RESUMEN
Ramucirumab monotherapy is one of the conditionally recommended regimens in second-line chemotherapy for advanced gastric cancer. However, there are few clinical data on ramucirumab monotherapy in Japanese patients. Herein, we present 4 case reports of advanced gastric cancer patients who received ramucirumab monotherapy. The 4 patients' age ranged from 65-81 years old(median: 70 years old), with a 3:1 male to female ratio. Since all cases were in poor performance status, administration of cell-killing anticancer drugs such as paclitaxel was contraindicated, and ramucirumab monotherapy was selected as an alternative. Ramucirumab was administrated 2-8 times(median: 3 times), resulting to a stable disease in 1 patient, and progression-free survival was noted to be 3-16 weeks(median: 5 weeks). Regarding complications, Grade 2 hypertension occurred in 1 patient, and no serious adverse events were observed. Ramucirumab monotherapy is a well-tolerated second-line chemotherapy for patients with advanced gastric cancer in poor performance status, and it is expected to have some disease control effect.
Asunto(s)
Adenocarcinoma , Neoplasias Gástricas , Adenocarcinoma/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Masculino , Paclitaxel/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , RamucirumabRESUMEN
Objective There are no reports on whether or not trainees can safely carry out endoscopic procedures for the removal of common bile duct (CBD) stones. The aim of this study was to investigate the efficacy and safety of endoscopic treatments for CBD stones by trainees. Methods Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 1,016 consecutive patients at our institution during the 6-year study period. The endoscopically treated patients with CBD stones were included in this study. Physicians who had experienced ≥300 ERCP procedures were defined as experts, while those who had experienced <300 procedures were defined as trainees. The trainees were replaced by an expert when they could not achieve the established criteria. Patients were divided into the following three groups to retrospectively examine the patients' backgrounds, details of endoscopic treatments, and intra-/post-operative complications: Group A, completed by trainees under supervision of an expert; B, treated by an expert who switched in for a trainee in the middle of the procedure; and C, completed by an expert. Results A total of 325 patients with CBD stones underwent endoscopic treatments. The number included in Groups A, B, and C was 176, 102, and 47, respectively. The bile duct catheter insertion successes rates for Groups A, B, and C were 99.0%, 97.1%, and 100% (p=0.09), and the complete stone removal rates were 94.2%, 94.8%, and 100%, respectively (p=0.07), showing no significant difference among the three groups. Furthermore, the frequency of intra-/post-operative complications was not significantly different among the three groups (p=0.48, p=0.12, respectively). Conclusion This study showed that trainees could safely perform endoscopic procedures in accordance with our facility's criteria during ERCP.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica , Conducto Colédoco/cirugía , Cálculos Biliares/cirugía , Cirugía General/educación , Adulto , Anciano , Anciano de 80 o más Años , Cateterismo/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Esfinterotomía EndoscópicaRESUMEN
The Endoscopic procedures for common bile duct (CBD) stones are reportedly safe in the elderly patients. However, the definition of the elderly is different in each report. If the elderly are defined as people aged 85 years or older, data on the effectiveness and safety of endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones are limited. This study investigated the efficacy and safety of endoscopic procedures for CBD stones in patients aged 85 years or older. 1,016 consecutive ERCP procedures were performed at our institution from January 2009 to December 2014. Of these, 235 cases with CBD stones were finally analyzed. Group A patients were younger than 85 years and Group B patients were 85 years or older. Patient background, details of endoscopic therapy, complications, and related factors were retrospectively reviewed for 185 cases in Group A, and 50 cases in Group B. Patients in Group B showed high rates of dementia and cerebrovascular disorders and larger CBD stones and diameters, in comparison with patients in Group A. The complete removal rate of bile duct stones was slightly higher in Group A. However, there was no difference between the two groups in recurrence rate of CBD stones, complication and mortality rates, and length and cost of hospitalization. Despite some differences between the two groups, endoscopic procedures for CBD stones in patients aged 85 years or older can be performed effectively and safely without increasing medical costs.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/normas , Conducto Colédoco/patología , Cálculos Biliares/cirugía , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Femenino , Humanos , Masculino , Seguridad del Paciente , Estudios RetrospectivosRESUMEN
