[Six-year survival with recurrent intrahepatic cholangiocarcinoma achieved by simple S-1 administration].

We report here a rare case of a patient with recurrent intrahepatic cholangiocarcinoma that was treated with simple S-1 chemotherapy, who is still alive 6 years later. A liver tumor was identified in segments 5 to 6 in a 60-year-old male asymptomatic hepatitis B carrier. The tumor was diagnosed as hepatocellular carcinoma by MRI and CT. However, following its resection by extended posterior segmentectomy of the liver, pathological findings identified it as an intrahepatic cholangiocarcinoma. The surgical margin was cancer-negative. No additional adjuvant chemotherapy was administered because of the patient 's impaired renal function. When tumor recurrence was found by MRI 30 months later, an additional liver resection was planned but a laparotomy was eventually performed. This was because intraoperative findings revealed Glissonian sheath invasion with involvement of the umbilical portion. S-1 treatment(100mg/body/day)was started. Although the dose had to be reduced(mostly 75mg/body/day)due to hyperbilirubinemia and there were some interruptions in the regimen, in total of 42 g of S-1 was administered. The patient is currently still alive, 6 years after the detection of the tumor recurrence. This represents a rare case in patients with intrahepatic cholangiocarcinoma.

[A case of AGC with pCR after preoperative chemotherapy including S-1 plus cisplatin].

A 79-year-old man complaining of epigastralgia was examined and diagnosed with advanced gastric cancer (UML, Type 5, Ant-Less-Gre, cT4a, cN1, cH0, cP1, cStage IV). A poor prognosis was predicted, but we tried preoperative chemotherapy hoping for a down-staging of the tumor. We chose a regimen of S-1 plus cisplatin as follows: S-1 (60 mg/m2) was administered orally for 3 weeks followed 2 weeks of rest, and cisplatin (50 mg/m2) was administered by intravenous drip on day 8. After three cycles of treatment, diagnostic laparoscopic examination revealed a suspected serosal invasion of the main tumor, but peritoneal dissemination was not seen, and abdominal washing cytology was negative. After the fourth cycle of treatment, total gastrectomy with lymph node dissection (D1+No. 7, 8a, 9, R0) was performed. Histological examination of the resected specimens revealed no residual cancer cells in the primary lesion or regional lymph nodes, resulting in a diagnosis of complete response to chemotherapy according to the Japanese Classification of Gastric Carcinoma. The postoperative course was uneventful, and he has been fine as an outpatient.

[A case of retroperitoneal dedifferentiated liposarcoma successfully treated with IFM and CDDP].

A 53-year-old man was evaluated for a chief complaint of abdominal bloating. Physical examination revealed an abdominal distention and ascites, and CT showed multiple large retroperitoneal masses. The patient was diagnosed with retroperitoneal liposarcoma. Surgery was performed including the tumor, small bowel, and sigmoid resection, and an artificial anus was constructed. Multiple tumors in the peritoneum were noted. Large dark red tumors that were hemorrhagic were resected, but the yellowish tumors were unresectable. On histopathology, the dark red lesions showed dedifferentiated liposarcoma, and the yellowish lesions showed well-differentiated liposarcoma. One month postoperatively, peritoneal dissemination increased including nodular infiltration of the artificial anus and multiple hepatic metastases. Despite VAC chemotherapy (VCR 1.5 mg, ACD 0.5 mg, CPA 900 mg), progressive disease (PD) was noted. As second-line chemotherapy, weekly IFM (2 g)+CDDP (30 mg) was given. Shrinkage of the tumor infiltrates in the artificial anus, decreased abdominal bloating, and improved QOL were observed. A partial response (PR) against peritoneal dissemination was achieved. However, hepatic metastases increased, and the patient died 6 months after surgery. This case suggests that IFM+CDDP may be useful in dedifferentiated liposarcoma.

[A case of anal canal carcinoma with systemic lymph node metastases successfully treated by bevacizumab+mFOLFOX6 therapy].

We describe our experience with a patient who had unresectable anal signet-ring cell carcinoma with extensive metastases to the lymph nodes, lungs, and bones. The patient was treated with bevacizumab (Bev)+mFOLFOX6 and achieved complete response (CR). He was a man in his fifties, who visited a local doctor with the chief complaints of swelling in the axillary and inguinal regions. Signet-ring cell carcinoma was diagnosed by examination of a biopsy specimen from the inguinal lymph nodes. A search for the primary tumor was performed, and anal canal carcinoma with pagetoid spread was detected in the perianal region. Positron emission tomography-computed tomography (PET-CT) showed an accumulation in lymph nodes throughout the body, as well as in the lungs and the bones. Bev+mFOLFOX6 therapy was initiated. After completion of 4 courses, the lymph nodes were no longer palpable. PET-CT scanning showed no accumulation. During the 8th course, tumor markers decreased to the normal range, and CR was diagnosed. When 13 courses had been completed, the patient experienced grade 3 numbness of the hands and feet, so his treatment was changed to Bev+FOLFIRI therapy. In conclusion, Bev+mFOLFOX6 therapy achieved 6 months of CR in our patient who had anal signet-ring cell carcinoma with systemic metastases, which seemed likely to have a very poor prognosis.

Efficacy of postoperative UFT (Tegafur/Uracil) plus PSK therapies in elderly patients with resected colorectal cancer.

