[A Case of Advanced Breast Cancer in Which Mohs' Paste and Systemic Drug Therapy Allowed Local and Disease Control].

Local control of disintegrating advanced breast cancer is often difficult because of the exudate, bleeding, and the foul odor. The current author encountered a case of large breast cancer with ulceration in which drug therapy and local control with Mohs' paste allowed disease control. The patient was a 61-year-old woman. There was a large ulcerated lump in her right breast, and exudate, bleeding, and a foul odor were present. The woman was diagnosed with hormone-sensitive mucinous carcinoma based on a biopsy, and diagnostic imaging revealed axillary lymph node metastasis and multiple metastases in both lungs. Mohs' paste was used locally, and local control was achieved after 1 month. A year and a half after the start of systemic drug therapy, the breast lump disappeared, and lung metastases and lymph node metastasis had almost disappeared. A CR has been maintained 3 years and 5 months later. Mohs' paste was extremely useful in achieving local control of exudation and bleeding from exposed unresected cancer. This was an excellent treatment in the patient's terminal stages and as part of local treatment in combination with systemic drug therapy.

[A Case of HER2-Positive Gastric Cancer with Multiple Lung and Liver Metastases Showing Long-Term Survival].

A male patient in his 70s visited our hospital with a complaint of tarry stool. A detailed examination revealed gastric cancer( pap, tub1, HER2[3+]), with multiple lungs and liver metastases. Chemotherapy with 4 courses of capecitabine, cisplatin, and trastuzumab(Tmab)and 4 courses of weekly paclitaxel(wPTX)plus 3w-Tmab were administered, and CR was achieved. Thereafter, Tmab was administered alone; however, local recurrence of the primary lesion was observed 24 months after diagnosis, and treatment with PTX and Tmab was resumed. After 68 months of diagnosis, the recurrent tumor increased in size. Therapy with nab-PTX plus ramucirumab was initiated, following which, the tumor growth was restricted. Eventually, the patient died of another disease after 6 years and 5 months of diagnosis. Chemotherapy for unresectable advanced/recurrent gastric cancer has a remarkable antitumor effect; however, a complete cure with chemotherapy alone is difficult. Therefore, a multimodal treatment, including chemotherapy, surgical treatment, and radiation therapy, is important.

[Intraductal Papillary Mucinous Carcinoma with Penetration in the Colon and Retrograde Infection-A Case Report].

We report a case of intraductal papillary mucinous carcinoma(IPMC)penetrating the colon in an 82-year-old man. He visited our hospital with left upper abdominal pain. Abdominal CT showed IPMC of the pancreatic tail, measuring 7 cm, with tumor penetration to the colon and retrograde infection. After the antibacterial treatment, we performed distal pancreatectomy with colectomy. Pathological examination showed proliferation of adenocarcinoma of the gastrointestinal tract with penetration to the colon. Severe fibrosis and calcification surrounding the invasive cancer cells suggested a long disease duration. Despite adjuvant chemotherapy, he developed recurrence of peritoneal dissemination after 9 postoperative months, and subsequently, systemic chemotherapy was started. As intraductal papillary mucinous neoplasm(IPMN)might penetrate the adjacent organs, leading to a poor prognosis, even over a prolonged time period, IPMN should be followed-up appropriately and resected soon after the suspicion of malignant transformation.

A randomized controlled trial of postoperative intravenous acetaminophen plus thoracic epidural analgesia vs. thoracic epidural analgesia alone after gastrectomy for gastric cancer.

BACKGROUND: Acetaminophen is used in multimodal therapy for postoperative pain management. However, the additional effects of acetaminophen in combination with thoracic epidural analgesia (TEA) are not well understood. This prospective, multicenter randomized study was conducted to evaluate the efficacy of routine intravenous (i.v.) acetaminophen in combination with TEA for the management of postoperative pain in gastric cancer surgery. METHODS: A total of 120 patients who underwent distal gastrectomy were randomly assigned in a 1:1 ratio to receive i.v. acetaminophen every 6 h and TEA during the first 3 postoperative days (acetaminophen group) or TEA alone (control group). The primary endpoint was the sum of TEA rescue doses during the first 2 postoperative days. RESULTS: Final analysis included 58 patients in the acetaminophen group and 56 patients in the control group. The median number of TEA rescue doses was significantly lower in the acetaminophen group compared with the control group (3.0 vs. 8.0, p = 0.013). The median area under the curve (AUC) of the pain scores at coughing was significantly less in the acetaminophen group compared with the control group (285 vs. 342, p = 0.046) without an increase in postoperative complications. TEA rescue doses and pain score AUCs were significantly reduced by acetaminophen in patients who underwent open gastrectomy (p = 0.037 and 0.045), whereas there was no significant difference between patients who underwent laparoscopic gastrectomy in the two groups. CONCLUSIONS: In gastric cancer surgery patients, routine i.v. acetaminophen in combination with TEA provides superior postoperative pain management compared with TEA alone.