BACKGROUND/AIMS: Although multiple treatment options exist for the management of sigmoid colon volvulus, no study has examined the factors associated with successful endoscopic detorsion. This study aimed to examine the clinical course of patients with sigmoid colon volvulus and to identify factors related to successful endoscopic detorsion. METHODS: This study included 30 cases (21 patients) of sigmoid volvulus from among 545 cases of intestinal obstruction at a single center. We retrospectively examined the clinical course and the factors associated with the possibility of endoscopic detorsion of sigmoid colon volvulus. RESULTS: The rate of laxative use among the study participants was 76.2%; the rate of comorbid neuropsychiatric disorders was 61.9%; and 57.1% of patients had a history of open abdominal surgery. All patients were initially treated with endoscopic detorsion, and this procedure had a 61.9% success rate. The recurrence rate after detorsion was as high as 46.2%, but detorsion during revision endoscopy was possible in all cases. Statistical analysis revealed that the absence of abdominal tenderness (P=0.027), the use of laxatives (P=0.027), and a history of open abdominal surgery (P=0.032) were factors predictive of successful endoscopic detorsion. CONCLUSIONS: The results of our study are consistent with previous reports with respect to the success rate of endoscopic detorsion, the subsequent recurrence rate, and the proportion of patients requiring surgical treatment. In addition, we identified the absence of abdominal tenderness, the use of laxatives, and history of open abdominal surgery as factors predicting successful endoscopic detorsion of sigmoid colon volvulus.
RESUMEN
A 78-year-old man presented to our hospital with fever and brownish urine. Upon thorough examination, a diagnosis of obstructive jaundice and acute cholangitis associated with a lower bile duct tumor was made. Endoscopic retrograde cholangiopancreatography revealed entire circumferential stenosis of the lower bile duct. Examination of a transpapillary biopsy specimen of the lesion suggested adenosquamous carcinoma. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Histopathological examination revealed adenocarcinoma of the lower bile duct and squamous cell carcinoma components;a case of adenosquamous carcinoma was accordingly diagnosed. The lower bile duct tumor directly extended into the pancreatic parenchyma for approximately 1mm. We performed radical surgery and administered adjuvant chemotherapy with gemcitabine because of advanced neural invasion after consulting with the patient. There was no sign of recurrence 46 months after surgery. As adenosquamous carcinoma of the extrahepatic bile duct is rare, it is difficult to preoperatively diagnose the condition. Only a few cases have been reported till date.
Asunto(s)
Neoplasias de los Conductos Biliares/patología , Carcinoma Adenoescamoso/patología , Anciano , Antimetabolitos Antineoplásicos/uso terapéutico , Neoplasias de los Conductos Biliares/tratamiento farmacológico , Neoplasias de los Conductos Biliares/cirugía , Biopsia , Carcinoma Adenoescamoso/tratamiento farmacológico , Carcinoma Adenoescamoso/cirugía , Quimioterapia Adyuvante , Colangiopancreatografia Retrógrada Endoscópica , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapéutico , Humanos , Masculino , Pancreaticoduodenectomía , GemcitabinaRESUMEN
A 50-year-old man was admitted to our hospital for an adhesive ileus 14 years after total abdominal colectomy for ulcerative colitis (UC). The ileus decreased with conservative treatment, however, autoimmune hemolytic anemia (AIHA) was diagnosed due to worsening anemia, a positive direct Coombs test, low haptoglobin, high lactase dehydrogenase, reticulocytosis, and an increase in the erythroblastic series in a bone-marrow examination. Human parvovirus B19 (PV-B19) IgM and PV-B19 DNA were present, indicating the development of AIHA triggered by an infection with PV-B19. The patient is currently being monitored after spontaneous remission. This is the first report of UC after total abdominal colectomy complicated by AIHA triggered by PV-B19 infection.
