 2006 with a complaint of tarry stool, was referred to our hospital. The result of detailed examination revealed an advanced gastric cancer, multiple lymph node metastases and jaundice (T-Bil 3.3 mg/dL) due to multiple hepatic metastases. The performance status (PS) was level 4. In parallel with a whole body control, a combined therapy with S-1 and CPT-11 was performed from October 27 as the first-line therapy. As a consequence of the first course, the jaundice disappeared. After the second course, the patient left the hospital. However, the patient was re-admitted to hospital in January 2007 by a reason of fever and a deterioration of PS. As exacerbation of cancerous peritonitis and the primary tumor were seen, a weekly paclitaxel therapy was performed as the second-line therapy. Two courses of treatment resulted in the disappearance of ascites and a reduction of hepatic/lymph node metastasis. PS was improved to level 0 as well. After these therapies, the patient was discharged from the hospital. As of June 2007, he continuously receives chemotherapy as an outpatient.     

Locally advanced pancreatic cancer successfully treated by arterial infusion chemotherapy combined with stereotactic radiotherapy--a case report

We report a 60-year-old female with locally advanced pancreatic cancer successfully treated with stereotactic radiotherapy after arterial chemoinfusion. Using the indwelling catheter-port system with the unification of the pancreatic blood supply, we initially conducted an arterial infusion of weekly high-dose 5-FU (1,000 mg/m2/qw) combined with systemic gemcitabine (1,000 mg/m2/qw). As a result, the tumor was remarkably decreased. However, a part of the tumor where the drug had not been distributed remained in no reduction. Therefore, we added the stereotactic radiotherapy (50 Gy) targeted on the limited residual tumor and combined with concurrent systemic gemcitabine (1,000 mg/m2/qw). The residual tumors have been controlled well without distant metastases, and the patient is alive today 36 months after our initial treatment.     

A case of advanced gastric cancer successfully treated by neoadjuvant chemotherapy with CPT-11, CDDP and 5-FU

A patient with advanced gastric cancer was treated with combined administration of CPT-11 CDDP and 5-FU before operation. CPT-11 was given intravenously at a dose of 30 mg/m2/day on day 1 and day 8. At the same time, 5 mg/m2/day CDDP and 350 mg/m2/day 5-FU were infused for 2 weeks. The patient experienced no other adverse reaction than a mild degree of nausea. Histological examination of the resected specimen revealed complete disappearance of cancer cells both in the stomach and the regional lymphnodes.     

Case of advanced gastric cancer successfully treated with chemotherapy of weekly paclitaxel

We report a case of gastric cancer with ascites treated with chemotherapy. The patient is a 67-year-old male. Combination chemotherapy of S-1 and CDDP was given as the first-line treatment. However, the symptoms did not improve with that regimen, so we decided to change the chemotherapy to paclitaxel as second-line treatment. After 4 cycles, CT scan revealed decreasing ascites and endoscopy a reduction of the primary tumor. The patient has maintained a condition of decreasing ascites with improvement of QOL for 8 months. This regimen is considered effective treatment for unresectable gastric cancer.     

A case of advanced thymic cancer successfully treated with neoadjuvant intra-arterial infusion chemotherapy

We report the case of a 68-year-old man with advanced thymic cancer who was diagnosed as having squamous cell carcinoma by percutaneous needle biopsy. The CT scan showed pre-cardiac and pulmonary invasion, therefore the tumor was classified as Masaoka's stage III. Induction systemic chemotherapy consisting of CDDP (70 mg/m2, day 1), ADM (40 mg/m2, day 1) and ETP (70 mg/m2, day 1-3) was performed for the purpose of reducing the tumor size; however, the tumor's size did not shrink. Therefore, second line chemotherapy combined with selective intra-arterial infusion chemotherapy and systemic chemotherapy consisting of CDDP (70 mg/m2, day 1; intra-arterial), ADM (30 mg/m2, day 1; intra-arterial), VCR (0.5 mg/m2, day 3; systemic) and CPA (500 mg/m2, day 3; systemic) was performed. After this treatment, the tumor was reduced in size, and an extended thymectomy was subsequently performed. The histological diagnosis of the resected tumor was squamous cell carcinoma. Examination of the resected tumor revealed extensive necrosis and only a few cancer cells. These results show that intra-arterial infusion chemotherapy may be effective for local control of advanced thymic cancer.     

