[A Case of Advanced Breast Cancer in Which Mohs' Paste and Systemic Drug Therapy Allowed Local and Disease Control].

Local control of disintegrating advanced breast cancer is often difficult because of the exudate, bleeding, and the foul odor. The current author encountered a case of large breast cancer with ulceration in which drug therapy and local control with Mohs' paste allowed disease control. The patient was a 61-year-old woman. There was a large ulcerated lump in her right breast, and exudate, bleeding, and a foul odor were present. The woman was diagnosed with hormone-sensitive mucinous carcinoma based on a biopsy, and diagnostic imaging revealed axillary lymph node metastasis and multiple metastases in both lungs. Mohs' paste was used locally, and local control was achieved after 1 month. A year and a half after the start of systemic drug therapy, the breast lump disappeared, and lung metastases and lymph node metastasis had almost disappeared. A CR has been maintained 3 years and 5 months later. Mohs' paste was extremely useful in achieving local control of exudation and bleeding from exposed unresected cancer. This was an excellent treatment in the patient's terminal stages and as part of local treatment in combination with systemic drug therapy.

[A Case of HER2-Positive Gastric Cancer with Multiple Lung and Liver Metastases Showing Long-Term Survival].

A male patient in his 70s visited our hospital with a complaint of tarry stool. A detailed examination revealed gastric cancer( pap, tub1, HER2[3+]), with multiple lungs and liver metastases. Chemotherapy with 4 courses of capecitabine, cisplatin, and trastuzumab(Tmab)and 4 courses of weekly paclitaxel(wPTX)plus 3w-Tmab were administered, and CR was achieved. Thereafter, Tmab was administered alone; however, local recurrence of the primary lesion was observed 24 months after diagnosis, and treatment with PTX and Tmab was resumed. After 68 months of diagnosis, the recurrent tumor increased in size. Therapy with nab-PTX plus ramucirumab was initiated, following which, the tumor growth was restricted. Eventually, the patient died of another disease after 6 years and 5 months of diagnosis. Chemotherapy for unresectable advanced/recurrent gastric cancer has a remarkable antitumor effect; however, a complete cure with chemotherapy alone is difficult. Therefore, a multimodal treatment, including chemotherapy, surgical treatment, and radiation therapy, is important.

[Intraductal Papillary Mucinous Carcinoma with Penetration in the Colon and Retrograde Infection-A Case Report].

We report a case of intraductal papillary mucinous carcinoma(IPMC)penetrating the colon in an 82-year-old man. He visited our hospital with left upper abdominal pain. Abdominal CT showed IPMC of the pancreatic tail, measuring 7 cm, with tumor penetration to the colon and retrograde infection. After the antibacterial treatment, we performed distal pancreatectomy with colectomy. Pathological examination showed proliferation of adenocarcinoma of the gastrointestinal tract with penetration to the colon. Severe fibrosis and calcification surrounding the invasive cancer cells suggested a long disease duration. Despite adjuvant chemotherapy, he developed recurrence of peritoneal dissemination after 9 postoperative months, and subsequently, systemic chemotherapy was started. As intraductal papillary mucinous neoplasm(IPMN)might penetrate the adjacent organs, leading to a poor prognosis, even over a prolonged time period, IPMN should be followed-up appropriately and resected soon after the suspicion of malignant transformation.

[A Case of Multiple Bevacizumab-Related Colonic Perforations during Opioid Use].

We present the case ofa 54-year-old man who had been treated with bevacizumab-containing chemotherapy for a postoperative recurrence of lung cancer for 5 months; he had used opioids for cancer pain in his right lateral chest for 2 months. He was admitted to the hospital because his chest pain had worsened 5 days earlier and he was experiencing a dull pain in his lower abdomen. His condition was recognized as an aggravation of the cancer pain and his opioid dose was increased. He presented with intense abdominal pain 6 days after admission, and we diagnosed gastrointestinal perforations from an abdominal CT scan. Therefore, we undertook an emergency operation. Multiple perforations were seen on the transverse and descending colon; an extensive colectomy and a colostomy were performed. Histopathological findings showed that multiple ulcer perforations and normal mucosa coexisted throughout the resected specimen. Bevacizumab-induced ischemic changes were the suspected cause. When pain control becomes variable during opioid use, conditions such as bevacizumab-related gastrointestinal perforations should be considered, in addition to progression of the cancer pain itself, and the appropriate treatment should be administered.

[Examination of outcomes after conversion surgery for Stage IVGastric cancer in our hospital].

PURPOSE: We examined the outcomes of conversion surgery (CS) for Stage IV gastric cancer performed in our hospital. OBJECTIVE AND METHOD: We retrospectively examined the outcomes of 5 Stage IV gastric cancer patients, for whom surgical excision was possible and CS was performed after induction chemotherapy between January 2010 and December 2013. RESULTS: The median age of the patients who underwent CS was 62 years, and non-recovering factors were as follows: M1 (LYM) for 3 patients, H1 for 1 patient, and P1 for 1 patient. For all patients, the induction chemotherapy regimen consisted only of TS-1+cisplatin (CDDP). Using diagnostic imaging to determine treatment effect, we found that 2 patients showed a partial response(PR)as a result of the induction chemotherapy. As a result of CS, R0 surgery could be enforced to 3 cases and postoperative complications accepted neither. Ef-grade which of the histopathological judging of the chemotherapy were 1a: 4 cases, 2: 1 case. After adjuvant chemotherapy treatment in 3 patients, the median survival time (MST) of the CS patients was 22.5 months. In contrast, the MST of non-CS patients, who received treatments other than CS, was 4 months. These results indicate that the MST for CS patients was substantially longer compared to patients who did not receive CS (p=0.046). CONCLUSION: Although CS in response to Stage IV gastric cancer fully needed to examine selection of a case, the timing of operation introduction, etc. to be successful, a possibility of contributing to a prognosis improvement in a multidisciplinary treatment was suggested.

