[Successful Endoscopic Submucosal Dissection of Early Gastric Cancer in a Patient after Azacitidine Therapy for the Treatment of Myelodysplastic Syndrome].

A 76‒year‒old man was introduced to our hospital after being suspected of having early gastric cancer with an upper gastrointestinal endoscope that was performed to find the cause of anemia. Two cancers were revealed: type 0‒Ⅱa+Ⅰ lesion in the lesser curvature of the upper body and type 0‒Ⅱa+Ⅱc lesion in the greater curvature of the middle body. The blood test showed abnormalities(hemoglobin, 6.8 g/dL; platelets, 26,000/µg). Thus, myelodysplastic syndrome(MDS) was suspected, and since this was prioritized over gastric cancer, the patient was transferred to the hematology department. As high risk MDS was diagnosed, azacitidine therapy was initiated. After 2 cycles of treatment, the blood abnormalities improved(hemoglobin, 11.3 g/dL; platelets, 254,000/µg). ESD was performed in our department for the 2 lesions. Histopathological examination showed that both lesions represented well‒differentiated adenocarcinoma, and so radical resection was performed. Since MDS occurs due to aging and is common among patients, we believe that timely treatment is necessary.

[A Case of Advanced Gastric Cancer Confirmed as Pathological Complete Response Following S-1 plus Oxaliplatin Chemotherapy and Gastric Resection].

A 69-year-old woman presented with persistent nauseous, underwent upper gastrointestinal endoscopy, and was diagnosed with type 2 advanced gastric cancer at the antrum. Abdominal contrast CT image data revealed that there was a large, swollen, pancreatic superior lymph node invading the common hepatic artery. We determined that the tumor was unresectable and systemic chemotherapy was performed using S-1 plus oxaliplatin(SOX)therapy. After 5 courses of chemotherapy, the abdominal contrast CT image data indicated reduction of both the primary lesion and lymph node metastasis. A laparotomy was performed. As the No. 8a lymph node was forming hard scar tissue, we could not dissected clearly it from the common hepatic artery wall. We strongly suspected that cancer tissue remained at the artery wall. A distal gastrectomy and Roux-en-Y reconstruction were performed. Histologically, the resected specimen was determined to be Grade 3, with a pathological complete response(pCR). The patient was administered S-1 for 6 months after the operation and has enjoyed 2.5 years of recurrence-free survival. SOX therapy for unresectable gastric cancer and surgical intervention as conversion surgery were effective. This case demonstrated the possibility of life prolongation using these therapies.

[A case of simultaneous hepatic metastases of ascending colon cancer responding completely to tegafur/uracil plus oral Leucovorin therapy after primary lesion resection].

An 81-year-old woman, who suffered from ascending colon cancer with liver metastases, underwent right hemicolectomy. She did not undergo liver resection due to her age and her family's decision, and was treated with UFT plus oral Leucovorin therapy. The metastases were remarkably reduced in the early phase and disappeared completely on SPIO-MRI 2 years 9 months later. Adverse effects of this therapy are relatively few, and it can serve as first-line chemotherapy for advanced colorectal cancer.

[Two cases of stage IV gastric cancer who underwent total gastrectomy and achieved long-term survival by sequential chemotherapy].

We describe two patients, who suffered from Stage IV gastric poorly differentiated adenocarcinoma and underwent palliative total gastrectomy, were treated by sequential chemotherapy and achieved long term-survival. The first patient was a 55-year-old male with peritoneal dissemination. After total gastrectomy, he was treated with methotrexate-5-fluorouracil (MTX/5-FU) sequential therapy for 5 months, S-1 single-agent therapy for 4 years and weekly paclitaxel (PTX) therapy for 9 months. He is being treated with irinotecan (CPT-11) therapy as an outpatient now, and has achieved 5 year 8-month survival. The second patient was a 60-year-old female. We observed unresectable metastases around the pancreas, aorta, and transverse mesocolon. She was treated with S-1 single-agent therapy for 1 year 10 months, MTX/5-FU sequential therapy for 9 months. She is now receiving weekly PTX therapy for 3 months as an outpatient and has achieved 2 year 11-month survival.