[Four Cases of Locally Advanced Colorectal Cancer Resected after Neoadjuvant Chemotherapy with mFOLFOX6 plus Bevacizumab].

We describe 4 cases of locally advanced colorectal cancer resected successfully after neoadjuvant chemotherapy(NAC) conducted between April 2015 and August 2016. The NAC with mFOLFOX6 plus bevacizumab was performed after ileostomy for prevention of obstruction, because of tumor invasion into other organs. After chemotherapy, we could perform resection and avoid invasive surgery in either cases.

[A Case of Solitary Adrenal Metastasis from Rectal Cancer Treated by Adrenalectomy after Preoperative Chemotherapy].

Adrenal metastasis from colorectal cancer occurs in the presence of multiple synchronous metastases at other sites. We report a case of heterochronous solitary adrenal metastasis from rectal cancer. A 55-year-old man underwent anterior resection with D3 lymph node dissection for rectal cancer. The pathological stage of the tumor was III b, and adjuvant chemotherapy with mFOLFOX6 was administered for 6 months. Eighteen months after surgery, abdominal computed tomography(CT) revealed right solitary adrenal metastasis. His tumor marker levels were considerably elevated; therefore, he received preoperative chemotherapy with FOLFIRI plus bevacizumab(BV). After preoperative chemotherapy, his tumor marker levels decreased, and CT and FDG-PET/CT did not uncover any other metastatic lesions. The patient was diagnosed with solitary adrenal metastasis, and right adrenalectomy was performed. Histological examination confirmed the tumor to be adrenal metastasis from rectal cancer, and the histopathological Grade was 2. The patient received adjuvant chemotherapy with mFOLFOX6, and he is alive 7 months after adrenalectomy without evidence of recurrence. Adrenalectomy is recommended for solitary adrenal metastasis from colorectal cancer. Additionally, adrenalectomy after preoperative chemotherapy is an effective strategy for patients with solitary adrenal metastasis and high tumor marker levels.

[A case of gastric metastasis and carcinomatous peritonitis of breast cancer with improved QOL by stent implantation and gemcitabine].

A 73-year-old woman had undergone mastectomy for left breast cancer. One year later, bone metastasis was detected. After 7 years, the patient experienced epigastric discomfort, and gastrointestinal endoscopy showed stenosis of the pylorus and enlarged gastric folds. Stomach cancer was suspected at first, but gastric metastasis of breast cancer was diagnosed on the basis of endoscopic reexamination and computed tomography(CT)images. The patient could not drink water, and therefore, gastrointestinal stenting was performed, which facilitated ingestion to some extent. However, at the same time, an elevated serum carcinoembryonic antigen(CEA)level and jaundice were observed. Therefore, biliary tract stenosis due to carcinomatous peritonitis was diagnosed. We attempted to treat the jaundice with endoscopic retrograde cholangiopancreatography( ERCP)or percutaneous transhepatic cholangiography(PTCD), but the treatment was not successful, and an increase in ascites was noted. Accordingly, gemcitabine was administered as systemic therapy. As a result, ascites decreased and jaundice improved. Patients with gastric metastasis of breast cancer have poor quality of life(QOL)because of difficulties in ingestion or vomiting, and poor prognoses, because of frequent concurrent carcinomatous peritonitis. We experienced a case of gastric metastasis and carcinomatous peritonitis, and were able to improve the patient's QOL by gastrointestinal stenting and gemcitabine administration.

[Efficacy and toxicity of lapatinib plus capecitabine therapy in HER2-positive metastatic breast cancer].

We retrospectively investigated the efficacy and toxicity of lapatinib plus capecitabine in 45 HER2-positive breast cancer patients. The median number of treatment courses was 6(1-22). Brain metastasis developed in 18 cases(40%), and 19 cases(42.2%)had received previous capecitabine treatment for metastatic breast cancer. The objective response rate(ORR=CR+PR)was 22.2%(10/45), and clinical benefit rate(CR+PR+long SD=24w)was 46.7%(21/45).The median time to progression(TTP)was 24.9 weeks(95% CI: 15.2 -34.6 ), and the median overall survival(OS)was 78.1 weeks(95% CI: 55.7 -100.5)in all 45 cases. The median TTP was significantly longer in patients who had not received capecitabine previously(30 vs 16 weeks, 95% CI: 16.3 -43.7, p=0.0051 ). There was no statistical difference in median OS associated with previous capecitabine exposure(42.7 weeks, 95% CI: 21.4 -64, p=0.057 ). The median TTP was significantly longer in patients who received less than 2 treatment regimens with trastuzumab for MBC rather than 3 regimens more(27.3 vs 16 weeks, p=0.0257 ), but there was no statistical difference in median OS(81 vs 40.9 weeks, p=0.26 ). Lapatinib in combination with capecitabine is likely more useful in patients who are naive to capecitabine, who received less than two regimens for metastatic breast cancer.

