[The efficacy of postoperative adjuvant chemotherapy for esophageal cancer with lymph node metastasis].

The clinical significance of postoperative 5-fluorouracil+cisplatin(FP) therapy for esophageal cancer with lymph node metastasis was retrospectively investigated. Overall, 37 patients who underwent curative resection of esophageal squamous cell cancer with lymph node metastasis were investigated. Clinical background and prognosis were compared between patients treated with FP therapy(FP group, 13 patients) and patients treated without FP therapy(non-FP group, 24 patients). In the FP group, the completion rate and adverse events were also analyzed. No significant difference was found between the FP and non-FP group in terms of age, gender, tumor location, number of dissected lymph nodes, and number of lymph node metastases. However, the frequency of 3-field lymph node dissection in the FP group was higher than that in the non-FP group(p=0.04), and the risk for operation in the FP group tended to be lower than that in the non-FP group(p=0.06). There was no significant difference in disease-free survival between these groups(p=0.46). Overall survival time in the FP group tended to be longer than that in the non-FP group (p=0.06). In the FP group, 2 patients with Grade 3 adverse events were recognized, and the completion rate of FP therapy was 77%. Although we analyzed a small number of patients in this study, postoperative adjuvant chemotherapy using FP does not contribute to the prevention of recurrence in esophageal cancer patients with lymph node metastasis.

Mucosa-associated lymphoid tissue lymphoma of the appendix vermiformis.

A 60-year-old woman with right lower abdominal pain was admitted to our hospital. Computed tomography demonstrated right hydronephrosis and an irregular mass of 4 x 3 cm adjacent to the ileocecal region and iliopsoas muscle. Preoperative serum soluble anti-interleukin-2 receptor antibody was elevated (689 U/ml). Laparotomy showed an appendiceal tumor invading the cecum, mesocolon, right ureter, and duodenum. Right hemicolectomy with partial resection of the right ureter was performed. Histologic examination revealed diffuse infiltration of centrocyte-like cells, scattered plasma cells, and immunoblasts. The centrocyte-like cells were immunohistochemically positive for CD20 and CD79a, and were negative for BCL2, CD3, CD5, and CD10; this was compatible with primary mucosa-associated lymphoid tissue (MALT) lymphoma. The patient has shown a favorable course without recurrence for 2 years postoperatively. This is the sixth documented case of primary MALT lymphoma of the appendix. The spectrum of sites in which gastrointestinal MALT lymphomas occur should be expanded to include the appendix.

[Current trends and problems in chemotherapy for elderly patients with advanced gastric cancer].

PURPOSE: To assess current trends and problems in chemotherapy for elderly patients with unresectable gastric cancer. PATIENTS AND METHODS: Patients with unresectable gastric cancer were divided into two groups: an elderly group aged 70 years or older (n=28), and a control group aged younger than 70 years (n=46). The feasibility, safety, and efficacy of chemotherapy were compared between the two groups. The induction rate for a first-line treatment did not differ between the groups (89% for the elderly group versus 93% for the control group). A regimen comprising S-1 and cisplatinum (CDDP) was selected most frequently as the first-line treatment in both groups. When an analysis was restricted to patients given S-1 and CDDP, the elderly group showed fewer cycles of CDDP administration, a higher rate of grade 3 or worse adverse events, a lower rate of switching to a second-line treatment, and a shorter overall survival than the control group, although the p values did not reach a significant level. Among patients aged 70 years or more, those given S-1 alone showed an overall survival equivalent to that for patients given S-1 and CDDP. In conclusion, in clinical practice, it seems appropriate to consider whether the S-1+CDDP regimen is the most optimal first-line treatment for elderly patients with gastric cancer.