[Three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer].

We report three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer. CASE 1: An 86-year-old woman who received cetuximab after a colostomy for unresectable rectal cancer with synchronous liver and lung metastases. Serum levels of CEA and CA19-9 showed a significant decrease at 2 months, after which they showed a gradual increase. Computed tomography (CT) revealed a reduction in the rectal tumor. CASE 2: An 82-year-old woman who received cetuximab for peritoneal metastases after a transverse colectomy. Serum levels of CEA and CA19-9 decreased to normal levels at 2 months, and CT imaging revealed disappearance of the tumor in the peritoneal cavity. CASE 3: A 79-year-old man who received panitumumab for lung, liver and para-aortic lymph node metastases after a descending colectomy. Serum levels of CEA and CA19-9 showed a decrease at 1 month, after which they showed a gradual increase. No marked change in the tumor was observed by CT. No change was observed in performance status or Vulnerable Elders Survey( VES-13) score, and the effect on overall condition was minimal. Grade 1-2 acneiform skin rash, paronychia, and desquamation, and grade 2-3 dry skin and pruritis were observed. More precise instructions on measures for dealing with skin rash are necessary to obtain higher drug compliance.

[The efficacy of cetuximab for metastatic colorectal cancer].

Cetuximab (Erbitux) is a targeted therapy that used to treat metastatic colorectal cancer. It is classified as a "monoclonal antibody" and "signal transduction inhibitor" by binding to epidermal growth factor receptors (EGFR). We report 6 patients who responded well to cetuximab out of 8 patients with recurrent/advanced colorectal cancer who have received the drug at our hospital since November 2008. Four patients were men and 2 were women, with their ages ranging from 48 to 77 years. The primary cancers were located in the rectum (n=1), sigmoid colon (n=4), and ascending colon (n=1). Performance status (PS) was 0-1. These patients were treated with cetuximab as second-line (n=1), third-line (n=3), fifth-line (n=1), or seventh-line (n=1) therapy. Three patients received cetuximab monotherapy, while the other 3 were given CPT-11 (150 mg/m2, every 2 weeks) as concomitant therapy. Among the 3 patients receiving combination therapy, 2 patients had already received treatment with FOLFIRI. Even in the cetuximab monotherapy group, a partial response (PR) was observed in 2 patients, demonstrating a strong cytoreductive effect. Tumor markers also showed large decreases, with the percent decrease at 1 month being 31.7% and 60.8% in the monotherapy and combination therapy groups, respectively, while it was respectively 14.1% and 29.5% at 2 months. The mean progression-free survival (PFS) time and the time to treatment failure (TTF) were respectively 3.0 months and 4.5 months in the monotherapy group versus 7.3 months and 9.3 months in the combination therapy group. Acneiform rash and paronychia occurred in all 6 patients.

[Multimodal therapy for juvenile advanced rectal carcinoma].

A 37-year-old male with locally advanced rectal carcinoma and liver metastasis was treated by multimodal therapy. Since he had severe anemia and perineal abscess, sigmoid colostomy was constructed. After his general condition was recovered, the patient received systemic chemotherapy with mFOLFOX6 (6 courses) and whole pelvic irradiation (40 Gy). The rectal tumor showed a reduction in size, total pelvic evisceration combined with reconstruction of ileal conduit and rectus abdominus myocutaneous (RAM) flap were performed. He was followed by 7 courses of systemic chemotherapy with mFOLFOX6 and bevacizumab. After partial hepatic resection, he was followed by systemic chemotherapy with FOLFIRI and bevacizumab as an outpatient. Recent studies for outcomes in young colorectal carcinoma patients showed that the poor prognosis was not caused by its proper aggressiveness in biologic behavior but just the late diagnosis.

[A case of abdominal wall metastases detected after 2 years and 5 months from gastric cancer operation].

A 68-year-old woman underwent distal gastrectomy for gastric cancer in February 2003. The Histological type was poorly differentiated adenocarcinoma, and the final finding was T3 (se, INF gamma, ly1, v0), pN1, sH0, sP0, pCY0; fStage IIIA. Two years and 5 months after the operation, a painless tumor was noticed on the upper abdomen. Biopsy specimen showed adenocarcinoma. A CT scan detected abdominal tumors, and there was no other distant metastasis. Fourteen courses of systemic chemotherapy (IRIS) were performed for sixteen months. We detected several abdominal metastases, but no distant metastasis was occurred during IRIS.

[Sigmoid colon cancer with a tumor thrombosis in the splenic vein--a case report].

