[Radiofrequency (RF) ablation for liver metastases of colorectal cancer].

PURPOSE: To evaluate the effectiveness of radiofrequency ablation (RFA) for liver metastases of colorectal cancer. METHODS: RFA was used to treat 31 tumors (median diameter 1.5 cm, range 0.5-3.9 cm) in 13 patients of liver metastases of colorectal cancer. The median number of tumors treated per patient was 2. 9 (range, 1-10). RESULTS: Two patients had complications; bleeding and liver dysfunction. Four (12.9%) of 31 lesions developed a local recurrence after the treatment. We achieved a local control in 2 (92.6%) of 27 lesions <3.0 cm in diameter. In 4 (30.8%) of 13 patients, new metastases were observed at follow-up. One year survival rate from the initial ablation was 92.3% and 2-year was 46.2%. One year total local recurrence rate from the initial ablation was 55.6%. CONCLUSION: In the case of tumor greater than 3 cm, RF ablation is an effective method to treat hepatic metastases from colorectal carcinoma.

[A case of unresectable type 4 gastric cancer which has kept a long-term partial response with adjuvant systemic chemotherapy].

A 69-year-old woman was admitted to our hospital with complaint of epigastric discomfort in February 2006. The detailed examination had revealed type 4 advanced gastric cancer. An exploratory laparotomy was performed for the unresectable case due to peritonitis cartinomatoza. Postoperative S-1 monotherapy (100 mg/body, 4 weeks on, 2 weeks off) was started as an outpatient in April 2006. After 3-course, partial response (PR) was observed for the primary lesion by gastrointestinal endoscopy. In April 2007, the regimen was changed to S-1 (100 mg/body, 3 weeks on, 2 weeks off)+CDDP (60 mg/m2, days 8) combined chemotherapy, then the primary lesion showed a slight increase. Thereafter, the regimen was changed to S-1 monotherapy in March 2008, and S-1+CDDP combined therapy in July 2008 again. PR was kept observed for three years successfully after the exploratory laparotomy. A case of type 4 unresectable gastric cancer was reported that the postoperative chemotherapy of S-1 was effective.

[A case of radiation therapy successfully treated liver and lung tumors arising from postoperative cecum cancer].

The patient was an 85-year-old man who underwent a rt-hemicolectomy, cholecystectomy and choledocholithotomy for cecum cancer and bile duct stone. The tumor was a well differentiated adenocarcinoma, type 2 in the Japanese classification of colorectal carcinoma. The tumor was considered to be in stage II (ss, ly2, v0, n (-), P0, H0, M (-)). He did not receive any adjuvant chemotherapy. After 2 years and 3 months from the surgery, an abdominal MRI and an abdominal CT scan revealed a 30 mm hepatic nodule lesion. We diagnosed with liver metastasis of the cecum cancer. The patient refused both surgery and radio-frequency ablation therapy. We chose radiotherapy for liver metastasis. He was given a total dose of 50 Gy/25 fractions. After 3 months from the radiotherapy, the tumor was reduced gradually and tumor marker (CEA) was normalized. The disease was diagnosed as CR because no tumors were detected. There has been no liver recurrence. But after 4 years and 6 months from the surgery, 20 mm lung nodules in rt-lower lung were revealed by chest X-ray. Once more, we chose radiotherapy for lung tumor. He was given a total dose of 66 Gy/33 fractions. At present, the tumor was reduced gradually. There has been no recurrence since his irradiation. If the case was made a good choice, radiation therapy appears to be effective for liver and lung tumors from the colorectal cancer.

[Two cases of advanced gastric cancer with postoperative severe complications after neo-adjuvant chemotherapy].

We report two cases of advanced gastric cancer with severe postoperative complications after neo-adjuvant chemotherapy (NAC). The first case is a 60-year-old man who was diagnosed as a type 2 advanced gastric cancer with paraaortic lymph node metastases and the elevation of serum CA19-9 level. NAC was started, but no reductions were noted after 3 courses. Palliative total gastrectomy with distal pancreatectomy, splenectomy, cholecystectomy, and partial hepatectomy for T4 gastric cancer exhibiting obstruction were performed in June 2007. On postoperative day 10, abdominal CT scan revealed left subphrenic abscess, then CT-guided percutaneous drainage was performed. A culture of the abscess yielded Candida albicans and Candida glabrata. The second case is a 58-year-old man who was diagnosed as a type 2 advanced gastric cancer with multiple lymph node metastases and the elevation of serum CA19-9 level. NAC were performed, but no reductions were noted. A distal gastrectomy was performed in January 2008. On the first postoperative day, a severe abdominal distension was appeared suddenly and increasingly. An emergency laparotomy was undergone, but no findings of the bowel obstruction were observed. On postoperative day 2, a rise of serum beta-D-glucan level was recognized. Both cases were improved by an antifungal drug therapy.