[A case of advanced esophageal cancer patient surviving more than 7 years treated with chemoradiotherapy].

We report here a long-term survival case of advanced esophageal cancer with distant lymph node metastases, treated with definitive chemoradiotherapy (CRT). A man in his 60s with disturbance of swallowing was diagnosed as middle esophageal cancer involving multiple metastases of distant lymph nodes. CRT (combination of 5-FU and nedaplatin every four weeks for four courses with 66 Gy of radiation) was administered. After a completion of CRT, CT scan revealed shrinking metastatic lymph nodes. No tumor but a scar at the site of cancer was observed by endoscopy, and histopathology of biopsy specimen detected no tumor cells. From these results, we diagnosed the curative effect of CRT as complete response. Five years after CRT, a swelling of left inguinal lymph node with uptake of fluorine-18-fluorodeoxyglucose appeared and was extirpated, and the swelling was diagnosed histopathologically as metastasis of esophageal cancer. The patient is surviving with no recurrence for 7 years and 8 months from the first diagnosis. In cases of highly advanced esophageal cancer, a long-term follow-up should be performed.

[Two cases of complete response of primary esophageal carcinoma treated with 5-FU/CDDP as neoadjuvant chemotherapy].

CASE 1: A 67-year-old man with lower thoracic esophageal carcinoma, T2N0M0, cStage II, underwent neoadjuvant chemotherapy (NAC) with 5-FU/CDDP. After 2 courses of NAC, radical resection of the esophageal carcinoma was performed. Primary tumor was not palpable, and lymph node swelling was not found in the resected specimens. Pathologic examination of the resected specimens revealed no malignant cells in the esophagus. Histologic effect of the NAC was grade 3. We obtained down-staging of carcinoma in T0N0M0, fStage 0. CASE 2: A 58-year-old man with thoracic esophageal cancer, T3N2M0, cStage III, underwent NAC with 5-FU/CDDP. After 2 courses of NAC, radical resection of the esophageal carcinoma was performed. Primary tumor was not found in the resected specimens. Pathologic examination of the resected specimens revealed only an irregular fibrosis of esophageal wall, and no malignant cells in the esophagus. Two lymph node metastasis and surrounding fibrosis was found. We obtained down-staging of carcinoma in T0N2M0, fStage II. We report two cases of complete response of primary esophageal carcinoma treated with 5-FU/CDDP as neoadjuvant chemotherapy.

[A case of complete remission(CR)persisting from UFT-E in an old patient with liver metastasis of gastric cancer].

A 82-year-old woman with gastric cancer underwent distal gastrectomy with level 2 lymph node dissection(M, Less, 2.2 x 2.0 cm, type 1, fH0, fP0, fM0, fT2, fN2(+), por 1, med, INF beta, ly2, v2, fPM(-), fDM(-), fStage IIIa). At first, adjuvant chemotherapy was not given because of her advanced age, but CEA increased to 43.2 ng/mL and a CT scan showed multiple liver metastasis. After we began oral chemotherapy with UFT-E 300 mg/day, the CEA level normalized and a CT scan revealed the liver metastasis had disappeared within about 9 months. There were no side effects for a course, and she has been free from any sign of recurrence. This was a very rare case in which single administration of UFT-E caused complete remission. Even an old patient should be treated aggressively because this treatment is relatively safe.

Chemosensitivity of human pancreatic carcinoma cells is enhanced by IkappaBalpha super-repressor.

Pancreatic cancer has an unfavorable prognosis; surgery and chemotherapy at present have only limited value. To improve the prognosis of pancreatic cancer, effective non-surgical therapy is necessary. NF-kappaB is reported to be related to resistance to apoptosis, but its role in chemosensitivity remains controversial. We examined the effects on chemosensitivity of inhibition by induction of the super-repressor IkappaBalpha in pancreatic cancer cell lines, BxPC-3, Capan-1 and Panc-1. IkappaBalpha protein was transduced by infection of adenovirus vector AxCAhIkBDeltaN. Sensitivity to VP-16 and doxorubicin was increased significantly by IkappaBalpha induction in all three pancreatic cell lines. To investigate molecular events during IkappaBalpha induction, we examined the changes in expression of drug-resistance-related genes by real-time RT-PCR and those in apoptosis-related genes by cDNA microarray. There was no common change of gene expression before and after IkappaBalpha induction among the three pancreatic cancer cell lines, except for mdm2. Further examination of other genes is necessary for a better understanding of the molecular mechanisms of enhancement of chemosensitivity through IkappaBalpha induction. However, we have confirmed that IkappaBalpha induction leads to an increase of chemosensitivity of pancreatic cancer. Many problems remain before clinical application of this adenoviral system will be feasible, but our results may ultimately lead to an improved therapy of pancreatic cancer.