Paraneoplastic neurological syndrome in a patient with gastric cancer.

Paraneoplastic neurological syndromes (PNSs) are a heterogeneous group of neurological disorders caused by immune-mediated mechanisms. The incidence of PNS is much less than 1% for solid tumors, except for small-cell lung cancer and thymoma. We report a rare case of gastric cancer that presented with primary clinical findings of PNS. The patient was a 63-year-old woman who was admitted for worsening neuropathy. Laboratory and neurological tests excluded a nutritional deficit, diabetes mellitus, and connective tissue disease as causes of her neuropathy. Computed tomography (CT) of the abdomen, positron emission tomography (PET)-CT, and endoscopy of the stomach revealed gastric cancer with lymph node swelling. Distal gastrectomy was performed and pathological and immunohistochemical examinations indicated endocrine cell carcinoma. The gastrectomy stopped the exacerbation of her symptoms and recurrence was not observed, but the neurological disorders were irreversible. This case suggests that early diagnosis of the primary tumor is required to improve the outcome in patients with PNS.

Detection of gastric cancer cells in the blue lymph node and lymphaticus under sentinel lymph node biopsy using dye technique alone.

BACKGROUND/AIMS: We investigated whether or not there are cancer cells in the blue node (BN) and the sentinel lymphaticus (SL), which is detected using sentinel node biopsy (SNB). METHODOLOGY: Patent blue (1%) is injected submucosally into 4 to 5 different sites at 1 mL per site around the primary tumor. Blue-stained lymphatics and lymph nodes can be seen by turning over the greater omentum and lesser omentum extraperitoneally. If blue nodes or lymphaticus are found, biopsy is performed at this point. The study was conducted in 14 patients (11 males and 3 females, mean age 65.7 y/o) with a preoperative diagnosis of T1 tumor invasion and NO that there is no lymph node metastasis. Informed consent was obtained from the patients for SNB after patent blue staining and investigation of CEAmRNA and CK20mRNA. RESULTS: Of the 14 patients in whom BN and SL were identified, 1 (7.1%) had positive CEAmRNA and positive CK20mRNA of SL. CONCLUSION: Our present study shows the possibility for the existence of cancer cells in the lymphaticus from the tumor to BN. We should avoid the cut of lymphaticus when we perform gastrectomy.

[Feasibility of S-1/CDDP therapy for outpatients with advanced gastric cancer].

S-1/CDDP combination chemotherapy is conducted in many institutions, but most patients are hospitalized at the time of CDDP administration. We performed S-1/CDDP combination chemotherapy in 15 patients with advanced gastric cancer, and CDDP was administered in the outpatient department for 8 outpatients out of the 15 patients without renal failure or dysfunction. If outpatient chemotherapy can safely perform a regimen based on evidence, it brings about improvement in the QOL of the patient, and there are considerable advantages for economical care delivery. S-1/CDDP combination chemotherapy for outpatients was regarded as feasible with appropriate patient guidance.

Significance of volume-reduction surgery for far-advanced gastric cancer during treatment with novel anticancer agents.

BACKGROUND: We retrospectively assessed the survival benefit of novel anticancer agents (NACA) after volume-reduction surgery for far-advanced gastric cancer (FAGC). METHODS: From 1995 to 2005, 41 patients with FAGC underwent chemotherapy after volume-reduction surgery. Those treated since 2000 who received NACA were referred to as group A, and those treated before 2000, who received anticancer agents other than NACA, were referred to as group B. In addition, 21 patients with unresectable gastric cancer treated since 2000 who received NACA were referred to as group C. We investigated the significance of volume-reduction surgery during treatment with NACA. RESULTS: The median survival time (MST) was significantly prolonged in group A (626 days) compared to group B (364 days; P = 0.0156). Multivariate analysis showed that having one noncurative factor (NCF), and the use of NACA, were factors that contributed to survival time. Comparison between the subgroup of group A that had one NCF and the subgroup that had two or more NCFs revealed MSTs of 700 days and 180 days, respectively, with a significantly longer MST among the patients with one NCF (P = 0.0021). In addition, no difference from the MST of 333 days in group C was seen among the group A patients with two or more NCFs. CONCLUSION: The postoperative survival time of patients with one NCF was prolonged by the advent of NACA, but no significant prolongation was observed in the patients with two or more NCFs.