To establish the sufficient therapy for elderly colorectal cancer patients, we retrospectively compared postoperative Tegafur/Uracil (UFT; Taiho Pharmaceutical Co., Ltd., Tokyo, Japan) and UFT plus protein-bound polysaccharide kureha (PSK) therapies in elderly patients with resected colorectal cancer. A total of 63 patients were collected; 39 patients were administered only with UFT (control group) and 24 patients were treated with UFT+PSK (PSK group). There were no differences in patient background, surgical outcomes, and drug compliance between the two groups. The 3-year relapse-free survival rate was 47.8% in the control group and 76.2% in the PSK group (p = 0.041). The 3-year overall survival (OS) rate was 52.8% in the control group and 80.8% in the PSK group (p = 0.0498). By subset analysis, in the patients whose tumor location was the colon (p = 0.016) and whose preoperative lymphocyte percentage was below 18.7% (p = 0.017), RFS was significantly better in the PSK group. Adverse drug reactions were rarely observed. All the adverse reactions were grade 2 or below, with no severe reactions. The present retrospective study suggests a possible efficacy of postoperative adjuvant therapy with UFT plus PSK in elderly patients over 70 years of age with resected colorectal cancer.

Paraaortic lymph node dissection for gastric cancer in 244 consecutive cases.

BACKGROUND/AIMS: More than 20% of patients with advanced gastric cancer show paraaortic lymph node metastasis. However, whether extensive paraaortic lymphadenectomy is beneficial remains controversial. We performed a prospective study of paraaortic lymphadenectomy for patients with advanced gastric cancer. METHODOLOGY: From January 1991 to March 2004, 244 consecutive patients with advanced gastric cancer underwent gastrectomy with paraaortic lymphadenectomy with curative intent. The patients were divided into 3 groups according to the period: Group 1 (1991-1995), Group 2 (1996-1999), and Group 3 (2000-2004). RESULTS: Overall mortality rate was 2.4%, and it fell rapidly from 7.1% in Group 1 to 0% in Group 3. Postoperative complications occurred in 35.6%. High age and postoperative complications were significant predictive factors for operative death. Preoperative comorbidity, positive distal margin, and pancreatectomy were significant predictive factors of postoperative complications. Depth of cancer invasion was correlated with paraaortic node metastasis. Ten patients with paraaortic node metastases survived for more than 5 years. Operative curability and postoperative complications were significant prognostic factors for patients who underwent this procedure. CONCLUSIONS: Paraaortic lymph node dissection for gastric cancer should be performed in patients with tumors deeper than the serosa. Pancreatectomy should be avoided, with careful management required in cases of unavoidable pancreatectomy.

[Results of local ablation therapy for liver metastases from colorectal cancer using radiofrequency ablation and microwave coagulation therapy (RFA/MCT)].

UNLABELLED: In addition to hepatectomy and chemotherapy with intra-arterial infusion, local ablation therapy using RFA and MCT has been used for treatment of liver metastases derived from colorectal cancer. We investigated the results of local ablation therapy in such cases conducted at our department. SUBJECTS AND METHODS: This study was conducted in 9 out of 21 patients with liver metastases derived from colorectal cancer, who underwent local ablation therapy with RFA from September 2001. As adjuvant therapy, the divided administration of low-doses CDDP/FU was conducted in all cases. RESULTS: RFA and MCT were used in 9 cases (25 lesions) and in 15 cases (82 lesions), respectively. The three cases of RFA were combined with MCT. The severity of liver metastasis was H1 and H2 in one case each and H3 in seven cases. The tumor diameter was 1.0-4.7 cm (mean, 2.7 cm) and patients underwent cauterization from 1-6 times (mean, 2.4 times). Although there were no critical complications, pyrexia and increased AST/ALT were found. The three-year survival rate was 50%, and thus favorable prognoses were obtained. CONCLUSION: There were no notable complications associated with local ablation therapy for liver metastases derived from colorectal cancer, and this method was thus indicated to be effective for local control in cases in which hepatectomy is impossible.

[A case of long-term survival after chemo-radiation for postoperative local recurrence of rectal cancer].

The patient was a 64-year-old male who underwent an abdomino-perineal resection (D3) for advanced lower rectal carcinoma with a formulated vesicorectal abscess. The tumor was a well-differentiated adenocarcinoma, type 2 in the Japanese Classification of Colorectal Carcinoma, and was measured 5.5x4.3 cm in size. Histologically, the tumor was considered to be stage II (H0, P0, a2, n0 (0/86), ly0, v0). He received a postoperative chemotherapy with oral UFT-E (400 mg/day) for 1 year. After 2 years from the surgery, the patient developed a perineal pain, and pelvic CT scans revealed a 4 cm mass anterior to the sacrum. The CEA level was increased to 11 ng/ml. Consequently, a diagnosis of local recurrence was made, and radiochemotherapy was commenced. Radiotherapy was given to the pelvic region at a total dose of 70 Gy (Given 2 Gy each x 35 fragments). Chemotherapy with CDDP and 5-FU was administered via the right internal iliac artery followed by administration of 5'-DFUR (600 mg/day). After that regimen, a recurrence of the pelvic tumor caused an increase in pain, and the patient developed renal failure. He died after 4 years and 10 months from the initial detection of recurrence. This report presents a case of local recurrence of advanced rectal carcinoma, in which we were able to achieve a long-term survival and improvement in QOL by an intensive multidisciplinary therapy.