[A case of a patient with advanced rectal cancer and urinary bladder fistula surviving for 6 years after chemoradiotherapy without surgery].

A 60-year-old man with advanced rectal cancer and urinary bladder fistula received preoperative chemoradiotherapy with S-1(120mg/m / 2day)on weekdays and concurrent radiotherapy(65 Gy). After chemoradiotherapy, the clinical symptoms resolved and the tumor shrunk, as observed on endoscopic and radiologic examinations. However, remnant cancer was suspected; therefore, modified oxaliplatin, 5-fluorouracil, and Leucovorin(mFOLFOX6)therapy was initiated, although it was stopped after 3 cycles because of numbness in the lower extremities. Finally, clinical and pathological complete response(CR) was achieved by administering additional doses of S-1 for approximately 1 year after treatment initiation; CR was confirmed by using endoscopy and computed tomography(CT), and there has been no recurrence for 6 years. This case suggests that treatment without surgery is a viable alternative for advanced rectal cancer with pathological CR after chemoradiotherapy.

Prognosis assessment of patients with refractory ascites treated with a peritoneovenous shunt.

BACKGROUND/AIMS: We investigated the postoperative outcome and risk factors for DIC and mortality in cases of implanted PVS. METHODOLOGY: We reviewed the cases of 65 patients implanted with PVS from 2000 to 2010. Of these patients, 32 were diagnosed with peritonitis carcinomatosa, 21 had liver cirrhosis with hepatocellular carcinoma (HCC), and 12 had liver cirrhosis without HCC. RESULTS: The postoperative morbidity rate was 18.8%, 76.2%, and 58.3% in cases of peritonitis carcinomatosa, liver cirrhosis with HCC, and liver cirrhosis without HCC, respectively. Early death (within 7 days of surgery) was 7.7% (5/65), and the cause of death in all cases was DIC. Underlying disease, low platelet count, prolongation of prothrombin time (PT), and hyperbilirubinemia were the risk factors for development of DIC, whereas underlying disease, prolongation of PT, hypoalbuminemia, and hyperbilirubinemia were risk factors for early death. Multivariate analysis showed that liver cirrhosis with HCC and prolonged PT were the risk factors for DIC. CONCLUSIONS: Patients with refractory ascites due to liver cirrhosis with HCC and those with prolonged PT should not be considered for PVS.

[A case of pancreatic cancer treated by gemcitabine with sequential radiotherapy].

A 65-year-old man suffering from acute pancreatitis underwent MRI scanning, which revealed a low signal on the T1 and T2 sequences, and hypovascularity in arterial phase in the head of the pancreas. This corresponded to the area showing the absence of the lower common bile duct. FDG-PET was highly suggestive of pancreatic cancer (T4N1M0, Stage IVa) with lymph node metastasis. He was treated with systemic chemotherapy using gemcitabine (GEM) followed by radiotherapy. His symptoms gradually improved with a reduction in size of the primary lesion. The patient has been receiving systemic chemotherapy using S-1 without recurrence.

[Case report of advanced esophageal cancer patient surviving for a long time after asynchronous chemoradiation].

We have present a case of advanced esophageal cancer(Stage IVb), that has survived for 7 years and 4 months after systemic hemotherapy followed by radiation therapy. The patient is a female, 63 years old. We diagnosed her with esophageal cancer Stage IVb with direct invasion to the main bronchus and the metastatic lesion to the right lobe of thyroid gland. Then we initiated low-dose FP therapy(5-FU 500 mg/day/body, day 1-7, CDDP 10 mg/day/body day 1-5), and then continued UFT+CDDP(UFT 400 mg/day, CDDP 10 mg/day). About 4 years and eight months after chemotherapy we detected swelling of a mediastinal lymph node, which was assessed as a recurrence. Then we started the radiation therapy. Since she has received UFT, we have not seen any recurrences.

[A case with advanced carcinoma of the gallbladder responding to UFT monotherapy].

