[A case of ovarian metastasis from colon cancer successfully treated with multidisciplinary therapy].

An 80-year-old female patient was undergone sigmoidectomy with D2 lymph node dissection for type 2 sigmoid colon cancer in February 2007. A post operative pathological finding of cancer was SS, N0, P0, H0, M0 (Stage II), curative A. Twelve months after the operation, elevated CEA level was observed. CT scan and MRI revealed a mass of 10 cm in diameter with multiple cysts in the pelvic cavity, which was diagnosed a malignant ovarian tumor. In May 2008, total hysterectomy, bilateral oophorectomy, and partial omentectomy were performed and its pathological finding was metastatic ovarian tumor originating from colon cancer. Adjuvant chemotherapy was administered, as cancer cells were detected in the ascites. The patient has been in good health without recurrence for 25 months after the second operation.

[A case report of primary adenocarcinoma of small intestine].

This is an account of a case of primary adenocarcinoma of the small intestine with peritoneal dissemination successfully treated with chemotherapy. A 64-year-old woman was admitted with a complaint of severe abdominal distension. Abdominal computerized tomography revealed a bowel obstruction with tumor and the remarkable small bowel dilation of oral side of tumor. The tumor was found at surgery to be at the ileum 15 cm proximal from the ileocecal region. Peritoneal dissemination was recognized around the ileocecal region, so ileum partial resection was performed for the primary cancer lesion and dissemination region. Pathological diagnosis of the resected specimen was adenocarcinoma with lymph nodes metastasis. The peritoneal dissemination consisted of metastatic adenocarcinoma from small intestine. After an operation, internal use of S-1 was performed as adjuvant chemotherapy. But a recurrent lesion at the ovarium was detected 6 months after surgery. The patient was subsequently treated with resection of the ovarium. For lung metastasis, the combination chemotherapy with mFOLFOX6 + bevacizumab was administered. Primary small intestinal adenocarcinoma is a rare disease, and it is often diagnosed as advanced cancer because of few characteristic symptoms. So carcinoma of the small intestine usually has a poor prognosis.

[A case of successful control of recurrent duodenal carcinoma receiving paclitaxel].

We have experienced a case of successful control of recurrent duodenal carcinoma receiving paclitaxel chemotherapy. A 61-year-old woman with epigastralgia was diagnosed with pyloric gastric carcinoma upon upper gastrointestinal endoscopy and biopsy. Distal gastrectomy with D2 dissection was performed. However, at the resected organ, the lesion was on the duodenum. So, we additionally resected the anal edge. And 13a, 13b, 12a, p lymph nodes were dissected for duodenal carcinoma. Later, the CEA level was increased, and abdominal CT scan showed swelling of paraaortic lymph nodes. Recurrence of the duodenal carcinoma was diagnosed in February 2007, and S-1 administration was begun. But, we dosed down with S-1 due to severe diarrhea. In spite of combined S-1 and CPT-11 chemotherapy, the CEA level increased, and lymph nodes were getting larger. She then underwent the paclitaxel chemotherapy during the 5 months without severe side effects. The CEA level decreased significantly and metastatic lymph nodes were reduced observed by CT scan. Paclitaxel chemotherapy is effective for duodenal cancer.

[A case of advanced gastric cancer with liver metastases resected successfully after S-1 monotherapy and S-1/CDDP combination chemotherapy].

The patient was a 75-year-old man, who was diagnosed with type 3 gastric cancer with solitary liver metastasis whose diameter was 12 mm. Distal gastrectomy with D2 lymph node dissection was performed in June 2008. S-1 monotherapy (120 mg/day, day 1-28/42 days) for liver metastasis started as the first-line chemotherapy. After 3 courses, the diameter of liver metastasis enlarged to 22 mm. Moreover, S-1 and CDDP combined chemotherapy (S-1: 120 mg/day, day 1-21/ 35 days, CDDP: 60 mg/m2, day 8/35 days) was performed as the second-line chemotherapy, nevertheless the diameter of liver metastasis enlarged to 26 mm. No distant metastasis without solitary liver tumor was observed for 6 months after gastric resection, so a partial hepatic resection was performed in February 2009. Five months after the operation, the patient is doing well and shows no signs of recurrence of the cancer. A combination gastrectomy with D2 lymphadenectomy and postoperative chemotherapy was considered to be a radical treatment for H1, Stage IV gastric cancer.

[A case of left inguinal malignant lymphoma occurred after radical operation for gastric cancer and gastrointestinal stromal tumor].