Evaluation of the efficacy of palonosetron for prevention of chemotherapy-induced nausea and vomiting in patients with gastric cancer treated with S-1 plus cisplatin.

PURPOSE: The purpose of our study was to evaluate the efficacy of a new combination antiemetic therapy consisting of palonosetron, aprepitant, and dexamethasone in gastric cancer patients undergoing chemotherapy with S-1 plus cisplatin. METHODS: This prospective, multi-institutional observational study assessed patient-reported nausea, vomiting, use of rescue therapy, change of dietary intake, and Functional Living Index-Emesis (FLIE) questionnaire results. The percentages of patients showing complete response (CR; no emesis and non-use of any rescue antiemetics) and complete protection (CP; no significant nausea and non-use of any rescue antiemetics), change of dietary intake, and impact of chemotherapy-induced nausea and vomiting on daily life during the overall (0-120 h after cisplatin administration), acute (0-24 h), and delayed (24-120 h) phases were examined. These findings were compared with our previous study, which used granisetron, aprepitant, and dexamethasone, to assess the relative effectiveness of palonosetron versus granisetron in combination antiemetic therapy. RESULTS: Of the 72 included patients, 66 (91.6 %), 70 (97.2 %), and 50 (69.1 %) achieved CR, and 48 (66.7 %), 61 (84.7 %) and 49 (68.1 %) achieved CP during in the overall, acute, and delayed phases of cisplatin administration, respectively. Approximately half of the patients had some degree of anorexia. FLIE results indicated that 78.6 % of patients maintained their quality of life. Palonosetron was not superior to granisetron in combination antiemetic therapy. CONCLUSIONS: Three-drug combination antiemetic therapy with palonosetron, aprepitant, and dexamethasone was tolerable in gastric cancer patients undergoing treatment with S-1 plus cisplatin. The predominance of palonosetron to granisetron was not demonstrated in this study.

Currarino syndrome in an adult presenting with a presacral abscess: a case report.

INTRODUCTION: Currarino syndrome (Currarino triad) was described in 1981 as a triad syndrome with a common embryogenesis in infants and with three characteristics: anorectal stenosis, a defect in the sacral bone, and a presacral mass. We describe here an unusual case of Currarino syndrome in an adult presenting with a presacral abscess but no meningitis. CASE PRESENTATION: A 32-year-old Japanese man presented with fever, arthralgia and buttock pain. A digital rectal examination showed mild rectal stenosis with local warmth and tenderness in the posterior wall of his rectum. Computed tomography showed a scimitar-shaped deformity of his sacrum and an 8cm presacral mass, which continued to a pedicle of his deformed sacrum. This was diagnosed as Currarino syndrome with a presacral abscess. The abscess was drained by a perianal approach with our patient treated with antibiotics. His symptoms soon disappeared. After three months, an excision was performed through a posterior sagittal approach. His postoperative course was uneventful and he was discharged 10 days after surgery. A histopathological examination revealed an infected epidermoid cyst. He has been free from recurrence as of four years and six months after surgery. CONCLUSIONS: We report a case of Currarino syndrome in an adult who presented with a presacral abscess but no meningitis. Abscess drainage followed by radical surgery resulted in a successful outcome.

[A case of recurrence after resection of gastric cancer successfully treated by combination chemotherapy with CPT-11 and CDDP].

A 62-year-old man received total gastrectomy and splenectomy for gastric cancer in April 2008. The pathological diagnosis was stage IIIA(pT3N2M0). After the surgery, he was treated with oral administration of S-1 as postoperative adjuvant chemotherapy, but stopped after five months because of a drug eruption and general fatigue. He visited our hospital with complaints of abdominal pain and appetite loss in January 2010. Tumor marker(CEA)was elevated, and he was diagnosed as local recurrence with metastasis to the mediastinal/Virchow lymph node and thoracic vertebra after several examinations. He started to undergo combination chemotherapy with CPT-11 and CDDP. After three courses of treatment, local recurrence had almost disappeared and CEA level was normalized. After five courses of treatment, FDG-PET showed that all recurrent tumors had decreased in size and FDG uptake. We finished this combination chemotherapy after ten courses. After the treatment, PET-CT detected a slowly-growing right lung tumor. He received S6 segmentectomy of the right lung in May 2012. The pathological diagnosis was squamous cell carcinoma, and he was diagnosed as primary lung cancer(pT1aN0M0, stage I A). He was followed without showing any recurrence of gastric cancer in October 2012.