s-1-(combination) and Adenocarcinoma--Mucinous

A 60s man was diagnosed with rectal cancer and underwent low anterior resection of the rectum. The pathological diagnosis was mucinous adenocarcinoma, pT3(SS), pN0, pM0, pStage Ⅱ. Two years after the primary surgery, contrast-enhanced CT showed local recurrence on the oral side of the anastomosis. As the tumor had invaded the left seminal vesicle and coccygeus muscle, neoadjuvant chemoradiotherapy(NACRT)(S-1 80mg/m / 2 plus 45 Gy/25 Fr)was performed. After NACRT, abdominoperineal resection, including the left seminal vesicle, coccygeus muscle, and coccygeal bone, was performed. Pathological examination showed a histological response of Grade 2 and that R0 resection was achieved. Although the only radical treatment of locally recurrent rectal cancer is R0 resection, we performed R0 resection with Grade 2 histological response to NACRT.

Topics: Adenocarcinoma, Mucinous; Antimetabolites, Antineoplastic; Chemoradiotherapy; Drug Combinations; Humans; Male; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Oxonic Acid; Rectal Neoplasms; Tegafur; Treatment Outcome

The MAGIC trial has shown perioperative chemotherapy does significantly improve overall survival of patients with gastric and esophagogastric junction carcinoma. The approach to evaluate the effectiveness of adjuvant chemotherapy is urgent in clinical practice.. Totally, 264 patients with locally advanced gastric carcinoma (including esophagogastric junction carcinoma) treaded by perioperiate chemotherapy (SOX or XELOX) from May 2012 to December 2017 in our cancer center were included. Tumor response was evaluated by tumor regression grade (TRG, Mandard system) and Response Evaluation Criteria in Solid Tumor (RECIST v1.1). The clinical characteristics and the effect on survival were analyzed.. Univariate analysis showed TRG was correlated to tumor size, Lauren classification, grade of differentiation, histological type, postsurgical T category (ypT), postsurgical N category (ypN), vascular invasion or lymphatic invasion and so on. However, only Lauren classification and ypT were independent factors for TRG. On contrary to RECIST, TRG was founded to be a prognostic factor for DFS and OS on univariate analysis. Cox proportional hazards were established to evaluate the relationship among TRG, clinical-pathological factors and survival. On multivariate analysis, the chemotherapy cycle, Lauren classification, vascular invasion or lymphatic invasion, ypN and postsurgical pathologic stage were independent factors for OS and DFS, while TRG were negatively correlated to survival.. TRG seems to be a promising prognostic indicator and it predicts the prognosis of patients with locally advanced gastric cancer after adjuvant chemotherapy more reasonably in comparisons to RECIST v1.1.

Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Carcinoma, Signet Ring Cell; Chemotherapy, Adjuvant; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Oxaliplatin; Oxonic Acid; Retrospective Studies; Stomach Neoplasms; Survival Rate; Tegafur; Young Adult

Oral fluoropyrimidine S-1 contains tegafur, which is metabolized to 5-fluorouracil by cytochrome P450 2A6 (CYP2A6). We here examined associations between CYP2A6 polymorphisms and treatment outcomes of adjuvant S-1 in gastric cancer patients.. Patients received adjuvant S-1 (40 mg/m. Patients (n = 200) were enrolled between November 2007 and July 2013 with the following clinical characteristics: median age, 57 years (range, 32-83 years); 128 men, 72 women. With a median follow-up of 46.4 months, the 3-year relapse-free survival (RFS) and overall survival (OS) rates were 83.1 % (95 % CI, 77.7-88.5 %) and 94.8 % (95 % CI, 91.6-98.0 %), respectively. Genotype distributions were as follows: W/W (n = 49, 24.5 %), W/V (n = 94, 47.0 %), and V/V (n = 57, 28.5 %). Overall toxicity did not differ according to genotype for any grade (p = 0.612) or grade ≥3 (p = 0.143). However, RFS differed significantly according to CYP2A6 genotype. The 3-year RFS rates were 95.9 % for W/W, 83.1 % for W/V, and 72.5 % for V/V (p = 0.032). Carriers of W/V and V/V genotypes had a poorer RFS with a hazard ratio of 3.41 (95 % CI, 1.01-11.52; p = 0.049) and 4.03 (95 % CI, 1.16-13.93; p = 0.028), respectively, compared with the W/W genotype.. CYP2A6 polymorphisms are not associated with toxicity of S-1 chemotherapy, but correlate with the efficacy of S-1 in the adjuvant setting for gastric cancer.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Biomarkers, Tumor; Carcinoma, Signet Ring Cell; Chemotherapy, Adjuvant; Cytochrome P-450 CYP2A6; Drug Combinations; Female; Follow-Up Studies; Gastrectomy; Genotype; Humans; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Polymorphism, Genetic; Prognosis; Real-Time Polymerase Chain Reaction; Retrospective Studies; Stomach Neoplasms; Survival Rate; Tegafur

