[Long-Term Survival from Gastric Cancer Treated with Radiotherapy for Distant Lymph Node Recurrence-A Case Report].

A 69-year-old man was diagnosed with advanced gastric cancer in the upper body of the stomach and underwent total gastrectomy with D2 lymph node dissection. At the diagnosis, the pathological stage was T2N3M0(Stage ⅢA). The patient underwent adjuvant chemotherapy with S-1 for a year. Two years after surgery, metastasis in subclavian and axillary lymph nodes was diagnosed by positron emission tomography-computed tomography(PET-CT). He rejected systemic chemotherapy, and radiotherapy(RT)at 56 Gy/28 Fr was administered. After RT, the metastatic lymph node completely regressed. However, CT showed lymph node metastasis in the right cervical, supraclavicular, and mediastinal zones over 1 year and 6 months after RT. These body regions received RT at a total dose of 40 Gy/20 Fr, and cancer significantly shrank again. Five years after following the second RT, the patient remains alive with no signs of relapse. RT may be a promising method for localized distant metastasis in patients who did not receive chemotherapy.

Strangulation of the small intestine caused by an intra-mesosigmoid hernia: a case report.

Sigmoid mesocolon hernia is an uncommon type of internal hernia with only a few cases reported to date. This disease entity can progress rapidly to cause vascular disturbance, necrosis, and perforation of the bowel wall; therefore, early diagnosis and surgical treatment are essential. We describe the case of an intra-mesosigmoid hernia in a 60-year-old man without history of previous abdominal surgery who presented with sudden acute abdominal pain and vomiting. Based on computed tomography, which showed ascites and small bowel obstruction, we diagnosed him as having strangulation of the small intestine caused by a sigmoid mesocolic hernia and performed emergency surgery. Laparotomy revealed small intestinal strangulation, extensive engorgement, and discoloration of bowel loops. Approximately 100 cm of the small intestine extending from the ligament of Treitz had undergone strangulation and herniated into the defect of sigmoid mesocolon, leading to a diagnosis of an intra-mesosigmoid hernia. Because the incarcerated portion of the small intestine was viable, we did not perform intestinal resection and reconstruction but closed the defect in the sigmoid mesocolon. His postoperative course was uneventful.

[A case report of successful treatment for rectosigmoid cancer with peritoneal dissemination after neoadjuvant chemoradiotherapy with XELOX and bevacizumab].

A 60-year-old woman underwent emergency operation for ileus due to rectosigmoid cancer. Intraoperative cytology and peritoneal dissemination were positive. After performing sigmoid colostomy, she underwent neoadjuvant radiation therapy (40 Gy)and eight courses of a XELOX and bevacizumab regimen. FDG-PET did not indicate FDG accumulation after chemoradiotherapy, thus, we performed low anterior resection. Peritoneal dissemination and washing cytology were negative in the second operation. Neoadjuvant chemoradiotherapy with XELOX and bevacizumab were useful for down staging in patients with advanced colorectal cancer.

Complete Response of Para-Aortic and Lateral Pelvic Lymph Node Recurrence of Rectal Cancer Treated to S-1 Monotherapy.

This report presents a case of para-aortic and lateral pelvic lymph node recurrence of rectal cancer that showed complete response to S-1 monotherapy. A 69-year-old man underwent low anterior resection for rectal cancer in 2007. Para-aortic lymph and right lateral pelvic lymph node recurrence occurred in 2008. He received a fluorouracil/folinic acid plus oxaliplatin regimen; however, G4 neutropenia and G3 fatigue were experienced. We started S-1 monotherapy as a salvage treatment. Abdominal computed tomography did not reveal any para-aortic and lateral pelvic lymph nodes recurrence after 10 cycles of S-1 monotherapy. Hence, response in this case was classified as a complete response. No recurrence was noted 36 months after the complete response. S-1 monotherapy is likely to be effective in treating patients with metastatic colorectal cancer who do not respond to standard combination chemotherapy.

Complete response of liver metastasis of gastric cancer treated by s-1 chemoradiotherapy: a case report.

This paper presents a case of suspected liver metastasis of gastric cancer and a virtual complete response to S-1 chemoradiotherapy. A 69-year-old man underwent distal gastrectomy for gastric cancer in 2008. Multiple liver metastases occurred in 2009. He underwent 15 courses of S-1 therapy and radiation therapy (37.5 Gy). Abdominal computed tomography showed virtual complete disappearance of liver metastasis after chemoradiotherapy. Hence, this case was interpreted as a complete response. No sign of recurrence was noted 18 months after complete response was confirmed. S-1 chemoradiotherapy is likely to be effective in treating patients with liver metastases of gastric cancer.

Complete Response of Isolated Para-aortic Lymph Node Recurrence from Rectosigmoid Cancer Treated by Chemoradiation Therapy with Capecitabine/Oxaliplatin plus Bevacizumab: A Case Report.

Para-aortic lymph node recurrence is a rare type of metastasis from colorectal cancer, and no treatment has yet been established. Here, we report on a case of isolated para-aortic lymph node metastasis from rectosigmoid cancer that showed complete response to chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab. A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Para-aortic lymph node recurrence occurred in 2011. She underwent radiation therapy (50 Gy) and 8 courses of capecitabine/oxaliplatin plus bevacizumab. Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy. Hence, this case was interpreted as a complete response. No recurrence was noted 6 months after the complete response. Chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab is likely to be effective in treating patients with para-aortic lymph node recurrence.

[A case report of pathologically complete response of locally advanced rectal cancer after neoadjuvant chemoradiotherapy with XELOX and bevacizumab].

A 70-year-old man was admitted to our hospital for constipation. A clinical examination showed locally advanced rectal cancer with possible invasion to the prostate gland and pelvic wall. After performing colostomy, he underwent neoadjuvant radiation therapy (40 Gy) and six courses of a XELOX and bevacizumab regimen. A subsequent examination demonstrated significant reduction of the tumor, so we performed super low anterior resection and colo-anal anastomosis. Pathological examination revealed no residual cancer cells and showed pathological CR. Neoadjuvant chemoradiotherapy with XELOX and bevacizumab were useful for down staging and function-preserving surgery in patients with locally advanced rectal cancer.