Primary extramedullary plasmacytoma of the sigmoid colon with perforation: a case report.

BACKGROUND: Extramedullary plasmacytomas account for 4% of all plasma cell tumors and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. Extramedullary plasmacytoma of the colon with perforation has not been reported. CASE PRESENTATION: A 77-year-old woman with a 1-year history of lower abdominal pain and nausea was admitted to our hospital. An abdominal computed tomography scan revealed a sigmoid tumor with perforation. The patient underwent emergency surgery. Pathological examination led to a diagnosis of plasmacytoma of the colon. The patient did not undergo postoperative adjuvant chemotherapy. She has had no recurrence in 14 months of regular follow-up. CONCLUSIONS: We have herein described a rare case of extramedullary plasmacytoma of the gastrointestinal tract with perforation involving the sigmoid colon.

[A Case of Study Stable Disease after Hepatic Arterial Infusion Chemotherapy in a Patient with Systemic Chemotherapy-Resistant Liver Metastases of Colon Cancer].

A 62-year-old man was underwent sigmoidectomy for sigmoid colon cancer(T3N1H0P0, Stage III a). He received a postoperative systemic chemotherapy with SOX. Five months after the operation, multiple liver metastases were detected by CT scan. Systemic chemotherapy(bevacizumab and SOX, bevacizumab and FOLFIRI)did not reduce the liver metastases. So 4 courses of hepatic arterial infusion(HAI)chemotherapy with CDDP 10mg/day and 5-FU 500mg/day for 2weeks were performed without severe adverse events. All the liver metastases decreased in size remarkably, and the hepatic resection was able to be performed. We think HAI chemotherapy is one of the useful options for resistance to systemic chemotherapy for liver metastases from colorectal cancer.

Endoscopic radiofrequency ablation in elderly patients with hepatocellular carcinoma.

BACKGROUND: The number of elderly patients with hepatocellular carcinoma (HCC) has increased in Japan. PATIENTS AND METHODS: A total of 280 patients with HCC treated with endoscopic radiofrequency ablation (ERFA) were enrolled in the present study. The patients were divided into two groups, an elderly group (≥ 70 years) and a non-elderly group (<70 years) and their clinical and survival data were compared. RESULTS: The cumulative overall survival rates in the elderly and non-elderly groups were equivalent: 73% and 70% at three years and 57% and 52% at five years, respectively (p=0.900). The disease-free survival rates were 21% and 23% at three years and 17% and 14% at five years, respectively (p=0.628). No significant effects were observed between the two groups due to any of the covariates in the survival analysis (all p-values for interaction ≥ 0.19). The complication rates were also comparable: 5.1% in the elderly group and 8.6% in the non-elderly group. CONCLUSION: ERFA is safe and provides excellent therapeutic effects in elderly as well as non-elderly patients with HCC.

[A Case Report of Advanced Gastric Cancer Demonstrating CR after Treatment with S-1 and Paclitaxel].

Here, we report a case of advanced gastric cancer that demonstrated CR after treatment with S-1 and paclitaxel. The patient was an 80-year-old woman with gastric cancer in whom upper gastrointestinal endoscopy (GIF) revealed a type 3 tumor in the cardia of the stomach that was pathologically diagnosed as a well-differentiated adenocarcinoma. Computed tomography showed no lymph node involvement or metastasis. Considering her advanced age and cardinal functional disorder, she was administered chemotherapy consisting of S-1 and paclitaxel. Depending on a state, a side effect, I changed a dose and inter-dose interval from head to foot and I treated it by foreign going to hospital and continued it. Gradual tumor reduction was observed on GIF (2011/1/25). CR was diagnosed without tumor disappearance, with accepted malignant findings on biopsy. The patient has now survived for 7 years 9 months after diagnosis. The present case demonstrates that combination therapy of S-1 and paclitaxel is safe and useful for patients with risk factors such as advanced age and underlying disease.

[A case of gastric cancer treated with chemotherapy with weekly paclitaxel and expandable metallic stent placement that resulted in long-term quality of life].