Asunto(s)
Anemia Hemolítica Autoinmune/etiología , Colectomía/efectos adversos , Colitis Ulcerosa/cirugía , Infecciones por Parvoviridae/complicaciones , Parvovirus B19 Humano/patogenicidad , Anemia Hemolítica Autoinmune/virología , Colectomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Parvoviridae/tratamiento farmacológico , Infecciones por Parvoviridae/inmunología , Parvovirus B19 Humano/inmunología , Prednisolona/administración & dosificación , Remisión Espontánea , Resultado del Tratamiento , Espera VigilanteRESUMEN
BACKGROUND: Parameters reported in pathologic reviews have been failing to assess exactly the malignant potential of gastrointestinal cancers. We hypothesized that malignant potential could be defined by common latent variables (hypothesis I), but there are substantial differences in the associations between malignant potential and pathologic parameters according to the origin of gastrointestinal cancers (hypothesis II). We shed light on these issues by structural equation modeling. MATERIALS AND METHODS: We conducted a cross-sectional survey of 217 esophageal, 192 gastric, and 175 colorectal cancer patients who consecutively underwent curative surgery for their pathologic stage I cancers at Keiyukai Sapporo Hospital. Latent variables identified by factor analysis and seven conventional pathologic parameters were introduced in the structural equation modeling analysis. RESULTS: Because latent variables were disparate except for their number, 'three' in the examined gastrointestinal cancers, the first hypothesis was rejected. Because configural invariance across gastrointestinal cancers was not approved, the second hypothesis was verified. We could trace the three significant paths on the causal graph from latent variables to lymph node metastasis, which were mediated through depth, lymphatic invasion, and matrilysin expression in esophageal cancer, whereas only one significant path could be traced in both gastric and colorectal cancer. Two of the three latent variables were exogenous in esophageal cancer, whereas one factor was exogenous in the other gastrointestinal cancers. Cancer stemness promoted viability in esophageal cancer, but it was suppressed in others. CONCLUSION: These results reflect the malignant potential of esophageal cancer is higher than that of the other gastrointestinal cancers. Such information might contribute to refining clinical treatments for gastrointestinal cancers.
Asunto(s)
Neoplasias Gastrointestinales/patología , Modelos Teóricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/cirugía , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de NeoplasiasRESUMEN
A 65-year-old man was referred to our hospital with a primary complaint of unintentional weight loss. Upper gastrointestinal endoscopy showed a large duodenal tumor, and computed tomography (CT) showed tumor invasion of the pancreatic head, associated with lymph node swelling around the tumor and abdominal aorta. After 4 courses of chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6), follow-up upper gastrointestinal endoscopy and biopsy showed no evidence of a duodenal tumor. However, follow-up CT showed persistent lymph node swelling near the superior mesenteric artery. The patient therefore underwent pancreaticoduodenectomy with curative intent. At 18 months after the surgery, there were no findings suggestive of tumor recurrence.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Duodenales/tratamiento farmacológico , Metástasis Linfática , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Terapia Combinada , Neoplasias Duodenales/patología , Neoplasias Duodenales/cirugía , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Masculino , Compuestos Organoplatinos/uso terapéuticoAsunto(s)
Perforación del Esófago/complicaciones , Cuerpos Extraños/complicaciones , Enfisema Mediastínico/etiología , Mediastinitis/etiología , Animales , Diagnóstico Diferencial , Ingestión de Alimentos , Endoscopía Gastrointestinal , Perforación del Esófago/diagnóstico , Cuerpos Extraños/diagnóstico , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Mediastinitis/diagnóstico , Persona de Mediana Edad , Alimentos Marinos , Tomografía Computarizada por Rayos XRESUMEN
