[Palliative anti-cancer chemotherapy is safely executable in a hemodialytic patient with unresectable advanced gastric cancer].

A 75-year-old man with chronic renal failure was on maintenance hemodialysis.He was admitted to our hospital for advanced gastric cancer with multiple liver metastases (cStage IV).Three courses of tegafur-uracil (300 mg/day daily) plus docetaxel (20 mg/m², every 3 weeks) as first-line treatment and nine courses of tegafur-uracil (same dose) plus CPT-11 (64 mg/m², day 1, 15, every 4 weeks) were given without any complications.Docetaxel and CPT-11 were given on days between hemodialyses. No severe adverse effects of more than grade 3 were encountered. The standard regimens in our country for unresectable advanced gastric cancer are the S-1 single or S-1/CDDP combined chemotherapies that have already been evidenced in the JCOG 9912 and SPIRITS trial. However, no standard chemotherapy for patients on hemodialysis has been reported as yet.Therefore, doctors in charge must arrange an individualized regimen for each patient, considering metabolic characteristics of each anti-cancer agent.In this context, our case was considered to be very suggestive, and that is why we report it here in detail.

[A case of well differentiated mucinous carcinoma of the gallbladder].

We report a case of well differentiated mucinous carcinoma of the gallbladder. An 80-year-old man was admitted to our hospital because of fever and CT showed a mass in the fundus of the gallbladder and choledocholithiasis. Endoscopic removal of the common bile duct stones was done. Abdominal ultrasonography and CT showed a 4 cm mass in the fundus of the gallbladder. Based on a diagnosis of adenomyomatosis or mucinous carcinoma of the gallbladder, a laparotomy revealed a white mass in the fundus of gallbladder. Intra-operative pathological diagnosis of lymph node of cystic duct was mucinous carcinoma. Therefore, we conducted partial resection of the liver with D1 lymph node dissection. Pathological diagnosis confirmed well differentiated mucinous carcinoma of the gallbladder. His postoperative course was uneventful, and he is doing well without recurrence.

[An elderly hemodialytic case of recurrent esophageal cancer given combination chemotherapy with docetaxel and nedaplatin who showed temporal relief of swallowing disturbance].

An 82-year-old man was admitted for recurrent and unresectable esophageal cancer. His performance status was grade 2, although he was on hemodialysis due to chronic renal failure since 2003. Esophagogastroduodenoscopy revealed stenosis of esophagus by the recurrent tumor. After percutaneous endoscopic gastrostomy, he received biweekly combination chemotherapy with docetaxel (18 mg/m(2)) and nedaplatin (16 mg/m(2)). Hemodialysis was carried out one hour after termination of nedaplatin infusion. As severe adverse reactions due to anticancer-chemotherapy were not encountered, he could receive four courses of chemotherapy in our outpatient clinic. Difficulty in swallowing improved after the second course was finished. Finally, he died of acute myocardial infarction. In conclusion, combination chemotherapy with docetaxel and nedaplatin can be safely carried out for a patient with recurrent and unresectable esophageal cancer even on hemodialysis by appropriate down-dosing of anticancer agents.

[Retrospective analysis of generalized chemotherapy for unresectable advanced gastric cancer].

In Japan where the incidence of gastric cancer is high, the standard regimens for unresectable advanced gastric cancer are the S-1 single or S-1/CDDP combined therapies that are evidenced by the JCOG9912 and SPIRITS trial. We performed retrospective analysis on chemotherapy for unresectable advanced gastric cancer in our division from 2003 to 2008. Seventy-six patients were subjected to this study. Among them, 66 patients (86.8%) received S-1-containing regimens. Mean survival time (MST) of all patients was 309 days. MST of S-1/Paclitaxel (PTX), S-1/CPT-11 and S-1/CDDP regimens were 289, 339 and 411 days, respectively. MST of S-1/CPT-11 was significantly longer than that of S-1/PTX (p<0. 01). Next, we compared the MST among different performance statuses (PS). The respective MST of PS 0, 1, 2 cases (361, 289 and 161 days) evidenced no statistically significant difference, although the MST was shorter depending on the progression of PS. Considering the histology, the MST of patients with well- and moderately-differentiated adenocarcinoma was significantly longer than that of poorly-differentiated adenocarcinoma and signet-ring cell carcinoma (p=0. 04). The call is for more effective chemotherapy in the future based on results we will obtain from controlled studies that may also deal with the second-line chemotherapy regimens, chemotherapy for aged people and molecular-targeting cancer agents.

