[A case of multiple liver metastases from nonfunctioning neuroendocrine pancreatic tumor curatively resected after successful intra-arterial chemotherapy].

We report a case of 33-year-old woman for nonfunctioning neuroendocrine pancreatic tumor with synchronous multiple liver metastases. For the primary pancreatic legion, we performed pylorus-preserving pancreatoduodenectomy at first. Three weeks after the surgery, the patient started to undergo intra-arterial chemotherapy with a weekly administration of high-dose 5-FU (1,000 mg/body) for residual liver metastases. Any severe adverse events were not observed. After 20 courses, a partial response was achieved and she underwent curative operation with partial resection for 4 metastatic legions and RFA for others. Histopathological findings of resected specimens revealed no viable neoplastic tissues. She is alive with no sign of recurrence 3 months after the surgery. Although a surgical resection is accepted as the standard therapy for liver metastases of nonfunctioning neuroendocrine pancreatic tumor, intra-arterial chemotherapy might be an alternative therapeutic option for unresectable case.

[A case of advanced rectal carcinoma with multiple lung metastases responding to irinotecan combined with 5-fluorouracil and l-leucovorin (IFL) as neoadjuvant chemotherapy (NAC)].

A 53-year-old man, admitted for inguinal hernia, complained of body weight loss in a preoperative condition check. We examined the digestive tract and diagnosed stage IV advanced rectal carcinoma with multiple lung metastases. It caused ileus, so emergency colostomy was performed. After that his general condition recovered, and two cycles of neoadjuvant chemotherapy (NAC) by irinotecan combined with 5-fluorouracil and l-leucovorin (IFL) therapy were performed on an outpatient basis. Lung metastatic nodules disappeared. We established a diagnosis of down staging for stage IIIa, and performed a lower anterior resection with D 2 lymph node dissection to allow a curability-A resection. The pathological effect of NAC was Grade 2. Post-operatively, two cycles of IFL therapy were then performed. There has been no sign of recurrence, and no adverse effects by chemotherapy have been seen during this treatment. Thus, NAC by IFL therapy can be one of the useful treatment approaches for patients with advanced rectal cancer.