Systemic chemotherapy based on 5-fluorouracil (5-FU) is a standard treatment for unresectable or recurrent large intestinal cancer. Although hyperammonemia is a known side effect of 5-FU that can cause serious pathological conditions, only a few cases have been reported. We describe 4 cases of 5-FU-related hyperammonemia with impairment of consciousness in patients who received 5-FU chemotherapy for large intestinal cancer with multiple liver metastases. Hemodialysis was effective in 1 severe case. There have been no detailed reports on the use of hemodialysis for hyperammonemia caused by 5-FU. Renal dysfunction is considered to be a risk factor for hyperammonemia caused by 5-FU and it is necessary to pay particular attention in patients with renal dysfunction who receive chemotherapy with 5-FU. Here we summarize our cases together with 16 previously reported cases of hyperammonemia caused by 5-FU in Japan.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Fluorouracilo/efectos adversos , Hiperamonemia/inducido químicamente , Neoplasias Intestinales/tratamiento farmacológico , Intestino Grueso , Neoplasias Hepáticas/secundario , Anciano , Anciano de 80 o más Años , Humanos , Hiperamonemia/terapia , Neoplasias Intestinales/patología , Masculino , Persona de Mediana Edad , Diálisis RenalRESUMEN
A 59-year-old man was admitted to the hospital because of upper abdominal pain. Endoscopic examination and computed tomography showed a polypoid tumor located in the 2nd portion of the duodenum with invasion to the pancreas head, and biopsy findings suggested a gastrointestinal stromal tumor. He underwent a pancreaticoduodenectomy, and the tumor, which measured 6.5×6.5 cm, was resected. Histologically, the tumor contained two divergent components: differentiated tubular adenocarcinoma and sarcomatoid tissue composed of spindle tumor cells. The tumor directly extended to the pancreas head and metastasized to multiple lymph nodes. The adenocarcinoma cells were positive for AE1/3 and cytokeratin 7 and negative for vimentin. In contrast, the sarcomatoid tissue was negative for epithelial markers and positive for vimentin. The tumor was finally diagnosed as duodenal carcinosarcoma. Duodenal carcinosarcoma is very rare, and only seven cases have been reported to date.
Asunto(s)
Carcinosarcoma , Neoplasias Duodenales/cirugía , Carcinosarcoma/cirugía , Colectomía , Neoplasias Duodenales/patología , Endoscopía Gastrointestinal , Humanos , Masculino , Persona de Mediana Edad , Pancreatectomía , Tomografía Computarizada por Rayos XRESUMEN
An 87-year-old woman was diagnosed with primary diffuse large B-cell lymphoma of the pancreas by endoscopic ultrasonography-guided fine needle aspiration. Complete remission was achieved after treatment with six courses of R-CHOP chemotherapy. However, two and a half years later, she was readmitted because of weakness during walking. At this time, laboratory tests revealed hypercalcemia associated with high plasma levels of parathyroid hormone-related protein (PTHrP), but bone lesions were not detected. Although computed tomography only revealed splenomegaly, we suspected a recurrence of her malignant lymphoma because she also had marked elevation of soluble interleukin-2 receptor and lactate dehydrogenase levels. Bone marrow examination revealed the involvement of Burkitt's lymphoma cells with malignant transformation. Immunohistochemical analysis confirmed that hypercalcemia was caused by a paraneoplastic syndrome related to PTHrP-producing B-cell lymphoma cells. Unfortunately, the patient's general condition rapidly deteriorated, and she died soon after admission. Our case is unusual because of the presentation of bone marrow relapse of malignant lymphoma.
Asunto(s)
Hipercalcemia/etiología , Linfoma de Células B/complicaciones , Neoplasias Pancreáticas/complicaciones , Proteína Relacionada con la Hormona Paratiroidea/biosíntesis , Anciano de 80 o más Años , Biopsia , Femenino , Humanos , Linfoma de Células B/metabolismo , Neoplasias Pancreáticas/metabolismo , RecurrenciaRESUMEN
BACKGROUND: Recent studies have suggested that narrow band imaging (NBI) is useful for detecting superficial pharyngeal cancer. Nevertheless, pharyngeal observation is not a routine practice during upper gastrointestinal (GI) endoscopy. Two aims of this study were to evaluate the feasibility of pharyngeal observation during upper GI endoscopy and to determine the prevalence of pharyngeal cancer in asymptomatic high-risk patients. METHODS: Fifty-year-old or older asymptomatic males with smoking and drinking habits were prospectively recruited as a pharyngeal cancer high-risk group. A total of 224 high-risk patients underwent pharyngeal observation using NBI before conventional upper GI endoscopy. The