[A Case of Intrathecal Infusion of Methotrexate and Ara-C for a Patient with Meningitis Due to Recurrent Gastric Cancer].

A 69-year-old woman underwent total gastrectomy for advanced gastric cancer with pyloric stenosis. She had a good postoperative course and was discharged 2 weeks after surgery. She received adjuvant chemotherapy with S-1 after discharge. One month after the initiation of the adjuvant chemotherapy, she complained of wobbling and weakness of her limbs. She stopped intake of S-1, but the symptoms did not improve. She was admitted to the hospital, but she became unconscious and had headache and blurred vision. We conducted a cerebrospinal fluid examination and made a diagnosis of meningeal carcinomatosis. After we started intrathecal infusion of methotrexate and Ara-C, referring to case reports clinical symptoms, including unconsciousness, headache, and left upper limb paralysis, improved and the CEA level in cerebrospinal fluid decreased.

[A Case Report on a Successful Resection after FOLFIRI plus Cetuximab Therapy for Unresectable Colorectal Cancer with Multiple Liver Metastases].

The patient was a 66-year-old woman with a history of right breast cancer 20 years prior. Her chief complaint was hematochezia, and she was diagnosed as having rectal cancer. She underwent laparoscopic high anterior resection. We made a diagnosis of moderately differentiated adenocarcinoma, type 2, 25×20 mm, pMP, pN0, Stage I, KRAS being wild-type. Multiple liver metastases were detected 6 months after the surgery. Tumor contacted with grison. The tumor was not completely resected as evidenced by the small liver remnant volume. Conversion therapy was administered, and the patient received 6 courses of FOLFIRI plus cetuximab therapy. Alopecia and grade 1 eruption were observed as adverse effects of the chemotherapy. The tumor size was reduced, and we resected the tumor by performing right lobectomy and partial hepatectomy. At 1 year 3 months after surgery, no recurrence was observed.

[Home palliative care for a terminal stage cancer patient--a view point of autonomy support].

To recuperate from terminal stage cancer at one's dear old home is like a patient spending his time all day long with the family. Therefore, it is necessary for a patient to know his state of well being, and to comprehend how to cope with the expected change in cancer stages. In other words, the patient has to make his own decision as to what he wants to be cared for in the homecare environment, and he should provide information to the family and to caregivers. The author expresses such kind of a relationship as autonomy support, and it is an important viewpoint of home palliative care. Moreover, the idea of autonomy support was effective as well as relieving a severe pain of the disease from the patient. In our case for example, we experienced not only the amount of narcotic usage to control pain has decreased but the increase in narcotic amount at the near death period has also declined. In addition, we compared a home palliative care to a home recuperation of the senior citizen. As a result, the followings were emphasized: 1) In order to improve in the quality of home palliative care, it is important to catch the difference in subtle changes between the cancer patient and the senior citizen. 2) To note the problem of the sense of loss related to the welfare tools introduction. In this article, the problem of the cancer end stage caring was compared with the senior citizen homecare, and found that an autonomous support is clearly important.