We encountered a patient with gastric cancer who achieved long-term quality of life( QOL) by undergoing chemotherapy with weekly administration of paclitaxel and placement of an expandable metallic stent. An 82-year-old man visited our hospital with a complaint of discomfort during swallowing. Upper gastrointestinal endoscopy revealed a type 3 tumor in the cardial part of the posterior wall of the stomach, which was pathologically diagnosed as a well-differentiated adenocarcinoma. Computed tomography scans revealed no lymph node metastasis. Considering the patient was of advanced age and had a pulmonary function disorder, we administered chemotherapy with S-1. However, the patient experienced difficulty in swallowing medication at the start of therapy. Thus, a stent was inserted to continue the administration of chemotherapy with S-1 and cisplatin( CDDP). After completion of 4 courses of chemotherapy with S-1 and CDDP, an increase in the tumor marker level was observed; hence, we initiated chemotherapy with weekly paclitaxel. Currently, the patient is undergoing medical treatment at our outpatient department. Chemotherapy after stent placement for stenosis is considered useful for intensive therapy in high-risk patients such as those of advanced age. Here, we discuss the present case in light of a review of the related literature.

[A multicenter study of epirubicin-docetaxel(ET)as primary chemotherapy for patients with inflammatory breast cancer(IBC)].

We evaluated the efficacy and safety of the epirubicin plus docetaxel(ET)regimen, which is a combination of active agents given to patients with inflammatory breast cancer(IBC)as a primary therapy. Nineteen patients received ET(60, 60mg/m2) every 3 weeks for 4 courses, and appropriate surgery was offered unless disease progression occurred. Seventeen patients completed the ET regimen and 1 patient was excluded because of no diffuse erythema, leaving 18 patients evaluable for the response and safety profile of this regimen. Grade 3/4 hematological toxicities were neutropenia in 15 patients(79%), febrile neutropenia in 8 patients(42%)and anemia in 3 patients(16%). Six patients(63%)received granulocyte colony-stimulating factor for febrile neutropenia. Febrile neutropenia was observed only for 1 course in all 6 patients and progression to apparent infection was not observed. Grade 3/4 non-hematological toxicities were constipation in 3, nausea in 2, anorexia in 2, fatigue in 1, vomiting in 1, diarrhea in 1, and stomatitis in 1 patient. The ET regimen was given to 16 patients(89%)as planned. The median number of courses was 4(range: 2-4). The clinical response rate was 44%. The median time to progression was 9 months, and median overall survival was 26 months. It is concluded that the ET regimen was well tolerated and effective as a primary chemotherapy for IBC.

[Docetaxel in combination with epirubicin as the first-line chemotherapy for advanced and recurrent breast cancer: a multicenter phase II study].

This study examined the efficacy and tolerability of docetaxel(DOC)in combination with epirubicin(EPI)as the first-line treatment for patients with advanced and recurrent breast cancer. A total of 56 female patients with metastatic breast cancer not previously treated for metastatic disease received DOC(60mg/m²)and EPI(60mg/m2)on day 1 every 3 weeks. The patient characteristics included a median age of 53 years. Advanced disease was present in 86% of patients, and recurrent disease was found in 14%; 3 or more metastatic sites had been diagnosed in 38% of patients, and 59% patients were ER+. The median number of courses administered was 6. The median dose intensity was 18. 7mg/m²week for DOC and EPI, and the relative dose intensities were 93. 5%and 93. 3%, respectively. The clinical responses included a complete response in 5%, a partial response in 54%, and stable disease in 33% of patients, with a disease control rate of 92%. The progression-free survival was 78. 3%, and the overall survival was 91. 9% at 1 year. Grade 3/4 toxicities included neutropenia in 82%, leukopenia in 71%, febrile neutropenia in 16%, anorexia in 9%, and anemia in 7%of the patients. Neither congestive heart failure nor toxic death occurred. The D and E combination with doses of 60mg/m2 is an active and generally well-tolerated regimen that can be used as first-line chemotherapy for patients with metastatic breast cancer.

[A case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy].

We present a case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy. A 73-year-old woman visited our hospital with complaints of neck mass and discomfort during swallowing. Upper gastrointestinal endoscopy revealed a type 3 tumor in the middle portion of the esophagus, which was pathologically diagnosed as small cell carcinoma. A computed tomography showed lymph node swelling from neck to mediastinum. Then she was administered chemotherapy with CDDP plus CPT-11 and radiotherapy. The main tumor and lymph node swelling was remarkably reduced by chemoradiotherapy. The prognosis of small cell carcinoma of the esophagus is extremely poor because it may cause a general metastasis in early stage. This case was for long-term survival with chemoradiotherapy, and we report our case with the literature cited.

[The assessment of chemoradiation therapy with CDDP/S-1 for advanced gastric cancer that was actively bleeding].

