[A case of advanced gastric cancer with tumor embolus in portal vein successfully treated by neoadjuvant chemotherapy, operation and chemoradiotherapy].

A 66-year-old man was admitted to our hospital with a diagnosis of advanced gastric cancer, with a tumor embolus in the portal vein and lymph node metastases. Since curative surgery was deemed impossible, we started neoadjuvant chemotherapy using S-1 plus CDDP. After 1 course of chemotherapy, the embolus in the portal vein disappeared. After additional chemotherapy, the primary tumor and lymph nodes were reduced in size, and a total gastrectomy with splenectomy and lymph node dissection was performed. Although he received S-1 medication as adjuvant chemotherapy, a tumor embolus in the portal vein appeared 8 months after the operation. Chemoradiotherapy(S-1+total of 50.4 Gy)was performed and the tumor embolus disappeared.

Treatment of intraabdominal desmoplastic small round cell tumor with ifosfamide-based chemotherapy.

Intraabdominal desmoplastic small round cell tumor (IDSRCT) is a rare tumor with poor prognosis that usually develops in the peritoneal cavity, often in childhood and adolescence. This tumor typically arises as single or multiple masses, and is characterized by diffuse peritoneal implants and the involvement of regional lymph nodes. Because most patients are unable to achieve a complete response with chemotherapy alone, extensive efforts have been made to develop more effective chemotherapy regimens. Here, we report on a case of IDSRCT in a 33-year-old man treated with ifosfamide (IFM)-based chemotherapy. Before treatment initiation, the patient had extensive ascites in the peritoneal cavity and was experiencing abdominal fullness and anorexia. Currently, 8 months after his initial presentation, he is still undergoing chemotherapy and is in good general condition.

[A case of superficial small cell carcinoma of the esophagus].

A 69-year-old man complaining of odynophagia visited a nearby hospital, and was referred to our hospital with endoscopic findings showing a flat-elevated lesion 35 cm from the incisors. Biopsy in our hospital revealed small cell carcinoma with a squamous cell carcinoma component. Thoracoabdominal enhanced CT detected neither lymph node metastases, nor distant organ metastases. We selected subtotal esophagectomy and retrosternal reconstruction of gastric tube. Since small cell carcinoma of the esophagus has a dismal prognosis, we conducted a minimally invasive operation with two-field lymph node dissection from the standpoint of local treatment, then shifted early to postoperative chemotherapy. The pathological diagnosis was an undifferentiated carcinoma, small cell type, inf beta, pT1b (pSM), ie (-), ly0, v1, pIM0, pN0. Postoperatively, he underwent chemotherapy with CDDP+CPT-11 following small cell carcinoma of the lung. Here mains alive without evidence of recurrence in the two years three months since the operation.

[A long survival case of unresectable pancreatic cancer by chemoradiotherapy with gemcitabine as key drug].

A 64-year-old man complaining of left hypochondriac pain visited our hospital. He was diagnosed as locally advanced unresectable cancer of the pancreatic body over 4 cm in size, because the pancreatic cancer involved the main artery and portal vein. Although chemotherapy of gemcitabine(GEM)(1.2 g/body/week)was started, he developed meningeal carcinomatosis after 2 courses of GEM. The size of the primary lesion decreased at this period, and total brain irradiation was selected to treat the meningeal carcinomatosis. He sequentially received GEM alone afterward until radiotherapy was performed for the progression of the primary lesion 24 months after the diagnosis. Although GEM alone was continued thereafter, vertebral metastases were detected 30 months following the diagnosis. He was treated with combined chemotherapy of GEM and S-1 that was effective. Finally, he died of peritoneal dissemination 42 months after diagnosis. The dose of GEM was reduced during the radiotherapy, and the total dose was 113.2 g.