In March 2005, a 70-year-old male patient underwent distal gastrectomy with D2 lymph node dissection for type 3 gastric cancer located in the lower-third of the stomach, and partial gastrectomy for submucosal tumor located in the upper- third of the stomach. A post operative pathological finding of cancer was T2N0P0H0M0 (f-Stage II) and that of submucosal tumor was gastrointestinal stromal tumor. Although the adjuvant chemotherapy of S-1 was administered, it was discontinued because of cerebral infarction. Forty months after the operation, CT scan revealed a left inguinal lymph node swelling and recurrence of gastric cancer was doubted. FDG-PET scan confirmed increased uptake only in one lymph node of left inguinal region. In September 2008, left inguinal lymph node dissection was performed and its pathological finding was follicular lymphoma (grade 1). At present, the patient was doing well and showed no signs of recurrence. However, it is important to follow-up the patient carefully because the relapse rate of follicular lymphoma is comparatively high.

[Two cases of venous thrombosis occurred during systemic chemotherapy for colorectal cancer].

We reported two cases of venous thrombosis occurred during systemic chemotherapy for colorectal cancer. Case 1: A 68-year-old male, who had been operated for rectal cancer received systemic chemotherapy with liver and lung metastases. Three months after the chemotherapy, the chest CT showed venous thrombosis. Case 2: A 53-year-old female, who had been operated for rectal cancer received systemic chemotherapy with lung metastases. Ten months after the chemotherapy, the contrastradiogram from catheter showed venous thrombosis. Venous thrombosis should be considered when CV ports were placed especially with systemic chemotherapy for colorectal cancer.

[A case of successful treatment using octreotide acetate for occlusive ileus in terminal stage cancer].

We report a 35-year-old female bearing ovarian cancer who was suffering from intestinal obstruction due to multiple recurrences. The treatment of 300 microg/day of octreotide acetate was started. The symptom of obstruction, such as vomiting and nausea, caused by intestinal obstruction was suddenly controlled and the quality of life was improved. Octreotide acetate can be applied for the management of intestinal obstruction caused by metastases at the terminal stage of cancer.

[A case report-advanced pancreas cancer with liver and lung metastases well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting].

We report a case of advanced pancreatic cancer with liver and lung metastases that was well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting. The patient was a 74-year-old woman. Chief complaints were back pain and anorexia. She was diagnosed with pancreas cancer with liver and lung metastases at the time of first visit. We started systemic chemotherapy with gemcitabine 1 g/body and 5-FU 1 g/body alternately every other week on an outpatient basis. At 1.5 months (M) after initiation of chemotherapy, we started radiation therapy to the main tumor at a total dose of 40 Gy. After radiation, chemotherapy was resumed. As a result, the size of the main tumor decreased but metastatic liver tumors got larger. Then we changed to combination therapy with systemic chemotherapy (gemcitabine and 5-FU) and hepatic arterial infusion (5-FU weekly). Liver metastases almost disappeared after 7.5 M. Despite all these treatments, however, the number of metastatic lung tumors increased. The patient was hospitalized for 15 M and died after 17 M. We focused on and succeeded in the prolongation of lifetime and maintenance of QOL by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion therapy.

[Four cases of successful multidisciplinary treatment for hepatocellular carcinoma with portal venous thrombus].

CASE 1: TAI and radiation therapy were performed for a lateral segment and tumor thrombus extended into the left portal branch. Then, we diagnosed a tumor thrombus that extended into the right portal branch and TAI and operation were performed. The patient died about 9 months after the diagnosis of tumor thrombus. CASE 2: An operation was performed for hepatoma involving the right lobe and the tumor thrombus extended into the right portal branch. TAI and TAE were performed for residual tumor. The patient died about 12 months after diagnosis of tumor thrombus. CASE 3: An operation was performed for hepatoma involving an anterior segment and tumor thrombus extended into the right portal branch. Then, TAI, TAE and PMCT were performed for residual tumor. The patient is alive for 33 months with recurrence after the diagnosis of tumor thrombus. CASE 4: An operation was performed for hepatoma involving a posterior segment and tumor thrombus extended into the right portal branch. For recurrent TAI and TAE, radiation therapy was performed. The patient is alive for 20 months without recurrence after the diagnosis of tumor thrombus.

[A case of colon cancer liver metastases treated by combined therapies].

A 46-year-old male patient underwent sigmoidectomy with D2 lymph node dissection and partial resection of the bladder for advanced colon cancer in January 2000. The lesion was judged to be pT2, pN0, sP0, sH0, sM0 and Stage II, and the patient was treated on a regular schedule as an outpatient. Fourteen months after the first operation, liver metastases (S4, S5) were found and partial resections of the liver were performed. However, a recurrence had often been detected in the residual liver for five years afterwards. Liver resections had been repeated for four times before radiofrequency ablation was performed in January 2005. The patient received adjuvant chemotherapy with 5'-DFUR, 5-FU/l-LV (RPMI method), and TS-1. In January 2006, obstructive jaundice due to tumor growth occurred and a self-expandable metallic stent was placed in the narrowed portion of the intrahepatic bile duct. The patient is,currently undergoing FOLFOX4 and FOLFIRI regimens.

