[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 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.

[Assessment of esophageal cancer with remote metastases treated with multidisciplinary therapy].

We present three cases of patients diagnosed with esophageal cancer with distant metastases. We conducted chemotherapy, radiotherapy, RFA, and operation for main tumor and lymph node, lung, brain metastasis. They were for a long-term survival with multidisciplinary therapy. The longest survival time was about three years. We discussed our cases in light of review of the literature.

[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.

[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.

[Radio-frequency ablation (RFA) assisted endoscopic hepatectomy for hepatocellular carcinoma].

We introduced a new therapeutic approach for hepatocellular carcinoma (HCC); Radio-frequency ablation (RFA) assisted endoscopic hepatectomy (RFA-assisted EH). Seven patients with HCC, smaller than 3 cm and located on the surface of the liver, were entered into this study. RFA on the hepatic cutting line was achieved with a 2 cm Cool-tip needle at a 1-cm interval. RFA power was gradually increased to 100 W in a minute and ablation was stopped once an impedance-out state was attained of RFA power. Hepatic resection was achieved with various items in a coagulative hepatic parenchyma. If necessary, additional RFA could be performed during the hepatectomy. Patients' characteristics were described as follows; average age: 64 years, 5 males and 2 females, liver damage A: 5, B: 2, average tumor size: 27 mm, and average tumor number: 1.3 Two thoracoscopic and 5 laparoscopic approaches were selected. One application of RFA could make an elliptical coagulative area (2 cm x 1 cm). RFA was achieved eleven times on the hepatic cutting line and three times during the hepatectomy. The average operating time and blood loss was 256 minutes and 96 g, respectively. No blood product was needed. The average postoperative hospital stay was 11 days and no operative complication was encountered. All of the patients were well and without recurrence during the observation period (average: 6 months). We positively recommend RFA-assisted EH for HCC due to its perfect radicality and safety.