[A Case of Metastatic and Recurrent Colon Cancer Whose QOL Kept Longly by Multidisciplinary Treatment Including Six Times Surgical Operation].

The patient was 75-year-old male, he has been diagnosed as ascending colon cancer resected by rt. hemicolectomy in September 2010. Final diagnosis was tub2, T4b, N1, Cy1, M0, pStage Ⅲc. Despite adjuvant chemotherapy, a lung metastasis was found in April 2012, and it was treated by thoracoscopic partial lung resection. In July 2012, pelvic lymph node recurrence was found, and treated by radiation therapy. In August 2013, right testicular metastasis was resected. After 2 years chemotherapy free intervals, it was resumed by S-1→irinotecan(CPT-11)→regorafenib due to peritoneal disseminations. In July 2016, transverse colostomy was performed due to obstruction caused by peritoneal dissemination. Although, chemotherapy was continued after surgery by trifluridine plus bevacizumab(Bev)→CPT-11, recurrent tumor in rt spermatic cord was enlarged, which resected to reduce its pain. While continuing chemotherapy with CPT-11 plus Bev, rapid growth of peritoneal disseminated tumor with its rapture has induced peritonitis and sepsis, so it was forced to be resected by involving rectum, ileum, and ureter in February 2019. Finally, with totally 6 times these operations, continuing chemotherapy may be maintaining his QOL and prognosis.

[Percutaneous Transhepatic Cholangiodrainage to Alleviate Symptoms of Afferent Loop Obstruction--A Case Report].

The patient, a 78-year-old man, had undergone distal gastrectomy for a gastric ulcer 35 years previously. As melena was observed, he was referred to our department, and was subsequently diagnosed with residual gastric cancer and ascending colon cancer. Peritoneal metastasis of gastric cancer was found, and palliative surgeries, including right hemicolectomy, total gastrectomy, and Roux-en-Y reconstruction were performed. Although postoperative chemotherapy was commenced, side effects led to a decreased performance status (PS), which resulted in the patient shifting to the best supportive care (BSC). Five months after surgery, the patient was urgently transferred to the hospital with upper abdominal pain, and underwent computed tomography (CT) scan. The patient was diagnosed with acute afferent loop obstruction due to peritoneal metastases. It was not possible to perform endoscopic drainage because of the stenosis; therefore, percutaneous transhepatic cholangiodrainage (PTCD) was performed to reduce the pressure in the duodenal afferent loop. Herein, we report on a case of afferent loop obstruction, for which we performed decompression of the afferent loop with PTCD, allowing the patient to continue BSC for approximately 3 months.

[Advanced gastric cancer(Stage IV)leading to perforation during chemotherapy with S-1 plus cisplatin].

A 60-year-old man was diagnosed with advanced gastric cancer(Type 3)with multiple liver and lymph node metastases. The clinical stage was determined to be T3(SS), N2, M1, P0, H1, Stage IV, and a chemotherapy regimen of S-1 plus cisplatin (CDDP)was selected for treatment. During 3 courses of chemotherapy, the patient complained of severe abdominal pain, and an urgent laparotomy was performed with a tentative diagnosis of perforated gastric cancer. Surgical findings revealed a 5-mm perforation in the upper part of the anterior wall of the stomach, from the center of the tumor. Although we detected a metastasis only in S6 of the liver, we decided to perform total gastrectomy, D1 lymphadenectomy, and Roux-en-Y reconstruction. Pathological findings demonstrated that cancer cells were replaced by fibrosis, and tumor response after treatment was determined to be Grade 2. No lymph node metastasis was observed. The patient received chemotherapy with S-1 4 weeks after the operation, without any perioperative complications. The patient is alive 12 months after the operation, without any enlargement of the liver metastasis.

[A case of Stage IV gastric cancer in which a partial response was maintained for four years with multidisciplinary treatment].