A 63-year-old woman was admitted to the hospital for investigation of abdominal discomfort. Further examination revealed that she had sigmoid colon cancer. The serum CEA level was 20.1 ng/ml, and the CA19-9 level was 8.9 U/ml. Laparotomy findings showed H0, P0, and lymph-nodes swelling observed at LN253-LN16b2. Massive tumor thrombosis was present in IMV, the splenic vein, and the advanced region in the portal vein. Metastatic tumor was present in the pancreas body. An anterior resection of the colon combined with resection of lymph nodes, pancreas body and tail and spleen were performed. Resection of IMV and splenic vein including tumor thrombosis was performed prudently. Histological examination revealed that the pancreas tumor and tumor thrombosis were of the same origin (moderately differentiated from adenorarcinoma), and massive LN metastases existed. Post operative chemotherapy, an oral administration of UFT/UZEL, was performed. After 24 months of operation, there has been no sign of recurrence detected.

[Radiofrequency ablation for hepatocellular carcinoma and liver metastases].

We evaluated the efficacy of radiofrequency ablation (RFA) therapy for 29 patients with 36 hepatocellular carcinoma (HCC) nodules and 16 patients with 38 metastatic hepatic nodules. The mean tumor size was 26.4 mm. The primary lesions of patients with metastatic liver tumors were 9 colon cancer, 2 rectal cancer, 2 breast cancer, 2 gastric cancer, and 1 esophageal cancer. All nodules were treated using a Cool-tip RFA system. US-guided RFA was performed for 44 nodules, CT-guided RFA for 24 nodules, and intra-operative US-guided RFA for 6 nodules. In a mean observation period of 13.5 months, the mean complete ablation rate and the mean distant recurrence rate were 83.3% and 30.6% for HCC and 65.8% and 31.6% for metastatic nodules, respectively. The mean complete ablation rate of HCC was significantly higher than that of metastatic nodules (p < 0.05). The mean complete ablation rates of both HCC and metastatic hepatic nodules 3 cm or smaller in diameter were significantly higher than those of both tumors larger than 3 cm in diameter (p < 0.05). The mean distant recurrence rate of HCC in patients who have multiple nodules was 62.5% and it was significantly higher than that in patients who have a single nodule (28.6%) (p < 0.05). The mean complete ablation rate of metastatic nodules by intra-operative US guided RFA was 100% and it was statistically higher than that by other image guided RFA (p < 0.05).

[Radio-frequency ablation therapy for metastatic liver tumors from colorectal carcinoma].

UNLABELLED: Radio-frequency ablation therapy (RFA) as a treatment for metastatic liver tumors from colorectal carcinoma was examined. METHODS: Ten patients with a total of 30 liver metastases from colorectal carcinoma were treated using a Cool-tip RF system from March 2003 to December 2004. RESULTS: Patients had a mean age of 69.8 years and the mean diameter of the metastatic lesions was 29.5 mm (range, 5-82). Two patients had received RFA therapy 2 times, and another 2 patients had received 3 times. Critical complications were not seen, though 5 therapies were performed using CT-guided trans-pulmonary puncture. The rate of partial recurrence was 23.1% and the average observation period was 14.8 months. The partial recurrence had occurred within the mean period of 6.2 months. Although after multimodal therapy was given, it is suggested that repeated RFA for the liver metastasis would improve survival rates. CONCLUSION: RFA is a safe and effective treatment for metastatic liver tumors from colorectal carcinoma as multimodal therapy.

[A case of T4 esophageal squamous cell carcinoma in esophagogastric junction effectively treated by neoadjuvant FAP therapy].

A 59-year-old man was admitted to our hospital because of vomiting and body weight loss. Upper GI series and upper digestive tract endoscopy revealed type 3 cancer lesion in the area from the lower thoracic esophagus to the middle gastric body. In the biopsy specimen squamous cell cancer was shown. We perfomed neoadjuvant chemotherapy because the computed tomography revealed invasion to the diaphragm and aorta. After chemotherapy a 65% reduction was obtained, and we performed total gastrectomy with lower esophagectomy and lower mediastinal and abdominal lymph node dissection and Roux-en Y reconstruction in the left thoracoabdominal serial incision. In the histological examination, Grade 1 response was obtained in the primary specimen and Grade 3 response in the lymph node specimens. In the 44 months since surgery, the patient has remained well and disease free. It was suggested that a combination of neoadjuvant chemotherapy and surgery was successful treatment for this case.

[A case of lymph node metastasis after 7 years from Hartmann's operation for stage IV sigmoid colon carcinoma].

