[Efficacy of intraperitoneal chemotherapy for peritoneal recurrence of gastric carcinoma].

We report a patient in whom intraperitoneal chemotherapy was effective against peritoneal recurrence of gastric carcinoma. A 74-year-old woman underwent total gastrectomy with splenectomy and transverse colectomy for Borrmann type IV gastric carcinoma (curability B) in January 2000. The diagnosis was Stage IV gastric carcinoma (T4, N2, P1, H0, M0 and CY0). In July 2000, peritoneal recurrence occurred along with slight elevation of CEA. In September, two ports were inserted into the upper and lower peritoneal cavity for intraperitoneal chemotherapy with low-dose CDDP and 5-FU plus MMC. She was followed-up for four months as an outpatient and received intraperitoneal chemotherapy biweekly with good control of peritoneal metastasis. However, she died of bone and lung metastases in January 2001. Intraperitoneal chemotherapy was effective in this patient for peritoneal recurrence of gastric carcinoma and could be delivered on an outpatient basis while maintaining the patient's quality of life.

[An effective case of intraperitoneal and intra-arterial combined chemotherapy for unresectably advanced Borrmann type IV gastric carcinoma].

We report an effective case of intraperitoneal and intra-arterial combined chemotherapy for unresectably advanced Borrmann type IV gastric carcinoma. A 59-year-old man was admitted with advanced Borrmann type IV gastric carcinoma in June 1999. With informed consent, the patient underwent laparotomy, which revealed far advanced Stage IV gastric carcinoma of T4, N3, P1, H0, M1, CY1 for resection. Three ports to both subphrenic pouches and Douglas' pouch were placed for intraperitoneal infusion chemotherapy. Pathological findings of omental lesions were metastatic gastric carcinomas of por 2-histological type. Intraperitoneal and intravenous infusion combined chemotherapy with a modified low-dose CDDP and 5-FU regimen were started. The artery-side port was placed in the aorta at the Th. 9/10 levels for arterial infusion chemotherapy in September 1999. The patient was followed-up as an outpatient and continued to receive the intraperitoneal and intra-arterial combined chemotherapy. We report an effective case of intraperitoneal and intra-arterial combined chemotherapy for unresectably advanced Borrmann type IV gastric carcinoma, who could be followed-up as an outpatient while maintaining his quality of life.

Evidence that de novo protein synthesis is dispensable for anti-apoptotic effects of NF-kappaB.

The transcription factor NF-kappaB is a positive transcription factor for a number of genes and has been recognized as an anti-apoptotic regulator. However, the mechanism by which NF-kappaB blocks apoptosis is still controversial. Here, we demonstrate the evidence that NF-kappaB could attenuate the TNF-alpha-induced apoptosis without de novo protein synthesis using human pancreatic cancer cell lines, MIA PaCa-2 and Capan-2. The TNF-alpha-induced apoptosis was blocked by IL-1beta, a potent inducer of NF-kappaB activation. This inhibitory effect of IL-1beta was evident when cells were treated with protein synthesis inhibitors such as cycloheximide (CHX). Moreover, NF-kappaB decoy oligonucleotides could not block the anti-apoptotic effect of IL-1beta at doses sufficient to block the NF-kappaB-dependent transcription induced by IL-1beta. To confirm the role of NF-kappaB in blocking apoptosis, we generated stable cell lines expressing IkappaBdeltaN, a highly stable form of IkappaBalpha, a cytoplasmic inhibitor of NF-kappaB. In these stable transfectants, the antiapoptotic effect of IL-1beta was totally abolished, indicating that the anti-apoptotic action of IL-1beta could be ascribed to the NF-kappaB action. These findings show that de novo protein synthesis is dispensable for anti-apoptotic effects of NF-kappaB and support the possibility that NF-kappaB could exert its anti-apoptotic action through protein-protein interaction.

[An effective case of arterial infusion therapy of low-dose CDDP and continuous 5-FU for isolated hepatic recurrence of gastric carcinoma].

We report an effective case of arterial infusion therapy of low-dose CDDP and continuous 5-FU for isolated hepatic recurrence of gastric carcinoma. An 83-year-old man was admitted for epigastric pain and vomiting due to a huge liver metastasis of gastric carcinoma in May, 1997. Nineteen months earlier, in October of 1995, he had undergone distal gastrectomy and D2 lymph node dissection with Billroth I reconstruction. His conclusive stage and pathological findings were as follows. The conclusive stage was stage II: t3, n0, P0, H0. Histological typing was tub 2. Lymph node involvement was not detected, but venous invasion was found in the surrounding regional lymph nodes. CEA had been getting elevated from November, 1996. But he had been well until March, 1997, when CT scans revealed huge hepatic recurrence. The artery-side port was placed for hepatic arterial infusion therapy for liver metastasis. Intra-arterial bolus injection of low-dose CDDP (5 mg) and continuous intra-arterial infusion of 5-FU (250 mg/day for 7 days) were started. Through 4 courses of this arterial infusion therapy, the patient improved. CT scans revealed shrinking of liver metastasis after 3 months of this therapy. The patient was followed in an outpatient clinic and continued to receive this arterial infusion therapy once every 4 weeks. New lung metastasis was detected 9 months after the start, but liver metastasis continued to be responded. The patient died from bleeding into the bile duct from the liver metastasis 16 months after the start of arterial infusion therapy, when metastatic lesions of liver continued to shrink. Arterial infusion therapy of low-dose CDDP and continuous 5-FU may be effective for isolated hepatic recurrence of gastric carcinoma.