Aprepitant plus granisetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients with gastric cancer treated with S-1 plus cisplatin.

BACKGROUND: We aimed to evaluate the efficacy of a new combination antiemetic therapy comprising aprepitant, granisetron, and dexamethasone in gastric cancer patients undergoing chemotherapy with cisplatin and S-1. METHODS: Gastric cancer patients scheduled to receive their first course of chemotherapy with cisplatin (60 mg/m(2)) and S-1 (80 mg/m(2)) were treated with a new combination antiemetic therapy aprepitant, granisetron, and dexamethasone on day 1; aprepitant and dexamethasone on days 2 and 3; and dexamethasone on day 4. The patients reported vomiting, nausea, use of rescue therapy, and change in the amount of diet intake, and completed the Functional Living Index-Emesis (FLIE) questionnaire. The primary endpoint was complete response (CR; no emesis and use of no rescue antiemetics) during the overall study phase (0-120 h after cisplatin administration). The secondary endpoints included complete protection (CP; CR plus no significant nausea); change in the amount of diet intake; and the impact of chemotherapy-induced nausea and vomiting (CINV) on daily life during the overall, acute (0-24 h), and delayed (24-120 h) phases. RESULTS: Fifty-three patients were included. CR was achieved in 88.7, 98.1, and 88.7% of patients in the overall, acute, and delayed phases, respectively. The corresponding rates of CP were 67.9, 96.2, and 67.9%. Approximately half of the patients had some degree of anorexia. FLIE results indicated that 79.5% of patients reported "minimal or no impact of CINV on daily life". CONCLUSIONS: Addition of aprepitant to standard antiemetic therapy was effective in gastric cancer patients undergoing treatment with cisplatin and S-1.

[Protocol for the administration of modified FOLFOX6 (mFOLFOX6) in patients with unresectable/recurrent colorectal cancer].

In patients undergoing FOLFOX6 therapy for the treatment of unresectable/recurrent colorectal cancer, control of cumulative peripheral neuropathy is problematic. In our department, we stop using mFOLFOX6 as a primary therapy after 6 to 8 courses. Instead, we use mFOLFOX6 as a secondary therapy, and re-introduce mFOLFOX6 as a tertiary therapy; the patients undergoing this treatment protocol were included in Group A. We have studied the degree of neurotoxicity and the time of its occurrence in these patients compared to those undergoing the standard method (Group B; 12 cases). Grade 3 peripheral neuropathy was observed in both the groups. In Group B, peripheral neuropathy occurred in the primary treatment period, whereas in Group A, it appeared in the tertiary treatment period. Moreover, in Group A, we observed Grade 2 peripheral neuropathy in the primary treatment period in 3 cases, but this was promptly resolved after the therapy was shifted to the secondary treatment period. The period with neurological toxicities was shorter in Group A compared to Group B. When treating colorectal cancer with chemotherapy, it is important to elucidate how the prognosis can be improved while maintaining the quality of life( QOL). In our department, we place a greater emphasis on the QOL of the patient.

[A case of recurrent breast cancer that responded to bevacizumab].

We report a case of a 59-year-old woman who was forced to undergo mastectomy of the right breast (Rt Bt) plus axillary lymph node (Ax) dissection for right breast cancer at another hospital. The pathological diagnosis was invasive ductal carcinoma( scirrhou[s sci], pT2N2M0, Stage IIIA, estrogen recepto[r ER[]+], progesterone recepto[r PgR[]+], human epidermal growth factor receptor-2[HER2][2+]). Although no recurrence was observed after postoperative adjuvant chemotherapy and endocrine therapy, skin metastasis on the left back and pleuritis carcinomatosa were detected at our hospital 9 years and 6 months after the operation. Thereafter, bone metastasis, contralateral lymph node metastasis, and frequent occurrence of hepatic metastasis were sequentially detected. The patient was treated with chemotherapy (a total of 4 regimens) and endocrine therapy in addition to radiation therapy for lymph node metastasis over a period of approximately 2 years and 3 months; however, disease control was poor. Therefore, combined chemotherapy with paclitaxel and bevacizumab was initiated from February 2012. Soon after the initiation of combination therapy, the serum carcinoembryonic antigen (CEA) level gradually reduced and computed tomography (CT) revealed that the multiple-organ metastases had remarkably reduced in size. The response was classified as a clinical partial response (cPR). Although adverse events such as peripheral neuropathy, nose bleeding, and high blood pressure were observed, these were all of lesser that Grade 2 severity. The efficacy of chemotherapy was noted for 11 months.