[A successful case with CPT-11 + CDDP chemotherapy for recurrent gastric cancer of the remnant stomach].

We report a successful case with irinotecan (CPT-11 60 mg/m2) + cisplatin (CDDP 30 mg/m2) chemotherapy (once in 2 weeks) for recurrent gastric cancer of the remnant stomach. A 77-year-old man was performed a distal gastrectomy for duodenal ulcer 42 years ago. He had a total gastrectomy for gastric cancer of remnant stomach when he was at 73 years old. After the surgery, we treated this patient with S-1 mono-therapy for five courses. However, we finished this treatment for lymph-node metastases. Next we treated him with CPT-11 + CDDP. An abdominal CT revealed a CR after 6 courses. We finished this treatment after 12 courses for anemia (grade 3). After the treatment, the metastatic lymph-nodes appeared in no change. So we considered that CR was continued for 3.5 years.

[A case of liver metastasis of rectal cancer demonstrating complete response for more than two years to mFOLFOX6].

A man in his fifties with rectal cancer underwent low anterior resection in another Hospital in January 2006. He was finally diagnosed with Stage III a (pA, pN1, H0, P0). The patient who had postoperative complication such as ruptured suture left the hospital in May 2006, when he was detected with multiple liver metastases and was referred to our hospital for systemic chemotherapy. Systemic chemotherapy with mFOLFOX6 was performed from May 2006. Grade 3 diarrhea and grade 2 peripheral neuropathy, nausea and vomiting were observed. After 6 courses of mFOLFOX6, MRI revealed metastasis had been disappeared and levels of CEA and CA19-9 were decreased below normal. The treatment has been discontinued. Recurrence was not observed for 30 months.

[Third-line treatment of intermittent hepatic arterial infusion for unresectable liver metastases from colorectal cancer].

We report 6 cases of liver metastases from colorectal cancer with third-line treatment of intermittent hepatic arterial infusion and systemic chemotherapy for unresectable liver metastases with clinical signification of direct invasion to adjacent organs in Stage IV colorectal cancer. Subjects were 19 consecutive patients who underwent R0 surgery to the primary tumor for colorectal carcinoma, pT4, M1 in 1995-2003. We studied the relationship of pathological invasion to adjacent organs of tumor to other clinicopathological factors to prognosis. Of the 19 patients, 11 (57.8%) were R0 surgery to the tumor of metastases. Only 4 (36.7%) patients survived more than 3 years. The patient without excision did not survive for three years. The median survival time was only 8.5 months. Multivariate analysis indicated that only R0 surgery to the tumor of metastases was an independent prognostic factor. The optimum resection for adjacent organs may prolong a survival. But the extended resection is a possibility of shortening the survival time.

[A clinical significance of peritoneal carcinomatosis to recurrent colorectal cancer with ileus].

We studied a clinical significance of peritoneal carcinomatosis to metastatic recurrent colorectal cancer with ileus. The subjects were 16 patients with ileus confirmed in 1995-2005. Of the 16 patients, 7 had surgical treatment and the other 9 had conservative treatment. The median survival time of the 16 patients was 98 days; the 7 patients of surgical treatment were 235 days; the 9 patients of conservative treatment were only 67 days. Only 4 patients survived more than 200 days. These 4 patients had surgical treatment, and were the cases where no peritoneal fluid was confirmed and the metastatic tumor was excised. However, only 2 patients improved in QOL. The 3 patients in the surgical treatment were aggravated. An optimum resection may prolong a survival time and patient's QOL could be improved. On the other hand, an extended resection may contribute to shorting a survival time.

[Three successful cases with CPT-11 + CDDP chemotherapy where S-1 failed to respond to recurrent gastric cancer].

We report three successful cases with irinotecan (CPT-11 60 mg/m2) + cisplatin (CDDP 30mg/m2) chemotherapy (once in 2 weeks) where S-1 failed to respond to recurrent gastric cancer. Case 1: A total gastrectomy and splenectomy were performed for a cardiac gastric cancer (T3, N2, H0, P0, CY0, por 1, Stage IIIB). An abdominal CT revealed paraortic lymph node metastases 4 months after the surgery. No reductions were noted after S-1 monotherapy. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CRin after 11 courses. Case 2: A total gastrectomy, splenectomy and cholecystectomy were performed for a cardiac gastric cancer (T3, N3, H0, P0, CY1, tub1, Stage IV). After the surgery, we treated this patient with S-1 mono-therapy. However, we finished this treatment for abdominal recurrence. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CR after 24 courses. Case 3: A distal gastrectomy and cholecystectomy were performed for a pyloric gastric cancer (T2, N1, H0, P0, CY0, tub 2, Stage II). An abdominal CT revealed paraortic lymph node metastases 10 months after the surgery. We treated this patient with S-1 + paclitaxel (PTX) chemotherapy. No reductions were noted after 2 courses. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CR after 8 courses.

[Usefulness of TS-1 and lentinan combination immunochemotherapy in advanced or recurrent gastric cancer--pilot study aiming at a randomized trial].

The quality of life (QOL) of patients with advanced or recurrent gastric cancer is poor and their immunocompetence is low, making it important to conduct chemotherapy while at the same time improving their QOL and maintaining their immunocompetence. To improve QOL and increase compliance by reducing the side effects but not the antitumor effect of TS-1, a 2-week regime with 2-week administration of TS-1, and a 1-week drug-free interval in combination with the immunotherapeutic agent lentinan (LNT) was started in 5 patients with advanced or recurrent gastric cancer. Toxicity, efficacy, QOL, and immunological parameters were investigated preliminarily to examine whether or not usefulness of lentinan could be evaluated. QOL scores for appetite, nausea/vomiting, and abdominal pain/diarrhea showed improvement, although not in statistically significant values. The Th2 (CD4-positive, IL4-positive T cells) response in peripheral blood decreased significantly. TS-1 and lentinan combination immunotherapy was carried out safely with advanced recurrent gastric cancer. In order to examine the usefulness of LNT combined use, it was thought that a randomised trial using toxicity with not only efficacy but QOL and immunological parameters as indicators would be beneficial.

[Complications related to hepatic arteria infusion chemotherapy for liver metastasis].

Complications from hepatic arterial infusion chemotherapy were analyzed in 27 cases with liver metastasis from colorectal cancer from December 1994 to April 2002 in our department. The method used to place the catheter was laparotomy (LP) in 11 patients, intervention radiology (IVR) in 16 patients. Complications resulting in interruption of therapy occurred in 7 (26%) patients, and the IVR method was associated with a lower rate of complications than the LP method. The complications with the LP method were 3 (11%) cases of hepatic arterial occlusion, and 2 (7.4%) cases of catheter tip dislocation. The best indwelling route for the catheter thus seems to be the IVR method. The IVR method is our first choice for all patients now.