[A case of interstitial pneumonia induced by gemcitabine hydrochloride for unresectable bile duct cancer].

A 78-year-old man was admitted for obstructive jaundice and unresectable bile duct cancer on March 4, 2008. Since biliary drainage was extremely difficult, he began 2 treatment courses of gemcitabine hydrochloride (GEM 800 mg/m(2) on days 1, 8, 15 every 4 weeks). He suffered from dry cough and dyspnea on May 13, 2008. He was diagnosed as GEM-induced interstitial pneumonia with severe hypoxemia by CT scan and arterial blood gas examination. He recovered with two courses of steroid pulse therapy, diuretics and antibiotics. Alternatively, he was given oral S-1 ( 80 mg/m(2) 4 weeks on and 2 weeks off) from June 12, 2008. His QOL was well kept without jaundice for as long as a half year. This is the first report of GEM-induced interstitial pneumonia in bile duct cancer. In conclusion, interstitial pneumonia must be taken into consideration as a rare adverse reaction when GEM is used for biliary neoplasms.

[A case of hepatocellular carcinoma with liver cirrhosis type C surviving over 2 years by repeated transarterial infusion therapy using cisplatinum].

A 58-year-old man with hepatocellular carcinoma (HCC) with liver cirrhosis type C was admitted to our division in April, 2004 to receive transarterial chemo-embolization (TACE) as a first-line chemotherapy for HCC. Thereafter, he had TACE twice for multicentric HCC. In December, 2005, TACE was thought to have become ineffective since his multicentric HCC progressed. So, we employed transarterial injection therapy (TAI) with fine powder cisplatinum (IAC) as a second-line chemotherapy. Stable disease was accomplished by the 22 sessions of TAI with IAC. After February 2008, IAC was given in combination with degradable starch microspheres (DSM) to reinforce the anti-cancer effect. The total therapeutic sessions using IAC became 26 in number. Total IAC amount used reached to more than 2,200 mg without any serious adverse reaction. In conclusion, TAI using IAC is thought to be effective in the chemotherapy of HCC, safely controlling the tumor progression.

Minilaparotomy for early gastric cancer.

BACKGROUND/AIMS: From the experience of laparoscopic-assisted distal gastrectomy, it was considered that a gastrectomy with lymph node dissection could be performed through a minilaparotomy, placed as for gastroduodenostomy in laparoscopic-assisted distal gastrectomy. METHODOLOGY: Ten patients with early gastric cancer underwent gastrectomy with lymph node dissection via minilaparotomy. Minilaparotomy was performed via a seven-centimeter midline incision placed at the mid-upper abdomen. Two six-centimeter-wide Kent retractors were used to suspend the abdominal wall on each side, and a multipurpose surgical arm to retract the liver. The abdominal wound could be moved horizontally by pulling these retractors to the right or left. This movable wound allowed direct visualization of almost all the operative field for gastrectomy. RESULTS: No operation was converted to a standard open gastrectomy. The patients who had a tumor in the lower third of the stomach underwent complete D2 lymph node dissection. In the patients who underwent pylorus-preserving gastrectomy, near complete D2 lymph node dissection was performed. Mean operation time was 175 minutes. No significant complication was encountered. CONCLUSIONS: It was concluded that minilaparotomy could be used as an alteration to the standard open gastrectomy.

Metastatic hepatoma originating from the pons hepatis presenting extrahepatic growth--classification of different patterns covering REX's recessus.

A metastatic liver carcinoma which developed from the pons hepatis and presented as an extrahepatic mass on ultrasonography and computed tomography is reported. There have been no other reports of hepatoma documenting the extrahepatic growth developed from the pons hepatis. Herein we study the frequency of the pons hepatis and classify the form of REX's recessus. Of 125 cases that underwent upper abdominal operation, 46 cases (38%) had nothing under REX's recessus (Type I), 48 cases (37%) had a fibrous tissue under REX's recessus (Type II), and 31 cases (25%) had a pons hepatis (Type III). In Type III, some cases suggested that the pons hepatis was ready to disconnect from side to side. We conclude that Type II is a modified form of Type III, and Type I is a modified form of Type II.