[A case of lung metastases of carcinoma of the ampulla of vater effectively treated with S-1].

A 70-year-old female patient underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater in March 2007. In April 2009, multiple lung metastases were detected by CT scanning. The patient was treated with S-1 (80mg/day, day 1-28, followed by 2-weeks withdrawal)from April 2009. The shrinkage of lung metastases was diagnosed as a complete response based on the Response Evaluation Criteria in Solid Tumors(RECIST). No severe toxicities were observed. S-1 is an effective and safe anti-cancer agent available for lung metastases of carcinoma of the ampulla of Vater.

[Outcome of therapy for type 4 gastric cancer with peritoneal metastasis--diagnosis by laparoscopy and effect of chemotherapy].

UNLABELLED: Laparoscopy (st-lap) was performed for type 4 advanced gastric cancer cases, and chemotherapy was performed for P1 or CY1[ P(+)] cases. We present the results here. SUBJECTS: The subjects were type 4 advanced gastric cancer cases from October 2002 to December 2007 who underwent st-lap, as well as 7 P0 and CY0 [P(-)] cases (the operative group), and 18 P(+) cases which underwent chemotherapy (the chemotherapy group). The administration of S-1 (80 mg/m2: days 1-14)+PTX (120 mg/m2: day 1) every 3 weeks was the basic regimen of chemotherapy. RESULTS: After 5- course of chemotherapy, st-lap was performed in 11-PR case(61%) and 4-SD case, in which clinical symptoms had improved. An operation was performed for 11-P(-) case. Overall, there was 8-P(-) case(44%). The 1-and 3-year survival rates in the chemotherapy group in the 11 cases for which an operation was performed were 82 and 36%, respectively, and the 7 non-operative cases were 57 and 14%, respectively. Although there were no significant differences, the outcome was more favorable in the operative group. The 1-and 2-year survival rates in the operative and chemotherapy groups were 72, 39, 51 and 34%, respectively, and there was no significant difference. DISCUSSION: It was suggested that in cases of type 4 advanced gastric cancer, chemotherapy was necessary not only in P(+) but also in P(-) cases. Further investigation regarding the necessity of resection and choice of therapeutic regimen is required.

[A case of metastatic pancreatic cancer after combination chemotherapy with uracil-tegafur and gemcitabine].

We report a case of pancreas head cancer with liver metastasis treated with uracil-tegafur (UFT) and gemcitabine combined chemotherapy. A 66-year-old man was referred to our hospital for obstructive jaundice. We planned to perform a pancreatoduodenectomy, but a small nodule was found at laparotomy on the liver surface. The histopathological diagnosis was adenocarcinoma, so we inserted a self-expandable metallic stent (EMS) in this inoperable pancreas head cancer. We performed 9 courses of UFT and gemcitabine (GEM) combination chemotherapy. Renewed liver metastases did not appear, and the pancreas head tumor partially responded. Pancreatoduodenectomy was performed, and EMS could not be separated from the common bile duct. After treatment with an additional 11 courses of chemotherapy, he took S-1 orally because of a tumor recurrence. He survived for 24 months from the first laparotomy. Combination chemotherapy and surgery enhanced the survival benefit in this case.

Pilot study of intraperitoneal administration of paclitaxel and oral S-1 for patients with peritoneal metastasis due to advanced gastric cancer.

BACKGROUND: There is no standard treatment for peritoneal dissemination from gastric cancer. A novel combination chemotherapy has been introduced for patients with advanced gastric cancer with peritoneal metastasis. METHODS: This pilot study was performed on four patients to confirm safety and efficacy. They were diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy, or with metastasis to the transverse colon. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m(2) or 60 mg/body was administered intraperitoneally on days 1 and 8 and S-1, at 80-120 mg/body, was administered orally for 14 days followed by 7 days' rest, as one course. After five courses of this therapy, the primary gastric tumors were evaluated by conventional examinations, and second-look laparoscopy was performed to assess the efficacy of the treatment against the peritoneal metastases. RESULTS: After five courses, primary tumor reductions were confirmed, and no cancer cells were detected on pathocytological investigation during second-look laparoscopy in any of the patients. Three patients underwent total gastrectomy with lymph node dissection and one underwent left upper abdominal evisceration. Final histological staging showed two stage 3 and two stage 4 patients. The intraperitoneal administration of paclitaxel and the oral administration of S-1 were well tolerated. Three patients died, at 8, 15, and 29 months, respectively, after the initial treatment, and one has been alive for 54 months without recurrence. CONCLUSION: This chemotherapy can be used in the treatment of patients with peritoneal metastasis of gastric cancer.

[Pilot study of neo-adjuvant chemotherapy involving intraperitoneal administration of paclitaxel and oral S-1 for patients with T3 gastric cancer].

