[Aortoesophageal Fistula with Infected Thoracic Aortic Aneurysm Rupture;Report of a Case].

A 67-year-old man was referred to our hospital because of fever and discomfort of the throat. Gastrointestinal endoscopy revealed hematoma at the middle thoracic esophagus. Computed tomography revealed posterior mediastinal hematoma extending the descending aorta. Bacillus was detected in the blood culture. Aortoesophageal fistula with an infected thoracic aortic aneurysm rupture was diagnosed. First, thoracic endovascular aortic repair (TEVAR) was performed. Resection of the thoracic esophagus and omentopexy was conducted 15 days after TEVAR. Esophageal reconstruction using a gastric tube was performed 43 days after esophagectomy. He has been doing well since then.

[A Case of Sarcoidosis Associated with Esophageal Cancer].

A 67-year-old man was diagnosed with esophageal cancer. Computed tomography(CT)revealed multiple sites of bilateral mediastinal lymph node swelling. Serum levels of soluble interleukin-2 receptor(sIL-2R)were elevated; however, serum levels of angiotensin-converting enzyme(ACE)were normal. Thus, we could not confirm a diagnosis of sarcoidosis. Esophagectomy with neck lymph node dissection was performed. The resected specimen, comprising the mediastinal lymph nodes, showed noncaseating epithelioid cell granuloma; this supported the diagnosis of sarcoidosis. Cases of sarcoidosis associated with esophageal cancer are rare. It is difficult to distinguish between metastasis and sarcoid-like reactions from swollen lymph nodes using preoperative CT or positron emission tomography(PET). It is possible to differentiate lymph node metastasis from its sarcoid reaction it the patient received.

[A case of ampullary carcinoma progression-free for four years after treatment with TS-1].

A 63-year old man was referred to our hospital because of fever, appetite loss, and increased biliary enzyme levels. Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla, diagnosed as an adenocarcinoma via biopsy, and computed tomography (CT) revealed multiple tumors in the liver. Chemotherapy with TS-1 was initiated based on a diagnosis of ampullary cancer with multiple liver metastases. After TS-1 treatment, the multiple tumors were no longer detectable, and the primary tumor did not increase in size for 4 years. At this time, however, the patient experienced fever, jaundice, and appetite loss. The hepatic mass was not detected via CT or MRI. The primary tumor was determined to be resectable; therefore, we performed subtotal stomach preserving pancreatoduodenectomy. The patient was discharged 55 days after surgery and is alive without recurrence 2 years after surgery.

[A case of curatively resected locally advanced cancer of the pancreatic body treated by distal pancreatectomy with en bloc celiac axis resection after neoadjuvant chemotherapy].

A 68-year-old man with locally advanced pancreatic body cancer invading the celiac axis(CA, including common hepatic artery)and in contact with the superior mesenteric artery(SMA)underwent 2 courses of neoadjuvant chemotherapy(NAC); gemcitabine hydrochloride(GEM 1,000 mg/m / / 2, on day 1 and 15)and S-1(100mg/m2day, 2-weeks of continuous administration followed by 1-week rest). The tumor volume and the contact area to SMA were greatly diminished. All tumor markers were reduced. He underwent R0 resection by distal pancreatectomy with en bloc celiac axis resection(DP-CAR). After the surgery, he could continue adjuvant chemotherapy; (GEM 1,000 mg/m2)only twice because of malnutrition. Nine months later CT revealed local recurrence and multiple lung metastases. The patient died 371 days after surgery. Appropriate NAC can contribute to R0 resection in locally advanced pancreatic cancer.

[A case of colorectal neuroendocrine carcinoma effectively treated with bevacizumab+levofolinate+5-FU chemotherapy].

A 76-year-old woman was admitted to our hospital with diarrhea and weight loss in February 2007. A CT scan revealed a tumor in the abdominal cavity, and although a thorough investigation was conducted, no diagnosis was made. Therefore, she underwent diagnostic surgery in April 2007. Intraoperatively, the tumor was determined to have originated in the transverse colon, with invasion to other organs. The patient underwent a transverse colectomy, partial ileal resection, and partial resection of the bladder and peritoneum were performed. The pathological diagnosis was colorectal neuroendocrine carcinoma. FOLFOX4 chemotherapy was initiated in May 2007. However, a CT scan in June 2007 revealed a recurrent tumor in the right pelvis. Although right hemicolectomy and right oophorectomy were performed in August, a CT scan in September 2007 revealed a recurrent tumor in the right pelvis. Following treatment with bevacizumab+levofolinate+5-FU, the tumor disappeared. The patient continued to receive this chemotherapy regimen until August 2010, and CT scans showed a complete response. Even though colorectal neuroendocrine carcinoma is known to have a poor prognosis, the present case was effectively treated with bevacizumab+levofolinate+5-FU chemotherapy. Herein we provide discussion and suggestions about treatment for colorectal neuroendocrine carcinoma.