A case of type 4 advanced gastric cancer with aplastic anemia successfully treated with neoadjuvant chemotherapy and surgical resection

We have experienced a case of Type 4 advanced gastric cancer with aplastic anemia, which had been treated with S-1 and intra-peritoneal docetaxcel combination chemotherapy followed by surgery. Fifteen years ago, a 51-year-old woman was diagnosed as aplastic anemia but she ignored any treatment due to no symptoms. A Type 4 advanced gastric cancer was detected with a chief complaint of stomach heaviness in December 2009. Peritoneal lavage cytology was performed before treatment and showed positive peritoneal dissemination. Two courses of S-1 and intra-peritoneal docetaxcel combination chemotherapy was administered but no serious side effects occurred during the therapy. Total gastrectomy with D2 lymph node dissection was successfully undergone. The final stage was ypT4aN3H0M0P1, Stage IV. It appeared that S-1 and intraperitoneal docetaxcel combination chemotherapy was a safe regimen for a patient with aplastic anemia in our case.     

A resected case of effective treatment with TS-1 and CDDP for advanced gastric cancer with carcinomatous ascites

We encountered a resected case of advanced gastric cancer after successful chemotherapy. The patient remained alive in good condition without any signs of recurrence at 2 years and 8 months after surgery. The 40-year-old woman initially complained of low abdominal pain, which was diagnosed as gastric cancer with metastasis of ovaries and carcinomatous ascites. We administered TS-1 (100 mg/body/day) for 3 weeks followed by 2-week rest and CDDP (60 mg/body) on the 8th day of one cycle. After 3 cycles of treatment, carcinomatous ascites disappeared and the ovarian lesion was reduced. The patient underwent total gastrectomy, ileocecal resection, cholecystectomy and radical hysterectomy. The antitumor efficacy of the treatment was histologically Grade 2. We administered 17 cycles of TS-1 treatment, and the patient is alive in good condition at this writing. This shows that TS-1 and CDDP may have potent therapeutic efficacy in advanced gastric cancer patients. For the future, the safety and efficacious administration of TS-1 and CDDP should be examined further.     

A case of gastric cancer successfully treated with hyperthermo-chemo-radiotherapy

A 56-year-old woman was diagnosed as having gastric cancer with lymph node metastasis and invasion to the pancreas head and was admitted to our hospital in September, 1984. She was treated with hyperthermo-chemo-radiotherapy, using radiofrequency-induced hyperthermia (8 MHz) with a daily dose of fractionations at 42-43 degrees C for 60 minutes, 5 fractions per week of irradiation at 180 cGy and systemic chemotherapy. After the total doses of hyperthermia and radiation had reached 11.8 hours and 2500 cGy, the primary tumor and lymph node metastasis measured by X-ray examination were reduced in size. On October 8th, laparotomy was done, and total gastrectomy combined with total pancreatectomy, left hepatic lobectomy and right hemicolectomy was performed. Histologically, almost all of the cancer cells in the primary tumor and lymph node metastasis had disappeared. These results show that this multimodal therapy is effective for local control of gastric cancer, when used preoperatively.     

A case of liver metastases from gastric cancer successfully treated with induced hypertensive chemotherapy

We report a 77-year-old patient with gastric cancer who has survived 5 years after multidisciplinary treatment for both liver and brain recurrences. He underwent a D2 distal gastrectomy for macroscopically type 2 cancer at the lower third of the stomach on May 1997. The histopathological findings were as follows: O-IIc (SM2), poorly differentiated adenocarcinoma, pN2, ly2, v2, stage II. One year after surgery, a follow-up abdominal CT scan revealed multiple liver metastases. He received both hepatectomy and prophylactic hepatic arterial infusion of mitomycin C with induced hypertensive chemotherapy (IHC), a drug delivery system using the difference in blood flow between normal and tumor vessels by intravenously injected angiotensin-II. IHC was carried out monthly and the total dose of MMC was 74 mg (6 courses). Although he was disease-free for about 2 years, brain metastases were found on December 2000. He then underwent excision of the brain metastases and consecutive radiation by X-knife. Although he had a relapse of liver metastases on April 2002, he is still alive now. We consider multidisciplinary treatment including complete surgical resection as effective, even for recurrent or highly malignant gastric cancer.     