[Effectiveness of radiation therapy to the venous thrombosis between the inferior vena cava and right ventricle].

In the management of hepatocellular carcinoma (HCC), a tumor thrombus occurrence between the hepatic vein and right ventricle is life threatening. We studied the effectiveness of radiation therapy to the venous thrombosis between the inferior vena cava and right ventricle. CASE 1: A 66-year-old man who suffered from no hepatic viral infection had hepatectomy of the huge HCC (over 20 cm) and recurrence at the post dperated liver and lung. After transarterial embolization, he suffered from dispnea and was found with tumor thrombus from the left hepatic vein to right atrium. Radiation therapy to the tumor thrombus was done and dispnea disappeared. He died by pneumonia at 5 months after the radiation. CASE 2: A 74-year-old woman who had hepatecomy and RFA for multiple HCC. For the recurrence of HCC, TAE and RFA were performed. After the tumor thrombus in the inferior vena cava, mammarian cancer was found and radiation therapy was performed. She died after 4 months from lung edema, but no growth of tumor thrombus was found. CASE 3: A 79-year-old man who had TAE, hepatectomy, RFA and MCT for multiple hepatoma. After these treatments, tumor thrombus at the right ventricle was found. Although he suffered from portal tumor thrombosis, lung metastases, bone metastases and colon cancer after the radiation therapy, he is still alive at the 19 month of treatments. Radiation therapy is safe and effective for venous tumor thrombosis of HCC.

[A case of metastatic colon cancer treated with oxaliplatin combination chemotherapy].

A 77-year-old male had been operated for ascending colon cancer with liver metastases. After hepatic artery injection therapy and CPT-11 plus 5'-DFUR combination therapy, oxaliplatin-based systemic chemotherapy was performed. Consequently, the tumor size was controlled for about 10 months. During the chemotherapy, we observed grade 3 neurological toxicity, but not grade 3-4 blood toxicity. Thus, the QOL of the patient was properly maintained. We conclude that the oxaliplatin-based chemotherapy may be useful for patients suffering 5-FU and CPT-11 resistant metastatic colorectal cancer in Japan.

[A case report of hepatocellular carcinoma (Vp4)--an attempt to reduce residual tumor thrombus using combination therapy (hepatic arterial infusion, hepatic arterial embolization and radiation)].

A 57-year-old man was found to have elevated levels of HCC markers during an observation of chronic hepatitis C. Diffused hepatoma was involved in the posterior lobe, and tumor thrombus extended into the main portal vein (Vp4). Posterior segmentectomy and tumor thrombectomy were performed. But, CT scan 45 days after the operation showed an enhancement at the residual tumor thrombus in the posterior branch. The patient received a hepatic arterial infusion of 5-FU, followed by hepatic arterial embolization. Then, we chose radiation therapy to the tumor thrombus. The most recent CT showed no enhancement at the reduced tumor thrombus. There have been almost no reports of treatment for residual portal thrombus. Careful observations are necessary in such patients.

[Efficacy of the combination therapy in early stage of recurrent cholangio celluler carcinoma (CCC)].

We report a case of cholangio celluler carcinoma (CCC) with a good quality of life, in spite of the recurrence of peritoneum and portal hepatic lymph nodes (PHLN), due to the combination therapy that consisted of hepatic arterial infusion, systemic chemotherapy, radiation therapy and an insertion of a metallic stent into the bile duct. The patient was a 61-year-old man. Left hepatectomy was done due to multiple CCC. For the purpose of preventing the recurrence of CCC in residual liver, we performed an arterial infusion therapy. Ten months later, metastases to peritoneum and portal hepatic lymph nodes were found, so the resection of the peritoneum was performed, and cells in ascites were defined to be positive with cytology. After 2 years from the first operation, the size of portal hepatic lymph nodes had grown and both the billilbin and tumor marker levels had increased, so we started systemic chemotherapy, radiation therapy and insertion of a metallic stent into the bile duct. The tumor marker level decreased in a short time. Consequently, we inserted a metallic stent into the bile duct and radiation therapy was performed. Until the patient's death due to peritonitis carcinomatosa, the recurrence in residual liver occurred only once in three years after the first operation, and portal hepatic lymph nodes did not grow for two years after the recurrence.

[A case of unresectable cholangiocellular carcinoma treated with surgery followed by combination chemotherapy].