[A case of recurrent cholangiocarcinoma responding to weekly paclitaxel].

A 72-year-old male underwent right hepatic lobectomy and pancreatoduodenectomy due to extrahepatic bile duct cancer in October 2007, and multiple lung metastases were later detected by CT three months after surgery. We started treatment with administration of S-1 at 100 mg/body. The CT at the end of the five courses revealed the progression of the lung metastases. Therefore we tried GEM at 1, 600 mg/body. After six courses, CT revealed more progression of the recurrent tumors. We then changed the chemotherapy menu to weekly PTX at 130 mg/body. Three courses after the chemotherapy of PTX, CT showed remarkable regression of multiple lung metastases, and the serum levels of tumor marker CA19-9 were also reduced to within the normal range. This remarkable regression of metastases has been maintained for 6 months.

[Adverse events in patients treated with capecitabine as adjuvant chemotherapy after surgery for colorectal cancer--countermeasures against hand-foot syndrome].

Although the 2009 edition of the Guidelines for Colorectal Cancer Therapy recommend capecitabine as a standard postoperative adjuvant chemotherapy for colorectal cancer therapy, a characteristic adverse event, hand-foot syndrome, develops at a high incidence, and appropriate management is necessary to continue therapy. We investigated countermeasures against adverse events, particularly hand-foot syndrome, in patients treated with capecitabine. The subjects were 47 patients aged 64 years (27-84 years) who underwent surgery for colorectal cancer. They received 8 (2-16) courses of drug administration. No grade 3 blood or non-blood toxicity was noted, and the therapy was relatively safe excluding an enhanced anticoagulant effect. Grade-3 hand-foot syndrome developed in 3 patients, but there were only 10 grade-2/3 cases (21.7%) because humectants and oral vitamin B6 preparation (supportive therapy) were administered from therapy initiation. The incidence increased to 32.6% (15 patients) after June. Symptoms aggravated due to mechanical stimulation of the hands and legs in 5 patients because they were farmers growing cherries, suggesting that investigation of patient living background is also important. The incidence of grade-2/3 hand-foot syndrome was 21.1 and 75% in 39 and 8 patients, respectively, who were treated with supportive therapy from the initiation of drug administration and after several courses of drug administration or development of symptoms. This suggested the usefulness of early supportive therapy. The importance of preventive measures against hand-foot syndrome will increase as capecitabine is increasingly administered. Information exchange between medical staffs and providing patients with appropriate information may lead to management of adverse events and subsequently to continuation and obtaining effects of therapy.

[Combination of hepatic arterial infusion therapy and FOLFOX for colorectal cancer with multiple unresectable liver metastases causing severe liver dysfunction].

PURPOSE: The purpose of this study was to evaluate the efficacy of the combination of hepatic arterial infusion therapy and FOLFOX for colorectal cancer with multiple unresectable liver metastases causing severe liver dysfunction. SUBJECTS AND METHODS: The subjects were 13 colorectal cancer patients who had undergone resection of the primary tumor, and showed multiple, unresectable liver metastases and severe liver dysfunction. They consisted of 8 men and 5 women, with a median age of 63(29-77)years. Of these patients, 7 and 6 had colon and rectum cancers, respectively. They had an average of 8(3-22)liver metastases of 4.6(1.5-14.5)cm in diameter. During surgery, extrahepatic lesions were found in 3 patients(P in 2, and CY in 1). The preoperative serum LDH and ALP levels were high, at 1,099 (322-1,418)and 1,011(644-2,384), respectively. The follow-up period was approximately 500(248-928)days. Only 5-FU in FOLFOX4 or 6 m therapy was infused into the hepatic artery, and LV and L-OHP were injected into the central venous port about every two weeks. Response rates and adverse events were evaluated according to the RECIST criteria and CTCAE ver 3.0, respectively. RESULTS: The therapy was performed 14(6-22)times, with a response rate of 84.6% for liver metastases, facilitating hepatectomy in 1 patient. The overall response rate was 61.5%, with 1 patient dying of the primary cancer on the 265th day. Grade 3 adverse events were neutropenia and anorexia in only 1 patient each, and no adverse events were specific to hepatic arterial infusion. CONCLUSION: Since the follow-up period after this therapy was still short, only 13 patients have received the therapy. However, it appears that it can be performed relatively safely, and is effective for the control of extrahepatic lesions as well. Therefore, this therapy provides good control, and can be a treatment option.