[A long-term survival case of hepatic metastases after curative gastrectomy by combined therapies].

A 74-year-old female was performed distal gastrectomy (f-T3N0H0P0CY0M0, Stage II) for gastric cancer in 2003. After 14 months, CT scan showed a metastasis in S7 segment of the liver. We performed chemotherapies until seventh-line and radio-frequency ablation (RFA). It finally got a long-term survival of 36 months postoperatively. RFA may be one of the useful therapies of liver metastasis from gastric cancer.

[A case report of long-term survival of advanced gastric cancer (P1CY1) after gastrectomy].

A-57-year-old male was performed a total gastrectomy (f-T3N2H0P1CY1M0, Stage IV) for gastric cancer in 2004. We kept performing chemotherapies until the seventh-line, and the patient at last had a long-term survival of 46 months after surgery. If we recognized a tumor that had a tendency to be progressive, the long-term survival may be obtained by changing a regimen as early as possible.

[A case of stenosis of the reconstructed jejunum due to recurrent cancer after total gastrectomy in which stent-in-stent placement was effective].

OBJECTIVES: We report one case of stenosis of the reconstructed jejunum due to recurrent cancer after total gastrectomy in which stenting was effective and good QOL was achieved. CASE: The patient was a 70-year-old woman. In July 2000, the patient underwent total gastrectomy.Roux-en Y reconstruction with a diagnosis of gastric cancer. The pathological diagnosis was U-Post, Type 3, por 1, T3, N1, H0, P0, CY0, M0, and Stage IIIA. From 9 months after the operation, aphagia occurred and stenosis of the reconstructed jejunum was noted. Based on a biopsy of the stenosis, a diagnosis of post-operative recurrent gastric cancer was made. Although the patient received two cycles of low-dose FP therapy, complete response was not obtained, and the patient stayed at home under the IVH control for about 4 months. In June 2001, the patient was hospitalized for a stent placement due to the patient's request. METHOD: After a guide wire was endoscopically inserted and a good passage on the anal side of the stenosis was confirmed, a stent was placed. Self Expandable Metallic Stent (SEMS) was used. CLINICAL COURSE: Following the stent placement, the patient was able to ingest orally, but 6.5 months later, stenotic symptoms developed and another stent was deployed (stent in stent). CONCLUSION: Stenting is relatively simple and less invasive, which is useful for the improvement of QOL and in recurrent cases as well.

[Long survival and effective treatment of unresectable gastric cancer by TS-1 based chemotherapy with a sequential combination].

We report a case of peritoneal cancer dissemination and cytological appearance of cancer cells with Type 4 gastric cancer. Treatment with unichemotherapy and combination chemotherapy with TS-1 proved successful. The patient was a 58-year-old female,who complained of abdominal pain. She was diagnosed as unresectable Type 4 gastric cancer, T 3 NxH 0 P 1 CY 1 M 0, Stage IV (cytology: Class V). Thirteen days after surgery, chemotherapy with TS-1 (80 mg/body/day, 4 weeks) at 2-week intervals in 1 course was performed. However, due to side effects with marrow restraint of grade 1, we changed to the following chemotherapy regimen: TS-1 (80 mg/body/day, 2 weeks) at 4-week intervals as 1 course (23 courses in total). After 16 courses, a partial response (PR) was noted. As additional therapy to recover tumor marker (CA19-9) after 21 courses, combination chemotherapy with TS-1 (80 mg/body/day, 2 weeks) and CDDP (25 mg/body/day, day 1, 8, 15 drip infusion) was performed as one course. This chemotherapy was then performed in 3 courses and tumor markers did not deteriorate, so we changed docetaxel (DOC) (50 mg/body/day(day 1)) to CDDP, and tumor markers returned to the normal value. No recurrence and no side effects appeared (hematological or non-hematological) during this combination chemotherapy.

[A long-term survival case of metachronous liver metastasis from gastric cancer].

A 62-year-old man was admitted for gastric cancer. He was performed a distal gastrectomy with Billroth I reconstruction in August 1999. Then he had remnant gastric cancer and metachronous liver cancer in November 2002. He was performed a total gastrectomy and partial hepatic resection. The histological findings of remnant stomach and liver cancer showed a same pattern of the primary gastric cancer. Another metachronous liver cancer appeared in March 2006. He was treated with chemotherapy using S-1 (day 1-21) and CDDP 20 mg/m2 (day 1, 8 and 15) q5w. The size of liver metastasis was kept the same for 16 months.

[Bone metastasis of gastric cancer].

