[A Case of an Elderly Patient with Multiple Lung Metastases of Postoperative Pancreatic Cancer in Whom Lung Metastases Were Controlled by Biweekly Dose-Down Administration of Gemcitabine].

An 80-year-old woman was diagnosed with pancreatic head cancer, and pancreaticoduodenectomy was performed. Twelve months after the operation, chest CT scans showed the presence ofmultiple nodules in both the lungs. Because ofthe potential negative side effects of anti-cancer drugs, the patient underwent chemotherapy with dose-down biweekly adminis- tration ofgemcitabine (1,000mg/day/body≒750mg/m2. Chest CT examination every 2-3 months revealed no rapid increase in multiple tumors. Nineteen months after starting gemcitabine therapy, there was an elevation in tumor marker and a gradual increase in lung metastases. We performed combination chemotherapy with nab-paclitaxel. However, owing to side effects, only 2 courses of nab-paclitaxel were administered, and the therapy was switched to only gemcitabine administration. Later, respiratory distress accompanied by pleural effusion developed, and the patient died of the original disease 27 months after recurrence. Here, we report a case ofan elderly patient with multiple lung metastases ofpancreatic cancer in whom lung metastases were controlled by biweekly dose-down administration of gemcitabine.

[Usefulness of CT Colonography for a Patient with Three Synchronous Primary Descending Colon Cancers].

An 81-year-old woman presented with melena. Colonoscopy showed descending colon cancer, but the oral side of the tumor was excluded from observation because of easy bleeding related to the stenosis. CT colonography to evaluate the oral end of the intestine revealed 2 lesions in addition to the lesion observed on endoscopy. Before the surgery, the patient was suspected to have 3 synchronous primary descending colon cancers and underwent left hemicolectomy. Because CT colonography revealed synchronous multiple colon cancers in the patient, we performed surgery in one stage.

[A Case of Anastomotic Stage â Cecal Cancer Recurrence after Functional End-To-End Anastomosis].

An 83-year-old woman was referred to our hospital for cecal cancer, and ileocecal resection(D3 lymph node resection) with functional end-to-end anastomosis. Since the tumor was of histological Stage Ⅰ, no adjuvant chemotherapy was performed. One year and 9 months after the operation, an anastomotic recurrence was identified alongthe staple line using colonoscopy. We performed a resection of the anastomotic recurrence. At present, 6 months after the second operation, the patient remains in good health without evidence of recurrence. A few cases of anastomotic recurrence after surgery for Stage Ⅰcolon cancer have been reported in the literature available in Japanese. We report a rare case of an anastomotic recurrence of Stage Ⅰ cancer after functional end-to-end anastomosis.

[A Case of Intractable Pain Caused by Retroperitoneal Primary Unknown Cancer Recurrence That Was Improved by Palliative Cyberknife Therapy].

A 79-year-old man was diagnosed with retroperitoneal primary unknown cancer recurrence who underwent open fenestration and drainage(because radical cure resection is difficult). Two years after the fenestration, the patient developed severe hip pain and numbness of the right lower limb. Abdominal CT revealed a cystic tumor recurrence extending from the lower abdomen to the right perineum. We selected a palliative cyberknife therapy for pain control. Fractionated radiation using a cyberknife was administered for 5 days(25 Gy in 5 fractions). The hip pain was relieved, and a CT scan showed a reduction in size of the perineal tumor after the cyberknife treatment. The cyberknife therapy may be an effective and promising palliative treatment for patients with pelvic recurrence.