The patient was a 44-year-old man, who was investigated for lateral abdominal pain and liver dysfunction, and subsequently referred to our department with a diagnosis of unresectable intrahepatic cholangiocellular carcinoma (CCC). Radiological examinations revealed the huge mass in the right lobe of the liver with intrahepatic metastasis in the left lobe. The main tumor was surgically removed, but the metastases were not removed. A month after the operation, a subcutaneous implant reservoir was indwelled for repeated transcatheter hepatic arterial chemo infusion therapy (5-fluorouracil 500 mg/day continuous infusion, day 1-5, and CDDP 10 mg/day, day 1) from the right femoral artery. After 15 courses of home anti-cancer chemotherapy, abdominal CT revealed that the size of intrahepatic metastasis in the left lobe of the liver had not shown growth, whereas other metastitic sites popped up in the caudate lobe, which were free of chemical agent flow. There was no major complication related to the chemotherapy throughout the post-treatment course. Although he maintained a good level of QOL, he refused further chemotherapy due to depression. He died of liver failure 7 months after the operation. In conclusion, volume reduction surgery followed by transcatheter hepatic arterial chemo infusion might be promising as an effective therapy for non resectable CCC.

[A case of recurrent gastric cancer with peritoneal dissemination successfully treated with DJ stents against bilateral hydronephrosis and chemotherapy].

A 69-year-old female patient underwent total gastrectomy with a D2 lymph node dissection. Her final findings were of pT2, pN0, sP0, sH0, sM0 and Stage IB. After thirty-five months from the operation, peritoneal recurrence with ascites, bilateral hydronephrosis and stenosis of colon was found. TS-1 (80 mg/day/body) was administered for four weeks followed by a 2-week rest after DJ stents were inserted into bilateral ureters. At the end of two courses of TS-1, ascites disappeared and the decrease of tumor marker was observed. During the seventh course, symptoms such as abdominal fullness and ascites became worse. She underwent a weekly administration of paclitaxel (90 mg/body) as a second-line chemotherapy. This regimen was continued for three weeks followed by a 1-week rest. After four courses of paclitaxel, ascites disappeared and the tumor marker was gradually reduced. However, multiple bone metastases were found during the eighth course, and she died about two years after the recurrence. The toxic events were mucositis (grade 1) in TS-1, and alopecia (grade 2) and leukopenia (grade 1) in paclitaxel. No major adverse effects were observed. Although the prognosis of recurrent gastric cancer with peritoneal dissemination was extremely poor, this case might suggest a possibility that intensive therapies are useful in maintaining the quality of life and improving survival.

[Non-surgical treatment of hepatocellular carcinoma with tumor thrombus in the right atrium].

A 65-year-old Japanese man who had been suffering from severe and progressive dyspnea for more than 2 months underwent an extended right hepatectomy for hepatocellular carcinoma (HCC) in August 2001. Radiological examination, performed in August 2003, revealed the mass in the left lobe of the liver extended into the left hepatic vein, the inferior vena cava and the right atrium. Those clinical manifestations were supposedly attributed to HCC tumor thrombus in the right atrium. The decision to carry out the palliative operation for the tumor thrombus was not made because of poor prognosis in light of hemodynamic compromise indicating a reasonable liver function. A sequential course of treatments for the tumor thrombus was performed including transcatheter chemotherapy, transarterial chemoembolization and radiation therapy. Although a radiological response rate was 27% in diameter of the tumor thrombus, the clinical manifestations, such as dyspnea or edema, completely disappeared during the treatment. No surgical standard or interventional regimen for HCC tumor thrombus in the right atrium has been established. However, we here demonstrated the possibility for the treatment of the tumor thrombus with intensive combination therapies.

Iridium complex-catalyzed highly enantio- and diastereoselective [2+2+2] cycloaddition for the synthesis of axially chiral teraryl compounds.

An asymmetric [2+2+2] cycloaddition of an alpha,omega-diyne, possessing ortho-substituted aryl groups on its terminus, and a monoalkyne with oxygen functionalities gave various axially chiral teraryl compounds. The coupling proceeded with extremely high enantio- (>99.5% ee) and diastereoselectivities (dl/meso = >95/5) when catalyzed by an iridium-chiral phosphine complex. As the products were readily transformed into diol compounds by deprotection without racemization, the present procedure provides access to a new chiral pool of diol compounds with C2 symmetry.

[Evaluation of hepatic arterial infusion chemotherapy with levofolinate (l-LV) and 5-fluorouracil (5-FU) for multiple liver metastases from colorectal cancer].

We evaluated the effect of hepatic arterial infusion chemotherapy with levofolinate (l-LV) and 5-fluorouracil (5-FU) for multiple liver metastases from colorectal cancer. All patients received drugs on an outpatient basis every six weeks, followed by no medication for two weeks. In this regimen levofolinate (200 mg/m2) was administered for two hours and 5-fluorouracil (500 mg/m2) was administered for thirty minutes as a bolus. A complete response was obtained in five patients and a partial response in five patients; the overall response rate was 40%. All patients could receive this therapy on an outpatient basis because no patient had side effects of Grade 3 or over. It is suggested that our protocol may be useful for improvement of outcome.