The prognosis of patients with T3 gastric cancer is poor, even if a curative resection is performed. Novel combination neo-adjuvant chemotherapy has been introduced for T3 gastric cancer patients. This pilot study involving 5 patients was performed between December 2002 and March 2003. They were diagnosed with gastric cancer with serosal invasion (T3) without P1 and CY1 by staging laparoscopy. We selected a combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m2 was administered intraperitoneally on days 1 and 8, and S-1 at 80 mg/m2 was administered orally for 14 days followed by a 7-day-rest, as one course. After one course of this therapy, surgery was performed. The plasma concentration of paclitaxel was measured in two patients. Toxicites were generally mild, and no serious adverse reactions were observed. The plasma concentration of paclitaxel was about 100 ng/mL in the period of 1-6 hours after the administration. After one course, four patients underwent a total gastrectomy and one distal gastrectomy. The final histological stagings were included one stage IB, one stage II, one stage IIIA, one stage IIIB, and one stage IV. Three patients died at 10, 11, and 16 months after the initial treatment, and two have survived for 64 and 62 months. As the intraperitoneal administration of paclitaxel and oral S-1 was well-tolerated, further studies should be conducted involving T3 gastric cancer patients.

[A case of advanced sigmoid colon cancer performed resection of liver metastases after long-term control by S-1 and CPT-11 combination chemotherapy].

A 60-year-old man diagnosed as advanced sigmoid colon cancer was performed sigmoidectomy and D3 lymph node dissection. Intra-operative findings were SE, P0H1N4M (-), and Stage IV. One month after the operation, we started a combination chemotherapy using S-1 plus CPT-11 as one course for five weeks. S-1 (120 mg/body/day) was orally administered continuously for 3 weeks, and CPT-11 (80 mg/m2) was done intravenously on days 1 and 15. A Follow-up abdominal CT scan revealed a drastic reduction of liver metastasis and disappearance of para-aortic lymph node swelling (PR in). The combination chemotherapy was once finished after eight courses due to the patient's request. However, we started to administer the same regimen to him again six months later because of re-growth of liver metastasis. An additional six-course administration resulted in a reduction of liver metastasis by CT scan, and no other abnormal concentration besides two liver metastases by PET-CT examination was observed, and we performed a partial resection (two parts) of the liver and cholecystectomy 24 months after the first operation. The patient has been alive with disease free for five months since the second operation.

[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.

[The palliative role of percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in an advanced pancreatic cancer patient with duodenal stenosis--a case report].

Although a 64-year-old man with pancreatic cancer was referred to our hospital due to difficulty in the bile drainage, he was initially planned to have an operation at another hospital after relief of obstructive jaundice. Laboratory tests on admission revealed obstructive jaundice, pancreatitis and malnutrition (T-Bil 12.1 mg/dL, AMY 1170 IU/L, Alb 2.0 g/dL). Abdominal computed tomography (CT) detected a pancreas tumor and multiple liver metastases. Then, we determined to carry out palliative therapy. Percutaneous transhepatic cholangiography (PTC) showed a common bile duct obstruction, and a biliary metallic stent was placed. Endoscopic examination revealed a tumorous duodenal stenosis. We performed percutaneous endoscopic gastrostomy with jejunal extension (PEG-J), which was used for both transintestinal nutrition and decompression gastrostomy. After these therapies, the patient's condition improved better in 2 weeks as such that he could have stayed away from our hospital for several days. PEG-J was useful to improve a quality of life in pancreatic cancer patient with duodenal stenosis.

[Three cases of unresectable advanced gastric cancer treated with S-1 based chemotherapy after surgical bypass].

Case 1: The patient underwent gastrojejunostomy [T4 (pancreas), N2, P0, CY0] in April 2004, and then 23 courses of chemotherapy with S-1 + DOC (40 mg/m2/day 1:3 w). Then, the regimen was switched to CPT-11 because of a decreased efficacy of the treatment, and CPT-11 was continued for 10 courses. (The patient was alive for 36 months). Case 2: The patient was treated with S-1 [T4 (pancreas), N3, P0, CY0] after surgical bypass in November 2004. After two courses of chemotherapy with S-1, 9 courses of the second-line chemotherapy with PTX (120 mg/m2/day 1:3 w) were provided. As the disease progressed, 15 courses of CPT-11 (125 mg/m2/day 1: 2 w) were administered (The patient was alive for 29 months). Case 3: The patient was diagnosed as CY1 by staging laparoscopy in August 2005. The second-look laparoscopy revealed CY0 after 5 courses of S-1 + PTX (120 mg/m2/day1: 3 w). Although the second-look laparoscopy revealed CYO, gastrojejunostomy was performed because of P1 and T4 (pancreas). Chemotherapy with S-1 + PTX was continued for 18 courses, followed by OPT-11 (The patient was alive for 20 months). This report describes three cases of gastric cancer treated with S-1 based chemotherapy after surgical bypass, which resulted in the long-term survival and an improvement of the patients' quality of life.