[Role of palliative chemotherapy and shift from anticancer therapy to palliative care in patients with advanced or recurrent breast cancer].

We examined the role of palliative chemotherapy and the shift from anticancer therapy to palliative care in 30 patients who had died of advanced or recurrent breast cancer. Patients who received more than four chemotherapy regimens had a longer survival and started analgesics later than those who received less than three regimens. In addition, median survival time was prolonged in patients treated with both anthracycline- and taxane-containing regimens. Presence of bone metastases did not influence survival time, but extended the period of last hospitalization. In the average process of advanced or recurrent breast cancer, use of analgesics was started on the 500 th day and the last hospitalization was on the 760 th day from the diagnosis. Last chemotherapy was performed 29 days before death, and the median survival length was 811 days. Patients were treated as outpatients in 94% of the period from their recurrence until death. Therefore, it is especially important to support outpatients physically and mentally from the early stage of recurrence.

Laparoscopy-assisted and open distal gastrectomies for early gastric cancer at a general hospital in Japan.

BACKGROUND/AIMS: At general hospitals in Japan, laparoscopic surgery for early gastric cancer is not yet popular. The benefits and feasibility of this procedure remain to be established. The aim of this study was to evaluate the surgical outcome of laparoscopy-assisted distal gastrectomy (LADG) in comparison with open distal gastrectomy (ODG) in a general hospital. METHODOLOGY: We performed LADG in 20 patients with early gastric cancer between 2000 and 2001. Clinicopathologic data, blood analyses, clinical course and financial cost of treating patients with LADG were compared with 22 patients treated with ODG between 1998 and 1999. RESULTS: All patients were treated successfully by LADG. Neither reduced operative curability nor increased complications were found with this procedure. Although LADG required a significantly longer operation time than ODG, blood loss was lower in LADG than in ODG. The leukocyte count on day 1 and day 3, and serum C-reactive protein levels on day 1 were significantly lower after LADG than after ODG. There was no significant difference between LADG and ODG in the period and volume of analgesics required. High body temperature continued longer after ODG than after LADG. The first walking, passage of flatus and oral diet initiation were significantly earlier in patients with LADG than in those with ODG. LADG required a significantly shorter hospital stay and less total hospital charge than ODG. CONCLUSIONS: Laparoscopy-assisted distal gastrectomy offered faster recovery of gastrointestinal function, a shorter hospital stay, and consequently less financial cost when compared with open surgery. Therefore, LADG may be a safe and recommendable procedure for patients with early gastric cancer at general hospitals in Japan.

[A case of advanced gastric cancer with peritoneal metastases responding to bi-weekly paclitaxel therapy].

A 68-year-old man underwent bypass operation for gastric cancer, because the tumor was judged to be unresectable due to peritoneal dissemination. After the operation, the patient was treated with daily oral administration of 100 mg TS-1 for two weeks followed by one week rest as one cycle. However, symptoms such as anemia, ascites and edema became worse and the TS-1 resulted in progressive disease. Bi-weekly paclitaxel therapy (80 mg/m2/2 weeks) was then chosen as second line chemotherapy. Anemia and edema were reduced and computed tomography showed shrinkage in the size of lymph nodes and disappearance of ascites. Only grade 1 alopecia was observed as an adverse event during the therapy. Bi-weekly paclitaxel therapy could be safe and useful as the second line therapy.