feasibility of pharyngeal examination without sedation was assessed by a questionnaire for the first 60 participants. RESULTS: The median time for pharyngeal observation was 1.7 min. The questionnaire demonstrated 88% of participants thought the pharyngeal examination acceptable. The NBI examination identified 5 superficial pharyngeal cancers (2 Tis and 3 T1) in 224 high-risk patients; the prevalence of pharyngeal cancer in this group was 2.2%. Three of the 5 patients had a concurrent or past history of esophageal squamous cell carcinoma (ESCC). CONCLUSIONS: Pharyngeal observation using NBI during upper GI endoscopy is well tolerated and recommended for all high-risk patients, particularly those with a history of ESCC. Basel.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Detección Precoz del Cáncer/métodos , Endoscopía Gastrointestinal , Neoplasias Esofágicas/epidemiología , Imagen de Banda Estrecha , Neoplasias Faríngeas/diagnóstico , Neoplasias Faríngeas/epidemiología , Vigilancia de la Población/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Satisfacción del Paciente , Neoplasias Faríngeas/complicaciones , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Fumar , Encuestas y CuestionariosRESUMEN
A 71-year-old man was admitted to our hospital because of dysphagia, and primary endocrine cell carcinoma of the esophagus with multiple liver metastases was diagnosed. After 6 courses of CPT-11+CDDP combination chemotherapy, the liver metastases disappeared, although the esophageal squamous cell carcinoma component remained. Radiation therapy was added to treat the residual esophageal tumor, and a complete response was obtained. This case seems to suggest that multidisciplinary therapy, including chemotherapy, may be effective for treating esophageal endocrine cell carcinoma with other types of organ metastasis.
Asunto(s)
Neoplasias de las Glándulas Endocrinas/terapia , Neoplasias Esofágicas/terapia , Neoplasias Hepáticas/secundario , Anciano , Terapia Combinada , Neoplasias de las Glándulas Endocrinas/patología , Neoplasias Esofágicas/patología , Humanos , Masculino , Inducción de RemisiónRESUMEN
BACKGROUND: S-1, an oral fluoropyrimidine, is one of the standard chemotherapeutic agents for the treatment of metastatic gastric cancer(MGC). However, the most effective second-line regimen after failure of treatment with first-line agents such as S-1 is yet to be determined. The aim of this study was to investigate the various second-line chemotherapy regimens in MGC patients. METHODS: We retrospectively studied patients with MGC who received second-line treatment after failure of the first-line S-1 or S-1/cisplatin treatment. The overall survival times with each second-line regimen were determined using the Kaplan-Meier method, and the effect on overall survival was analyzed using Cox regression analysis. RESULTS: The median survival time for all patients was 14. 2 months(95% confidence interval(CI): 12. 88-15. 43 months)with a 1-year survival rate of 60. 4%. Kaplan-Meier analysis revealed that the second-line regimens containing irinotecan significantly improved the median survival time as compared to regimens without irinotecan(median survival time: 16. 5 and 13. 8 months, respectively). Cox regression analysis showed that irinotecan-containing regimens were associated with improved overall survival(hazard ratio: 0. 165; 95% CI: 0. 041-0. 665). CONCLUSION: The use of irinotecan-containing regimens as second-line chemotherapy after failure of first-line S-1 therapy may be beneficial for MGC patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/análogos & derivados , Resistencia a Antineoplásicos , Terapia Recuperativa , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Camptotecina/administración & dosificación , Camptotecina/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Combinación de Medicamentos , Femenino , Humanos , Irinotecán , Masculino , Metástasis de la Neoplasia , Ácido Oxónico/administración & dosificación , Ácido Oxónico/uso terapéutico , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tegafur/administración & dosificación , Tegafur/uso terapéuticoRESUMEN