Gallbladder carcinoma is a fatal disease with highly metastatic potential, and the chemotherapeutic regimen has not been established yet. We reported here a case of gallbladder carcinoma with lung and liver meatstases responding to a single agent, UFT. A 70-year-old female with advanced carcinoma of the gallbladder and bilateral pulmonary metastases were treated with UFT 600 mg/day weekday for half a year. Pulmonary metastases disappeared completely, and the primary lesion shrank markedly 6 months after. Unfortunately, the patient died 1.5 years after the start of treatment due to relapse of liver and lung lesions.

[A case of recurrent breast cancer with bone metastasis causing pancytopenia--efficacy of low-dose CPT-11+ MPA].

A 46-year-old woman underwent breast-conserving surgery. The patient was treated with six cycles of CMF and, subsequently, combination therapy with UFT and CPA. However, multiple metastases were detected in the thoracic vertebrae after two years and two months of surgery. Weekly administration of paclitaxel was initiated, but the drug could not be continued due to pancytopenia. CPT-11 (40 mg/body) once a week and medroxyprogesterone acetate (MPA) 600 mg a day was substituted for paclitaxel. During the treatment with CPT-11, no severe adverse reactions, such as myelosuppression and diarrhea, were observed, and the patient's condition was stable without discontinuing the chemotherapy. The results suggest that the low-dose CPT-11 and MPA therapy should improve the prognosis of advanced and recurrent breast cancers with only slight adverse effects.

[A case of hepatocellular carcinoma with multiple lung metastases responding to intermittent intrahepatic arterial chemotherapy of CDDP+5-FU].

A 72-year-old man who had multiple hepatocellular carcinoma underwent eight times intrahepatic arterial chemotherapies of SMANCS and two times percutaneous ethanol injection (PEIT) therapies over three years, but new diffuse lesions appeared in the liver. He was treated by intermittent intrahepatic arterial chemotherapy with CDDP 10 mg/body/w and 5-FU 500 mg/body/w. Three months after the start of this therapy, the liver tumor was enlarged and multiple lung metastases appeared. But ten months later, the size of the hepatic lesion was reduced and the lung lesion disappeared. Fifteen months later, a solitary metastatic lesion in the left lung was resected. After two years, peritonitis carcinomatosa was observed, and the patient died.

Switch moiety in agonist/antagonist dual effect of S19 ribosomal protein dimer on leukocyte chemotactic C5a receptor.

The cross-linked homodimer of S19 ribosomal protein (RP S19) induces monocyte predominant infiltration due to a dual effect on the C5a receptor in leukocyte chemotaxis, agonistic to monocytes and antagonistic to polymorphonuclear leukocytes (PMN) (H. Nishiura, Y. Shibuya, T. Yamamoto, Lab Invest 1998, 78:1615-1623). The agonistic ligand moiety was recently determined to be -Leu131-Asp132-Arg133- (Y. Shibuya et al, Am J Pathol 2001, 159:2293-2301). In this study we determined the moiety responsible for the antagonistic function. A C-terminal analogue peptide of RP S19, with 18 residues containing the agonistic ligand moiety as a part, reproduced the dual function in the leukocyte chemotaxis. A C5a analogue peptide attracted PMN as well as monocytes. When C-terminal 12 residues of RP S19 after the agonistic moiety, IAGQVAAANKKH, were connected to the C5a peptide, the chimeric peptide newly obtained the dual function, indicating that the C-terminal portion of RP S19 functions as a converter from the agonist to the antagonist. C-terminal truncation analyses indicated that the C-terminal His was not essential but the next Lys was necessary for the converter function. The homodimer of a mutant RP S19 that was truncated for the C-terminal 4 residues lost the monocyte selectivity in the leukocyte infiltration in vivo as in the case of the leukocyte chemotaxis in vitro. These results indicated that the conversion of the RP S19 dimer from agonist to antagonist of C5a receptor is attributed to the IAGQVAAANKK moiety between Ile134 and Lys144.