[Two Cases of Advanced Gastric Cancer Diagnosed as Pathological Complete Response after Preoperative Chemotherapy with S-1 and Oxaliplatin].

We herein report 2 cases of gastric cancer treated by S-1 and oxaliplatin combination therapy before later undergoing gastrectomy. The pathological results of both cases demonstrated complete response. Case 1 had a giant tumor which was suspected to have invaded the pancreas. Case 2 was associated with extensive lymph node metastasis. Based on the findings of these 2 cases, preoperative chemotherapy with S-1 and oxaliplatin for advanced gastric cancer shows sufficient efficacy.

[Long-Term Survival of Gastric Cancer with Multiple Liver and Lymph Node Metastases-A Case Report].

Currently, chemotherapy against unresectable advanced gastric cancer is progressing with the development new drugs and due to results of several clinical trials. Here, we reported a case of long-term survival of gastric cancer with multiple liver and lymph node metastases. A 68-year-old man was diagnosed with gastric cancer and Virchow lymph node, para-aortic lymph node, and multiple liver metastases at another hospital. He was referred to our hospital from Yamashita Naika Syokakika. We administrated 4 courses of S-1 plus CDDP. The main tumor and all metastatic lesions were significantly reduced. Subsequently, total gastrectomy, partial liver resection, and left neck and para-aortic lymph node resection(conversion surgery)were performed. The cancer cell was remnant at the main tumor and para-gastric lymph node. No cancer cells were detected in another lesion(R0 resection). Postoperatively, only S-1 was administered. However, 28 months after undergoing gastrectomy, liver metastasis occurred. Therefore, S-1 plus oxaliplatin, paclitaxel plus ramucirumab, and CPT-11 plus CDDP were administered. Liver metastases again increased and decreased, respectively. However, 46 months after gastrectomy, liver metastasis recurred and nivolumab was administered. Subsequently, liver metastases disappeared. At 55 months after gastrectomy, rectal resection was performed against rectal cancer and partial liver resection against liver metastases. Cancer cells were not detected in the resected specimens.

[A Case of Unresectable Pancreas Cancer with 32 Months Survival after Chemotherapy].

We report a case of unresectable pancreas cancer. A 70-year-old woman presented with worsening diabetes and serum CA19-9 elevation. A tumor with portal vein and supra-mesenteric vein invasion was observed by computed tomography. She was diagnosed with unresectable pancreas head cancer that was locally advanced. Chemotherapy was administered with gemcitabine and nab-paclitaxel for 19 courses, followed by gemcitabine alone for 4 courses. After the addition of 6 courses of chemotherapy, a 60%dose of chemotherapy was administered for 13 courses due to severe neutropenia. The patient died 32 months after the first visit. The 60% dose of gemcitabine and nab-paclitaxel also inhibited tumor growth. These findings suggest the effective and safe long-term use of gemcitabine and nab-paclitaxel.

[A case of recurrence gastric cancer patient who was post operated and multi drug chemotherapy was effective for administration of S-1 and docetaxel combination therapy].

Recently, chemotherapy against gastric cancer has been diversified with an appearance of new agents such as S-1, capecitabine, CPT-11, oxaliplatin, paclitaxel and docetaxel. But a prognosis of advanced or recurrent gastric cancer patient, who was failure of first- and second-line chemotherapy, was poor. We reported that a case of recurrence gastric cancer patient who was post operated and multi drug chemotherapy was effective for administration of S-1 and docetaxel combination therapy. A case was a 50-year-old man. He underwent distal gastrectomy and administered of multi anticancer drugs until about eight years after operation. But multi lung and liver and lymph-node metastases were appeared. We administered S-1 and docetaxel combination chemotherapy. After two courses, multi metastatic lesions were reduced in size, and tumor markers were decreased. The same combination therapy was administered for six courses, but metastatic lesions were increased again. At one hundred four months after the operation, he died in the palliative care unit.

[A case of a gastric cancer patient who obtained good treatment in spite of a nontreatment decision].

The patient was a 57-year-old male who had received schizophrenia and alcoholism treatments for ten years. Hospitalization and release was repeated many times over in the psychiatry department of the hospital up to the present time. He received an upper endoscopy because of a stomach ache in May, 2004. He was diagnosed as having gastric cancer (L, post, Type 2, T2 (SS), N2, stage IIIA). Neoadjuvant chemotherapy TS-1+CDDP was begun from the beginning. However, he refused the operation afterwards and we changed the treatment. The chemotherapy was maintained until January, 2005, to enforce seven courses of the treatment and to maintain the long NC for about ten months. Afterwards, he refused the treatment again and did not come to the hospital. After six months, he came to hospital again for pyloric stenosis due to a stomach cancer that developed. We placed a PEG to keep the route for access to the pylorus in August. And we used it to induce the self-expandable metal stent (EMS) to the pylorus. As a result, oral ingestion became possible. He was able to obtain a good QOL for three months until dying thereafter. It is thought that stenting is one of the most effective treatments to correspond to the diversification of the treatment policy.

[A case of unresectable hilar cholangiocarcinoma treated with an insertion of biliary stent and herbal medicine obtaining a good quality of life].

An advanced hilar cholangiocarcinoma was poor in prognosis and required a biliary duct drainage tube insertion to prevent jaundice. An endoscopically placed metallic biliary stent is efficient for improving QOL of patients with the disease. This case was of a 65-year-old man. He was admitted to our hospital with obstructive jaundice. Hilar cholangiocarcinoma was diagnosed by computed tomography (CT) and MR cholangiopancreatography (MRCP). Abdominal angiography revealed an unresectable cholangiocarcinoma through the portal vein obstruction and stenosis of the left hepatic artery for tumor invasion. After a second opinion and informed consent, he was inserted a biliary stent (non-covered metallic stent) under an endoscopy. The jaundice was improved further and other laboratory data showed normal results except for tumor markers. After the patient left the hospital, he came to our hospital as an outpatient basis for observation. He was prescribed herbal medicine from the other hospital. Now after ten months since the biliary stent insertion, he has been free from symptoms with normal laboratory data.

[A case of ascities decrease in malignant peritoneal mesothelioma by weekly intra-peritoneal administration of cisplatin and paclitaxel].

We report a case of malignant peritoneal mesothelioma (MPM) in a 63-year-old man. He had body weight loss and abdominal distension for one month, and was admitted to our hospital. Abdominal sonography showed a large mass occupying the right lower abdomen and an existence of a lot of ascites. Computed tomography and magnetic resonance image showed a lot of ascites and omentum cake. Cytology of the ascites was Class V but its histological classification was unknown. Then we performed biopsy of the tumor into the omentum with abdominal sonography. The histological diagnosis was MPM because the tumor cells showed positive for calretinin. He received a combination chemotherapy of weekly intra-peritoneal administration of cisplatin (70 mg/ day) and paclitaxel (100 mg/day). The ascites was decreased and per os (PO) was possible, but omentum cake was not changed. MPM was poor in prognosis and the control of ascites was difficult. We suggest that the chemotherapy of intra-peritoneal administration was a better procedure than others to control ascites with malignant tumors.