We evaluated 19 patients with bone metastasis after surgery for gastric cancer. In a number of cases, the located in the tumor was U and M region, of macroscopic 3, and the histological type was poorly-differentiated adenocarcinoma with high-grade of lymphatic invasion. The major symptom was lumbago and back pain. The serum AFP level was high in 73.7% of the cases, and LDH was high in 47.7%. The metastatic lesion was predominantly seen in the bone with red pulp such as lumbar and thoracic vertebra and rib. The median survival time was 189 days (range: 24-509) with a poor prognosis. However, newly developed anticancer drugs were very effective for some cases, indicating that such chemotherapy should be tried for cases with bone metastasis.

Vitamin K2-induced antitumor effects via cell-cycle arrest and apoptosis in gastric cancer cell lines.

Vitamin K2 (VK2) has a growth inhibitory effect on various types of cancer cells in vitro, and its efficacy has been demonstrated in clinical applications in a number of patients with leukemia and hepatocellular carcinoma. In this study, the effect of cell growth inhibition and apoptosis induction and the concomitant use of an anticancer agent by VK2 (menaquinone: MK4), on gastric cancer cell lines were examined. When 4 kinds of gastric cancer cells (KATO III, MKN7, MKN74 and FU97) were exposed to MK4, the cell growth was inhibited in an MK4 dose-dependent manner. Morphologically, apoptosis induced by MK4 was recognized in FU97, but only a slight number of apoptotic images was recognized in other cell lines. On the contrary, in all the cell lines, the percentage of APO2.7 positive cells increased significantly in the MK4-treated group as compared to the controls. Caspase-3 activity increased significantly in KATO III and FU97 as compared to the controls, while no significant differences were noted in MKN7 or MKN74. Moreover, in all the cell lines, the percentage of G0/G1-phase cells ( approximately 70% in KATO III and FU97, and > or =80% in MKN7 and MKN74) increased in comparison to the controls, suggesting that cell-cycle arrest had occurred. All of the gastric cancer cell lines were given MK4 in different concentrations and two kinds of anticancer agent, with the result that cell growth was inhibited by the anticancer agent in a dose-dependent manner when it was given with MK4 in concentrations of up to 10 microM. In conclusion, our results demonstrate that the effect of MK4 on apoptosis and cell-cycle arrest differs in differentiated (MKN7, MKN74) and undifferentiated (KATO III, FU97) gastric cancer cell lines, and that MK4 alone or with anticancer agents has an antitumor effect on gastric cancer cell lines.

[The efficacy of gastrojejunostomy for patients with unresectable gastric cancer].

We evaluated the efficacy of gastrojejunostomy for patients with unresectable gastric cancer. Thirteen patients had undergone gastrojejunostomy (GJ group) and 14 patients who couldn't receive gastrojejunostomy, but had only been observed into their abdomen in the operation (S group). Between two groups, there were no significant differences in the effective rate, median survival time and the number of dates the patient stayed home after the operation. Gastrojejunostomy was useful for patients with a strong case of stenosis in the stomach, and may improve the quality of life as one of the multimodal therapy.

[The efficacy of intra-peritoneal chemotherapy for the patients with cytology positive gastric cancer].

In this study, we assessed efficacy of repeated intra-peritoneal chemotherapy with CDDP for patients with cytology positive gastric cancer. The median survival time was 338 days, 1-year survival was 60% and 2-year survival was 45% of the patients. The POCY1 patients with repeated intra-peritoneal chemotherapy yielded a tendency to extend the survival rate than the patients without repeated intra-peritoneal chemotherapy (p = 0.06). But, no differences were found between the survival rate of P1CY1 patients with or without repeated intra-peritoneal chemotherapy. The patients using more than 3 anti-cancer drugs yielded a tendency to have a better prognosis than the patients using 2 or less anti-cancer drugs (p = 0.09). There was a possibility to which the multidiscipline treatment was effective for the POCY1 gastric cancer patients.

Measurement of serum thymidine phosphorylase levels by highly sensitive enzyme-linked immunosorbent assay in gastric cancer.

Thymidine phosphorylase (TP) is an enzyme that converts 5'-DFUR to 5-FU and also acts as an angiogenic factor. Measurement of serum TP levels has recently become possible by highly sensitive enzyme-linked immunosorbent assay (ELISA). We examined 38 patients with gastric adenocarcinoma to measure serum TP levels by highly sensitive ELISA method and tissue TP levels by conventional ELISA. In addition, immunohistochemical staining of normal and cancer tissues was also performed. Serum TP levels in patients with stages III and IV and inoperable or recurrent cancer were significantly higher than those in healthy controls. A high correlation was found between serum TP levels and tumor TP levels (r=0.65, p<0.0001). Moreover, serum TP levels were about 1/2500 of tumor TP levels. Tissue TP values in tumor were significantly higher than those in normal tissue. On the other hand, no significant differences among the cancer stages were found in either serum or tumor tissue. In conclusion, we demonstrate that serum TP levels strongly reflect tumor TP levels, and it may predict clinicopathological factors, prognosis, or sensitivity of anti-cancer drugs.