Endoscopic complete removal of the histologically unconfirmed gastric cancer with massive invasion as a giant biopsy.

A 68-year-old man underwent upper GI endoscopy in a mass screening, which showed a suspicious tumor in the antral region of stomach. However, histologic examination of repeated endoscopic biopsy samples (15 samples) revealed no neoplastic change. Although all the examinations including endoscopy, endosonography, and barium study pointed to the diagnosis of gastric cancer, we did not have histologic evidence of malignancy. Hence, complete endoscopic removal of the lesion using a new method of endoscopic mucosal resection (EMR) was performed as a giant biopsy. Histologic assessment of the endoscopically resected specimen confirmed invasive adenocarcinoma of the stomach. He then underwent distal gastrectomy with regional lymphadenectomy. Endoscopic resection of the tumor in the digestive tract is also a very useful diagnostic modality of the lesion when malignancy cannot be revealed by endoscopic biopsy.

Investigation into the usefulness and adverse events of CDDP, 5-fU and dl-leucovorin (PFL-therapy) for advanced colorectal cancer.

Biochemical modulation of 5-fluorouracil (5-FU) has been verified the evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. We investigated the therapeutic and adverse drug reaction of intensive chemotherapy using cisplatin (CDDP), 5-FU and dl-leucovorin (LV) (PFL-therapy), which may be producing dual biochemical modulation effect of 5-FU for advanced colorectal carcinoma. Administration schedule was 13 mg/m2 of CDDP, 300 mg/m2 of 5-FU, and 30 mg/body of dl-LV for 5 consecutive days. This regimen was repeated at 3-week intervals in hospital. Sixteen patients were enrolled in this study, most of whom had a history of previous chemotherapy as adjuvant treatment, and the response rate was 25%, with four patients having "partial response" and eight "no change". In respect to performance status, 46% of patients who completed the protocol were markedly improved in spite of their poor performance status before treatment. Moreover, when patients were classified into two groups based on changes of the serum level of CEA, "responder in CEA level" showed better prognosis than "non-responder in CEA level". Major toxicities were nausea, hyperglycemia and neutropenia. Three patients experienced Grade 4 hematological side effect, but these complications resolved quickly in all patients except for one patient. PFL-therapy is effective for advanced colorectal cancer with large tumor burden and showed the same prognostic result as the American and European trials in spite of smaller number of treatment cycles and a history of previous chemotherapy. We will be able to demonstrate the usefulness of this regimen for Japanese patients with advanced colorectal cancers after adding new cases to the present report.