PURPOSE: Gastrointestinal stromal tumors (GIST) are the most important mesenchymal tumors of the gastrointestinal tract. The vast majority of GISTs exhibit activating mutations of KIT or PDGFRA, but epigenetic alteration of GISTs is largely unknown. In this study, we aimed to clarify the involvement of DNA methylation in GIST malignancy. EXPERIMENTAL DESIGN: A total of 106 GIST specimens were studied. Levels of LINE-1 methylation were analyzed using bisulfite pyrosequencing. In addition, methylation of three other repetitive sequences (Alu Yb8, Satellite-α, and NBL2) was similarly analyzed, and CpG island hypermethylation was analyzed using MethyLight. Array-based comparative genomic hybridization (array CGH) was carried out in 25 GIST specimens. RESULTS: LINE-1 hypomethylation was significantly correlated with risk, and high-risk GISTs exhibited significantly lower levels of LINE-1 methylation than low-risk (61.3% versus 53.2%; P = 0.001) or intermediate-risk GISTs (60.8% versus 53.2%; P = 0.002). Hypomethylation of Satellite-α and NBL2 was also observed in high-risk GISTs. By contrast, promoter hypermethylation was relatively infrequent (CDH1, 11.2%; MLH1, 9.8%; SFRP1, 1.2%; SFRP2, 11.0%; CHFR, 9.8%; APC, 6.1%; CDKN2A, 0%; RASSF1A, 0%; RASSF2, 0%) and did not correlate with LINE-1 methylation or risk. Array CGH analysis revealed a significant correlation between LINE-1 hypomethylation and chromosomal aberrations. CONCLUSIONS: Our data suggest that LINE-1 hypomethylation correlates significantly with the aggressiveness of GISTs and that LINE-1 methylation could be a useful marker for risk assessment. Hypomethylation may increase the malignant potential of GISTs by inducing accumulation of chromosomal aberrations.
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Metilación de ADN , Tumores del Estroma Gastrointestinal/genética , Tumores del Estroma Gastrointestinal/patología , Elementos de Nucleótido Esparcido Largo/genética , Adulto , Anciano , Anciano de 80 o más Años , Elementos Alu/genética , Aberraciones Cromosómicas/estadística & datos numéricos , Hibridación Genómica Comparativa , Islas de CpG/genética , Metilación de ADN/fisiología , Progresión de la Enfermedad , Femenino , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , Análisis por Micromatrices , Persona de Mediana EdadRESUMEN
The patient was a 63-year-old man who underwent distal gastrectomy for advanced gastric cancer with lymph node metastasis and peritoneal dissemination. One year and eleven months after the operation,an increasing CA 19-9 concentration and metastases to the liver and peritoneum were observed. Oral TS-1 was given, but had to be discontinued because of anorexia and nausea. Chemotherapy consisting of paclitaxel (PTX) and CDDP was performed. PTX (80 mg/body) was administered weekly on day 1, 8 and 15, while CDDP (50 mg/body) was administered weekly on day 1 as one cycle. After two cycles of PTX/CDDP administration,metastases to the liver and peritoneum were not detected. The patient was treated with five courses of PTX/CDDP and survived without recurrence as of this writing. PTX/CDDP was associated with few adverse events in hospital visits, and thought to be an effective chemotherapy against recurrent gastric cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Ganglios Linfáticos/patología , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Gástricas/patología , Antígeno CA-19-9/sangre , Cisplatino/administración & dosificación , Terapia Combinada , Esquema de Medicación , Gastrectomía , Humanos , Neoplasias Hepáticas/secundario , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Neoplasias Peritoneales/secundario , Calidad de Vida , Neoplasias Gástricas/cirugíaRESUMEN
A 77-year-old man underwent gastrointestinal endoscopy that revealed a small flat elevated lesion in the gastric antrum. Endoscopically, we assessed the tumor as intramucosal cancer or adenoma, and biopsy specimens were diagnosed as showing borderline malignancy. At the second examination, performed 6 months later, the elevated lesion had grown, showing remarkable changes in its appearance, and a diagnosis of adenocarcinoma was confirmed pathologically. The patient underwent distal gastrectomy about 8 months after the first examination, and the tumor in the resected specimens showed a moderately differentiated adenocarcinoma invading through the entire submucosal layer, with metastasis to a regional lymph node. Microsatellite analysis of this early gastric cancer disclosed mutations in all six markers examined, indicating high-level microsatellite instability (MSI-H). The tumor also showed frameshift mutations of TGFbetaRII and BAXgenes, as well as hypermethylation of the hMLH1promoter. These results suggest that a deficiency of the mismatch repair system played a critical role in the progression of this cancer.