[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.

[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.