The case was a 49-year-old woman. In 1995, she underwent Hartmann's operation for sigmoid colon carcinoma. Histological stage was IV [se, n4(+), P0, H0, M(-)]. Adjuvant chemotherapy was performed by MMC and 5'-DFUR. After 7 years from the surgery, she had a lumbar pain. CT examination revealed a retroperitoneal tumor-like shadow and Para-aortic lymph nodes were swelling. In 2002, she underwent probe laparotomy. There were massive lymph nodes metastasis, and tumor resection was impossible. Following several systemic chemotherapies such as UFT/CPT-11 and TS-1, the tumor progressed and liver metastasis appeared. After 9 years from the first operation, she is still able to eat and her performance status is 1.

[A case of multiple superficial esophageal cancers with liver cirrhosis successfully treated by radiotherapy].

We report a case of multiple superficial esophageal cancers with liver cirrhosis successfully treated by radiotherapy. The patient was a 55-year-old man with liver cirrhosis who was under the treatment of internists at our hospital. Upper digestive tract endoscopic examination revealed multiple superficial esophageal cancers. We performed radiotherapy because pancytopenia was found in his peripheral blood data. The treatment was started on a outpatient basis, but the patient was hospitalized after sixteen treatments were finished because of hematemesis. Total irradiation was 66 Gy, and complete reduction was obtained. Eight months after the treatment, the patient shows no signs of recurrence. These results suggest that radiotherapy is an effective treatment for multiple superficial esophageal cancer.

[A case of resected spinal metastasis following colectomy and hepatectomy for descending colon carcinoma].

The patient was a 49-year-old man. In 1995, he underwent left hemicolectomy for descending colon carcinoma, and in 1996, partial hepatic resection was performed for liver metastasis. Post-operative chemotherapy was performed with 5'-DFUR. Five years later, he had lumbar and femoral pain. X-ray and MRI examination revealed a compression fracture and a spinal tumor at the XII thoracic vertebra. Though chemoradiotherapy was performed, the symptoms of pain, numbness and muscle weakness progressed. A resection of the metastatic spinal tumor was performed. Following several systemic chemotherapies, such as 5-FU/l-LV, CPT-11 + 5-FU/l-LV and low-dose CPT-11/UFT, radiotherapy was performed for the progressed bone tumor. At 2 years after surgery, he is still able to walk and no other site of recurrence has been detected.

[A case of metastatic vaginal tumor of rectal cancer].

The majority of vaginal metastases from extra-genital tumors are from colorectal cancer. A case of metastases to the vagina from a huge rectal carcinoma is described. A 55-year-old woman was admitted to the hospital because of a barium ileus after upper GI. Further examination revealed that she had a huge rectal carcinoma. Hartmann's operation combined with resection of the right ureter, posterior wall of the uterus and left ovary was performed. Postoperative chemoradiotherapy was performed with 60 Gy of irradiation to the small pelvis with 500 mg/day continuous infusion of 5-FU. After 18 months, she had genital bleeding. Digital examination revealed a vaginal tumor and metastasis of the rectal carcinoma to the vagina was confirmed histologically. Abdominoperineal resection of the rectum and vagina combined with simple total hysterectomy and bilateral salpingo-oophorectomy was performed. Thirty-three months after operation, there is no sign of recurrence.

[TS-1/CDDP therapy for advanced gastric cancer as neoadjuvant chemotherapy].

Five patients with inoperable advanced gastric cancer were treated with combination chemotherapy of TS-1 and cisplatin (CDDP). TS-1 of 80-120 mg/body/day was orally administered for 3 weeks followed by 2 drug-free weeks, and 60 mg/m2/day of CDDP was venally administered on Day 8. It was possible to evaluate all 5 patients for response and toxicity. Only low grade toxicities (Grade 1 or 2) of leukocytopenia, neutrocytopenia, anemia, nausea, diarrhea and stomatitis were seen. Four of 5 patients achieved a partial response, for a response rate of 80.0%. Stomach, liver, lymph node and peritoneal tumors responded to TS-1/CDDP. TS-1/CDDP therapy produces a high response in cases of gastric cancer, and it is useful as a neoadjuvant chemotherapy.

[A case of gastric cancer with paraaortic lymph node metastasis responding to TS-1/CDDP as neoadjuvant chemotherapy].

A 64-year-old male visited our hospital with complaints of epigastric pain. Computed tomography (CT) showed gastric cancer with extensive paraaortic lymph node metastasis. We decided that a curative operation was impossible, and administered the following chemotherapy. After 120 mg/day of TS-1 was orally administered for 3 weeks followed by 2 drug-free weeks with 90 mg of CDDP was administered intravenously on day 8, CT showed a 90.6% reduction in the paraaortic lymph node metastasis. No serious adverse reaction was observed. After 2 courses of this chemotherapy, surgery was performed after informed consent was obtained from the patient. Histrogical result showed PR. The patient is now healthy and no sign of recurrence has been observed. TS-1/CDDP therapy is useful for advanced gastric cancer.