[The Supportive Effect of Ninjin' Yoeito on Bone Marrow Function during Chemotherapy-Case Report].

Suppression of bone marrow function is one of the most common adverse effects of chemotherapy for gastrointestinal cancer. In 3 patients with gastrointestinal cancer who underwent chemotherapy, Ninjin' yoeito(NYT)was found to be effective in preventing this adverse reaction. Patient 1, a 76-year-old woman with rectal carcinoma(pT3N1bM0, pStage Ⅲb), underwent anterior rectal resection. Although chemotherapy(mFOLFOX6)was performed 6 weeks after the operation, the leukocyte and erythrocyte counts were decreased. NYT administration from day 9 of mFOLFOX6 chemotherapy resulted in the maintenance of bone marrow function and allowed continuation of chemotherapy. Patient 2 was a 65-year-old woman who underwent right hemi-colectomy for ascending colon cancer(pT3N0M0, pStage Ⅱ). A partial hepatectomy was performed for the second S8 liver metastasis, and NYT was administered at the time of introduction of mFOLFOX6. In patient 3, an 83-year-old woman who underwent total gastrectomy for gastric cancer(pT4a[SE]N3aM0, pStage Ⅲb), NYT was administered at the same time as the transition to second-line treatment with paclitaxel plus ramucirumab. In all cases, chemotherapy was continued without drug suspension or dose reduction after NYT administration. Thus, NYT may be effective in aiding the continuation of chemotherapy.

[A Case of Multiple HCC with Vp2 and Vv3 Invasion Controlled by Multidisciplinary Treatment Including Surgery].

The prognosis of HCC with vascular invasion is dismal, but surgery is elected when the hepatic reserve is adequate. The case involved a 68-year-old male HCV carrier. A 10 cm diameter tumor occupying the central 2 segments of the liver and liver metastasis in the left lobe were detected. The patient was diagnosed with multiple HCC with severe vascular invasion of Vp2 and Vv3. The tumor shrunk dramatically after starting HAIC therapy with cisplatin and oral administration of sorafenib. A laparoscopic partial hepatectomy was performed for the viable lesion. The tumor showed almost complete coagulative necrosis. Multiple hepatic metastases were found 4 months after surgery, but the tumor was under control at 25 months after the first HAIC due to HAIC, oral administration of sorafenib, and RFA. An improved prognosis for multiple HCC with severe vascular invasion can be expected by performing multidisciplinary treatments including surgery.

[Combination Chemotherapy Using Sorafenib and Hepatic Arterial Infusion with a Fine-Powder Formulation of Cisplatin for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis--A Case Report].

Sorafenib has been a standard therapy for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. Hepatic arterial infusion chemotherapy (HAIC) is still preferably performed in Japan because of its relatively good tumor-shrinking effect. We report a case of advanced multiple HCC with portal thrombus that responded to combination chemotherapy with sorafenib and repeat hepatic arterial infusion with a fine-powder formulation of cisplatin (IA-call®). A 57-year-old man presented for the treatment of HCC with alcoholic cirrhosis. Multiple HCC were found to be rapidly progressing with portal thrombosis. HAIC with IA-call® was performed, but the tumors progressed. TAE was performed 3 times thereafter and the main tumor shrunk to some extent. A month after the last TAE, the HCC was found to progress again, and oral sorafenib was administered. A reservoir and catheter were placed and HAIC with low-dose 5-fluorouracil and cisplatin was performed for 3 cycles following 1 HAIC cycle with epirubicin and mitomycin C, which was not effective. For 10 months after initial therapy, HAIC using IA-call® has been performed once for 6 weeks. After performing HAIC with IA-call® 5 times, the serum levels of HCC tumor markers AFP and PIVKA-Ⅱdecreased, and the tumors continued to shrink and were not stained on enhanced CT scan. The patient has been alive for 23 months after the initial therapy and has maintained stable disease.