The patient was a 63-year-old man with Stage IV gastric cancer (cT3, cNX, cM1[LYN]). After chemotherapy with S-1 plus paclitaxel (PTX), a partial response was achieved, and distal gastrectomy was subsequently performed. During continued chemotherapy with S-1 plus PTX after surgery, enlarged lymph nodes (#16) were observed. Metastasis was detected and treated with radiation therapy. Ten months after the cervical and Virchow lymph node metastases were detected, lymph node dissection was performed. After the second surgery, chemotherapy with S-1 plus cisplatin (CDDP) was selected, but the regimen was changed to S-1 alone because of cerebral infarction. This treatment resulted in the maintenance of a partial response for one year. However, lymph node metastases around the right iliac artery and left cervix subsequently appeared, and lymph node dissection was performed. Since the metastatic lesions remained inside the left parotid gland, radiation therapy to the cervical region was performed again. However, the right inguinal and iliac lymph node metastases enlarged, and we again attempted to treat them with radiation therapy. The patient died due to peritoneal dissemination four years and two months after his first visit.

[A case of diffuse infiltrating carcinoma of large intestine with liver metastases effectively treated with systemic chemotherapy].

We report a case of diffuse infiltrating carcinoma of the large intestine effectively treated by operation and chemotherapy. A 79-year-old woman with bone and liver metastases due to descending colon carcinoma underwent left hemicolectomy and colostomy. Pathological resected specimen findings showed a diffuse infiltrating carcinoma(lymphangiosis type). She re- ceived chemotherapy with 7 courses of mFOLFOX6, 8 courses of mFOLFOX6/bevacizumab(BV), and 5 courses of FOLFIRI/BV after surgical resection. The liver metastases reduced markedly as observed by abdominal CT scan. Twelve months later, DIC caused the death of the patient. Resection with lymphadenectomy and systemic chemotherapy may be effective for treatment of diffuse infiltrating carcinoma of the large intestine.

[A case of liver metastasis of gastric cancer undergoing non-curative operation responding completely to combination therapy of S-1 and CDDP].

We experienced a case with liver metastasis of gastric cancer that disappeared by S-1 administration following non-curative operation. A distal gastrectomy for advanced gastric cancer with liver metastasis was performed on a 71-year-old male. S-1 was administered at 100 mg/body/day for 4 weeks followed by withdrawal for 2 weeks, and CDDP was prescribed at 5 mg/body/day div, for 2 days per a week as 1 course. After one course of treatment, the liver metastatic lesion decreased in size (reduction ratio was 87.4%). For side effect, S-1 100 mg alone was administered beginning with the second course. This lesion became CR after four courses. The adverse events of grade 3 observed during S-1 administration were neutropenia and diarrhea. We changed S-1 to UFT after nine courses, and the patient has now survived 1 year without recurrence after the disappearance of liver metastasis.

Tranilast (N-3,4-dimethoxycinamoyl anthranilic acid): a novel inhibitor of invasion-stimulating interaction between gastric cancer cells and orthotopic fibroblasts.

BACKGROUND: Fibroblasts produce various cytokines that affect the invasion ability of cancer cells. We have previously reported that gastric fibroblasts play an important role in the metastatic process of gastric cancer. Tranilast is a clinical drug for inhibition of fibroblast growth. To develop a drug for cancer invasion, the effect of Tranilast on the invasion-stimulating interaction was examined. MATERIALS AND METHODS: The human gastric carcinoma cell line, OCUM-2D, and the gastric fibroblast cell line, NF-10, were used. The effect of Tranilast on the invasion ability of OCUM-2D cells with NF-10 cells was examined by invasion assay. RESULTS: The invasion ability of OCUM-2D cells was significantly increased by co-culturing with NF-10 cells (p < 0.01). Tranilast, at concentrations of more than 0.01 mM, significantly suppressed the invasion ability of OCUM-2D cells co-cultured with NF-10 cells. Tranilast decreased matrix metalloproteinase-2 (MMP-2) and transforming growth factor-beta 1 (TGF-beta 1) production from fibroblasts. TGF-beta 1 enhanced the MMP-2 production from fibroblasts. The invasion ability of gastric cancer cells was increased by MMP-2 and TGF-beta 1 from fibroblasts and this effect was inhibited by Tranilast, which decreased the MMP-2 and TGF-beta 1 production from fibroblasts. CONCLUSION: Tranilast may be a promising new drug for preventing the metastasis of gastric cancer.