[A case of peritoneal dissemination caused by recurrent hilar cholangiocarcinoma treated with intraperitoneal infusion of cisplatin (CDDP) and systemic chemotherapy].

Six years and 9 months ago, a 72-year-old man underwent left hepatectomy for a hilar cholangiocarcinoma(T2N0M0: Stage II A). At 3 years and 2 months after surgery, he was admitted for rectal tumor and reoperation. From surgery, it was diagnosed as peritoneal metastases of the cholangiocarcinoma, and an intraperitoneal infusion port was placed. He was treated with gemcitabine administered iv at day 1 and CDDP ip at day 8 every 3 or 4 weeks for 2 years. Then, gemcitabine was changed to docetaxel because of elevation of CA19-9. Both docetaxel iv and CDDP ip were administered for one and half years. For 3 years and 4 months, 12.2 g of CDDP, 28.0 g of gemcitabine and 920 mg of docetaxel were administered. As serum CA19-9 elevated again, he has been treated with S-1 and docetaxel ip for 3 months. This case indicates that intraperitoneal application of CDDP with systematic chemotherapy was effective for carcinomatous peritonitis without serious side effects.

[A case of pericardial tamponade caused by recurrent breast cancer treated with intrapericardial and intrapleural infusion of cisplatin (CDDP)].

Breast cancer rarely metastasizes to the pericardial cavity to cause cardiac tamponade. We have recently experienced a case of pericardial tamponade due to recurrent breast cancer. A 41-year-old woman who underwent modified radical mastectomy for a right breast cancer (T(1)N(3)M(0), Stage IIIA) 8 years and 8 months ago, was admitted for dyspnea and cough. Chest X-ray and CT scan revealed cardiomegaly and right pleural effusion, and cardiac echogram showed marked retention of pericardial effusion. A diagnosis of cardiac tamponade was made, and pericardiocentesis and thoracentesis were carried out immediately. Based on cytodiagnosis of pericardial and pleural effusion, the diagnosis was pericardial and intrapleural metastases of the breast cancer. Dyspnea was improved by pericardiocentesis and thocacentesis. Both intrapericardiac and intrathoracic instillation of CDDP prevented reaccumulation of pericardial and pleural effusion. After local chemotherapy with CDDP, systemic chemotherapy of CPT-11 was started. Thereafter the patient was discharged from the hospital and recovered her daily activities. This case indicates that intrapericardiac application of CDDP was effective for carcinomatous cardiac tamponade without serious side effects.