[Case study--an elderly patient with Stage IV advanced gastric cancer achieved good performance status (PS) without subjective symptoms for more than two years by chemotherapy].

An 83-year-old male with Stage IV gastric cancer of performance status 1 (PS 1) was treated with fluoropyrimidine (TS-1) since January 2003 in our department. As the patient exhibited decreased renal function due to his age, we set the basic dose at 80% of the recommended dose of 80 mg/body/week. We administered 11 four-week cycles, each with a two-week drug-free washout period, and six two-week cycles, each with a two-week drug free washout period. The first cycle of chemotherapy ameliorated the subjective symptoms; the level of a tumor marker then returned to normal, and the ascites disappeared. The patient's condition was maintained at a favorable PS level without any subjective symptoms for approximately 20 months. In late September 2004, however, an exacerbation of the primary foci was confirmed by routine endoscopic examination. As second-line chemotherapy, we initiated weekly administration of paclitaxel (PTX). Due to the patient's age and high PS level (PS 2) at the time of intervention, we utilized a reduced dose of 70 mg/body/dose. After a short premedication period, the patient was administered PTX intravenously for one hour once a week for three weeks, then given a one-week drug-free washout period (one cycle). After the first cycle of PTX administration, all subjective symptoms disappeared, the PS level returned to zero,and the patient was discharged. In total, four cycles of the PTX regimen were given. Throughout the treatment period, we did not observe any significant adverse events (grade 2 or higher). Treatment achieved a favorable PS level. To design an effective chemotherapy regimen for elderly patients, it is important to establish an effective dose and dosing method based on the patient's chronologic age and a thorough evaluation of the patient's systemic conditions, including the PS level.

Microwave coagulation therapy for a liver tumor involving the root of the left hepatic vein of the residual liver after extended right hepatectomy.

A 54-year-old man had received low anterior resection for rectal carcinoma and extended right hepatectomy for a metastatic liver tumor. One year later, imaging studies disclosed a metastatic liver tumor in segment 2 of the liver. The residual left hepatic vein was completely invaded by the tumor from the root of the hepatic vein to the confluence of several branches by intraoperative ultrasonography. To resect partial liver with the involved hepatic vein was deemed impossible. Microwave coagulation therapy was performed on the tumor and the involved hepatic vein, as we had established the safety of microwave irradiation to the main hepatic vein without interference of the hepatic venous flow in an experimental study. The patient remains well 40 months after the surgery without recurrent signs. The hepatic venous flow of the irradiated hepatic vein is maintained well according to serial examination of Doppler ultrasonography.