In the management of inoperable patients with advanced gastric cancer, it is important to control a tumor bleeding actively and to make sure that the patient can take meals through the stenotic cardia for the purpose of keeping the patients' quality of life well. We treated five gastric cancer patients with chemoradiation therapy consisting of CDDP (6 mg/m2) and S-1 (100 mg/body). In the treatment results, we have never seen an active tumor bleeding and anemic state, which required a blood transfusion after the treatment. In all of the 5 cases, a total quantity of taking meals increased due to a cardia stenosis improvement by tumor. We thought this treatment was useful for patients with cardia stenosis and actively bleeding in advanced gastric cancer.

[Successful treatment of embolization and chemoradiationtherapy with S-1 for the advanced gastric cancer which was actively bleeding].

In the management of inoperable patients who have advanced gastric cancer, it is important to control an active tumor bleeding for the purpose of keeping the patient's quality of life well. We treated two patients: embolization with coil to aneurysm in the gastric tumor in one case, and embolization and chemoradiationtherapy with S-1 in the other. In results, we have never seen an active tumor bleeding and anemic state requiring a blood transfusion after the treatment. Both patients died from other diseases. We think these treatments are useful for patients with active bleeding in advanced gastric cancer.

[A case of successfully repeated resections of pulmonary metastasis after hepatectomy of hepatocellular carcinoma].

A 73-year-old woman was diagnosed with solitary hepatocellular carcinoma (18 cm in diameter) in the right lobe. Right hepatic lobectomy was performed in March 2004. Solitary pulmonary metastasis in the left lung was detected by CT scan in April 2006. Thoracoscopic resection of pulmonary metastasis was performed. But in February 2007, solitary pulmonary metastasis in the right lung was detected by CT again. Second thoracoscopic pulmonary resection was performed. Fifty-one months after the initial surgery, she is alive without recurrence in the lung. In patients with pulmonary metastasis of hepatocellular carcinoma, if recurrence in the remnant liver is well controlled and pulmonary metastasis is completely resectable, repeated resections of pulmonary metastasis can be an effective treatment and improve survival.

[A case of advanced accessory breast cancer effectively treated with trastuzumab and paclitaxel].

A 53-year-old woman was admitted for left axillary mass. The computed tomography showed an invasive mass in the left axilla and left supraclavicular lymph node swelling. Histological findings of axillary mass revealed infiltrating ductal carcinoma of scirrhous type. We diagnosed advanced accessory breast cancer, and the patient was treated by combination chemotherapy with paclitaxel and trastuzumab. The lesions disappeared after 4 courses of chemotherapy and was clinically diagnosed as complete response (CR).

[A case of advanced rectal cancer responding to radiation therapy and chemotherapy with S-1].

We report a case of a 72-year-old man with advanced rectal cancer who refused an operation for cancer therapy. We underwent radiation therapy (40 Gy) for the purpose of suppressing tumor bleeding. Consequently, we administered S-1 (100 mg/day) orally. As a result, the tumor has disappeared by radiation therapy and chemotherapy with S-1 for 2 years. We have recognized no side effects. This therapy seemed to be an effective treatment for poor-risk elderly patients.

[Long survival of a colon cancer case with multiple liver metastases cured by multidisciplinary therapy].

The patient was a 79-year-old a man who had a sigmoid colon resection for sigmoid colon carcinoma in another hospital 11 years ago. Four years later,he was noted to have multiple unresectable hepatic metastases on CT. Therefore,intrahepatic arterial and portal infusion with CDDP 10 mg + 5-FU 250 mg, respectively,were started. His CEA level decreased to the normal range,and a partial response (PR) was achieved. But two years later, the CEA level increased again,so radiofrequency ablation (RFA) therapy was given during abdominal surgery. Then, IFL, CPT-11+S-1, and FOLFOX were administered. Currently, the patient is being treated as an outpatient with CPT-11+S-1. The patient's multiple hepatic metastases were treated with multidisciplinary therapy, and the man has lived for 6 years 11 months since his first hepatic metastases were noted. The multidisciplinary therapy that was used lengthened this patient's life.

[Second-or third-line chemotherapy with CPT-11+TS-1 for 5 cases of metastatic and recurrent colorectal cancer].

The 3-drug regimen of CPT-11+5-FU+l-LV is generally used for metastatic and/or recurrent colorectal cancer. We have applied this treatment as the first-line intervention in our hospital. However,when the efficacy is reduced we try chemotherapy using CPT-11+TS-1 for 5 outpatients as second- or third-line chemotherapy. Decreased CEA levels were subsequently observed in 4 of 5 cases. In addition, 2 cases exhibited grade 1 or 2 adverse effects, but no case developed neutropenia. We could expect such effects even for patients after only 5-FU, and this treatment may be performed safely on ambulatory patients.