A case of advanced gastric cancer with splenic vein thrombus successfully treated with S-1 plus CPT-11 neoadjuvant chemotherapy

A 63-year-old male admitted for hematemesis was diagnosed with type 3 advanced gastric cancer located in the upper and middle body of the stomach in an endoscopic examination. Abdominal computed tomography demonstrated lymph nodes metastasis and a splenic vein thrombus. Since curative resection was not deemed possible, we performed neoadjuvant chemotherapy using S-1 (120 mg, day 1-21) plus CPT-11 (135 mg, day 1 and 15) except for down-staging. After 4 courses of chemotherapy, gastric tumor and metastatic lymph nodes were reduced in size and the splenic vein thrombus was disappeared, and then total gastrectomy was performed (tub2, T2 (MP) N0 H0 M0 P0 CY0, Stage IB). S-1 medication was applied as adjuvant chemotherapy. Forty months passed from the operation, the patient remains alive with no signs of relapse.     

A case of advanced gastric cancer with peritoneal metastasis successfully treated over 19 months with postoperative chemotherapy after non-curative surgery

We report a case of non-curatively resected gastric cancer successfully treated with postoperative continuous chemotherapy, resulting in long-term survival of 19 months. A 75-year-old woman underwent non-curative resection with total gastrectomy for advanced gastric cancer with peritoneal metastasis in June, 2005. Postoperatively, at first, she received oral administration of S-1. However, due to grade 2-3 nausea and anorexia, the dose of S-1 was reduced. After four courses, the value of the tumor markers increased. Next, we chose sequential methotrexate and 5-fluorouracil therapy, but no decrease tumor markers could be obtained. Then, 9 months after surgery, biweekly paclitaxel (PTX) chemotherapy was performed. The value of the tumor markers gradually decreased or stopped increasing, and PTX was administered 18 times. In this period, the quality of life of this patient was good. Eighteen months after surgery, the value of the tumor markers increased again, and S-1 and CPT-11 combination therapy was chosen. However, the patient died of brain infarction 19 months after surgery. Thus, continuous and persevering chemotherapy could be effective for advanced gastric cancer with peritoneal metastasis and may be promising for long-term survival.     

A case of advanced gastric cancer successfully treated by TS-1 and CDDP after jejunostomy

A 65-year-old female with unresectable advanced gastric cancer accompanied by multiple lung metastases underwent jejunostomy and was treated with TS-1 and CDDP. One course consisted of TS-1 (80 mg/day) via an intestinal fistula tube from days 1 to 14 followed by 14 days rest and CDDP (80 mg/day) was administered by 24-hour continuous intravenous infusion on day 8. After 3 courses, the primary tumor and lymph node metastases decreased in size (PR), and CT scan showed the multiple lung metastases had disappeared. Total gastrectomy (D 2) and splenectomy were performed after chemotherapy. The final diagnosis was Stage IIIA and the pathological response to chemotherapy was Grade 2. The patient has survived for over 14 months after surgery and has presented no signs of recurrence.     

A case of advanced gastric cancer with long-term survival treated by chemotherapy and surgical cytoreduction

A 74-year-old man was revealed to have type 3 gastric cancer with lymph-node metastasis in the third group (N 3) and liver metastasis (H 1). Since we regarded a curative operation as impossible, we started preoperative chemotherapy using TS-1 plus irinotecan hydrochloride (CPT-11) on the premise that we would perform surgical cytoreduction after the chemotherapy. After two courses of chemotherapy, both the primary lesion and the liver metastasis were reduced in size, and the paraaortic lymph-nodes disappeared. Subsequently, a distal gastrectomy (D 0, curability C) was performed. The patient has been receiving postoperative chemotherapy using TS-1 and paclitaxel as an outpatient for 2.3 years. Although there is not enough evidence to support the benefit of surgical cytoreduction, chemotherapy combined with surgical cytoreduction would improve the survival time without deterioration of quality of life (QOL) in patients with advanced gastric cancer. This combined therapy should be considered as one of the promising strategies for advanced gastric cancer.