[A case of intrahepatic cholangiocarcinoma successfully treated by hepatic arterial infusion chemotherapy].

The patient was a 67-year-old man who had been operated for eshophageal cancer 4 years ago. He was diagnosed as intrahepatic cholangiocarcinoma by CT after 2 years of the operation. After admission to our hospital, he was treated by hepatic arterial infusion chemotherapy with CDDP, levofolinate calcium (L-LV) and 5-FU with chronomodulation. After a few more months of the treatment, abdominal CT revealed that the size of hepatic tumor decreased remarkably. There were no side effects without bone marrow suppression (grade 1). It seemed that hepatic arterial infusion chemotherapy with chronomodulation may be an effective strategy against intrahepatic cholangiocarcinoma in high risk case.

[Assessment of efficacy of arterial infusion chemotherapy with gemcitabine for four cases of advanced pancreatic cancer].

We treated 4 cases of advanced pancreatic cancer: 2 cases were nonresectable and the other 2 cases did not choose an operation but arterial infusion chemotherapy with gemcitabine after the transcatheter peripancreatic arterial embolizaiton. One case resulted in a tumor decrease but the other 3 cases observed a tumor progress. Although we confirmed cancer pain suppression in all cases and a disappearance of tumor fever in one case, the survival period was 7 months in spite of the treatment. As for the complication of arterial infusion chemotherapy with gemcitabine, we recognized bone marrow suppression (grade 1) in 3 cases. This therapy seemed to be effective for suppression of pain and tumor fever caused from the advanced pancreatic cancer. However, we need to improve in survival period from this therapy.

[A 6-year-survival case of esophageal adenosquamous cancer with liver metastases cured by multidisciplinary therapy].

A 65-year-old man was diagnosed as esophageal cancer with multiple liver metastases (S2 10 mm, S7 10 mm, S8 15 mm). The preoperative diagnosis was stage IV (T 3 N 3 M 1 Pl 0), and he was operated palliatively by esophagocardiofundectomy and intrathoracic anastomosis for oral food intake. The postoperative histological diagnosis was adenosquamous carcinoma. One month after the operation he was administered orally UFT-E (300 mg/day) and PSK (3g/day). He was also treated by hepatic arterial infusion therapy with CDDP (10 mg/week). After 180 mg of CDDP, liver metastases were evaluated for PR. This therapy was discontinued after 410 mg of CDDP by vomiting and hypotension. 16 months after, DOC (20 mg/week) was given by arterial infusion and CR of liver metastases was achieved 18 months after. Then he was given 840 mg of DOC and oral administration of UFT-E and PSK was performed for about 5 years. He was free from the recurrence of cancer as an outpatient and had a good QOL. We think that esophageal cancer with liver metastasis should be aggressively treated surgically so as to allow oral food intake, and liver metastasis should be treated with chemotherapy because postoperative hepatic arterial infusion therapy is effective and provides a good QOL.

[Utility of arterial infusion chemotherapy and radiation therapy for the pelvic local recurrence of rectal cancer].

We treated 3 cases of local pelvic recurrence due to a rectal cancer post operation by arterial infusion chemotherapy with 5-FU and levofolinate calcium and also by radiation therapy. The result of imaging analysis showed that a recurrent tumor was decreased effectively in 2 cases by chemo-radiation therapy. We confirmed the cancer pain and tumor bleeding were gone for all of the 3 cases. As for side effects of arterial infusion chemotherapy and radiation therapy, we confirmed a paralysis of the pelvic nerve in 1 case and dermatopathy in 1 case. This therapy seemed to be an effective treatment for elderly patients with inoperable cases.

[Utility of convex echo probe in laparoscopic radio frequency ablation therapy for hepatocellular carcinoma].

We have examined the utility of the convex echo probe, which has the fine gutter of a puncture needle in laparoscopic radio frequency ablation therapy. When we use a flexible linear echo probe in RFA treatment, we have to puncture tumor with the hand piece in free hand. But it is difficult to treat in the case of HCC which is located in S1 and the lower area of S5 and S6 because we have a narrow space where colon, duodenum and netz are close for safe and exact puncturing of the tumor. We used a convex echo probe in RFA to the above mentioned area of the liver. We punctured with the hand piece exactly and easily without preliminary puncturing of the tumor. So we can perform RFA treatment successfully and safely by a choice of an appropriate echo probe.