The patient was a 65-year-old male, who underwent low anterior resection for rectal cancer. The pathological diagnosis showed mucinous adenocarcinoma, pSS, and pN0. He complained of diarrhea and melena 4 months after the surgery. Abdominal computed tomography and colonofiberscopy showed a local recurrence of rectal cancer. Because the tumor was diagnosed as unresectable, combined chemotherapy of S-1 (100 mg/day, per os, 4 weeks of treatment and 2 weeks of rest) and PSK (3 g/day, per os, the same schedule as S-1) was started. After the 2 courses of chemotherapy, computed tomography and colonofiberscopy showed a complete disappearance of the tumor. The chemotherapy was continued until the 9th course and then stopped. Five years and 4 months since the induction of a complete response, the patient is still alive without disease recurrence. Combined chemotherapy of S-1 and PSK may be one of useful choices for recurrent colorectal cancer.

Topics: Adenocarcinoma, Mucinous; Aged; Antibiotics, Antineoplastic; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Humans; Male; Neoplasm Recurrence, Local; Oxonic Acid; Proteoglycans; Rectal Neoplasms; Tegafur; Treatment Outcome

We assess the effect of chemoradiation therapy for four cases of advanced rectal cancer. The radiation therapy consisted of 40-50 Gy delivered in fraction of 2 Gy/day. A treatment of 5-fluorouracil (500 mg/body) with l-leucovorin (100 mg/body) intravenously once a week, or oral S-1 (100 mg/day/body) for four weeks, was given during radiation therapy. Efficacy for primary carcinoma was evaluated as partial response in all four cases. We performed a curative operation in two cases. Histological efficacy for primary tumors was diagnosed as Grade 2 and Grade 3. Grade 3 adverse effect for neutropenia occurred in one patient, and Grade 3 adverse effect for appetite loss occurred in 2 patients. All cases survived without a recurrence for a period of 4 months-5 years and 3 months. Chemoradiation therapy was safe and an effective treatment prior to curative operation for advanced rectal cancer which invaded the pelvic organ.

Topics: Adenocarcinoma, Mucinous; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Combined Modality Therapy; Drug Combinations; Female; Fluorouracil; Humans; Male; Oxonic Acid; Pelvis; Rectal Neoplasms; Tegafur

We report patients with advanced Stage IV gastric cancer responding to chemotherapy with S-1 or UFT. Case 1: The patient was a 59-year-old man with Stage IV gastric cancer because of CY 1. After surgery, chemotherapy with S-1 (100 mg/body/day) was performed for one year and 11 months. At present, 5 years and 5 months after surgery, this patient shows no signs of tumor recurrence. Case 2: The patient was a 68-year-old woman with Stage IV gastric cancer because of P 1. She was treated with 200 mg/day of UFT for one year and 9 months. At present, 5 years after surgery, she shows no signs of tumor recurrence. We considered that the longterm survival of such patients is attributable to chemotherapy with S-1 or UFT. The OPRT activity of the two cases was high, so chemotherapy with S-1 or UFT was thought to be effective for them.

Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur; Uracil

The first patient is a 60-year-old man who underwent total gastrectomy and splenectomy for type-3 gastric cancer after neoadjuvant chemotherapy. The second patient is a 69-year-old woman who underwent distal gastrectomy for type-2 gastric cancer and pyloric stenosis after neoadjuvant chemotherapy. Some peritoneal dissemination was observed in these two cases. No re-growth of peritoneal dissemination was seen for three years or more from treatment with the oral anticancer drug TS-1. Treatment on an outpatient basis, therefore, greatly contributed to their quality of life. We consider TS-1 as a first-line anti-cancer drug for advanced gastric cancer.

Topics: Adenocarcinoma, Mucinous; Administration, Oral; Aged; Antimetabolites, Antineoplastic; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Male; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Stomach Neoplasms; Survivors; Tegafur

A 64-year-old woman was admitted to the hospital for abdominal fullness and constipation. In the pelvic cavity, an abdominal CT scan revealed massive ascites showing malignancy on histological examination. Upper GI endoscopy revealed type 3 gastric cancer from the anglus to the cardia. A barium-enema showed a stenotic lesion at the sigmoid colon due to peritoneal dissemination. An abnormally high CA125(1,400 mg/ml) level was detected in serum. We performed systemic chemotherapy of TS-1, CDDP and peritoneal infusion of docetaxel on the nonresected gastric cancer with peritoneal dissemination. After 2 cycles, cytology of ascites revealed no malignancy, and the serum CA125 value regained its normal level. After 3 cycles, the killer cell effect was recognized by laparoscopic examination and the stenotic change of sigmoid colon had almost disappeared. The patient clinically achieved good QOL by this method, which was very effective for nonresected gastric cancer with peritoneal dissemination.

Topics: Adenocarcinoma, Mucinous; Antineoplastic Combined Chemotherapy Protocols; Cardia; Cisplatin; Docetaxel; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Quality of Life; Stomach Neoplasms; Taxoids; Tegafur

An 83-year-old male with Stage IV gastric cancer of performance status 1 (PS 1) was treated with fluoropyrimidine (TS-1) since January 2003 in our department. As the patient exhibited decreased renal function due to his age, we set the basic dose at 80% of the recommended dose of 80 mg/body/week. We administered 11 four-week cycles, each with a two-week drug-free washout period, and six two-week cycles, each with a two-week drug free washout period. The first cycle of chemotherapy ameliorated the subjective symptoms; the level of a tumor marker then returned to normal, and the ascites disappeared. The patient's condition was maintained at a favorable PS level without any subjective symptoms for approximately 20 months. In late September 2004, however, an exacerbation of the primary foci was confirmed by routine endoscopic examination. As second-line chemotherapy, we initiated weekly administration of paclitaxel (PTX). Due to the patient's age and high PS level (PS 2) at the time of intervention, we utilized a reduced dose of 70 mg/body/dose. After a short premedication period, the patient was administered PTX intravenously for one hour once a week for three weeks, then given a one-week drug-free washout period (one cycle). After the first cycle of PTX administration, all subjective symptoms disappeared, the PS level returned to zero,and the patient was discharged. In total, four cycles of the PTX regimen were given. Throughout the treatment period, we did not observe any significant adverse events (grade 2 or higher). Treatment achieved a favorable PS level. To design an effective chemotherapy regimen for elderly patients, it is important to establish an effective dose and dosing method based on the patient's chronologic age and a thorough evaluation of the patient's systemic conditions, including the PS level.

Topics: Adenocarcinoma, Mucinous; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Drug Administration Schedule; Drug Combinations; Humans; Male; Neoplasm Staging; Oxonic Acid; Paclitaxel; Prognosis; Pyridines; Stomach Neoplasms; Tegafur

A 74-year-old man was revealed to have type 3 gastric cancer with lymph-node metastasis in the third group (N 3) and liver metastasis (H 1). Since we regarded a curative operation as impossible, we started preoperative chemotherapy using TS-1 plus irinotecan hydrochloride (CPT-11) on the premise that we would perform surgical cytoreduction after the chemotherapy. After two courses of chemotherapy, both the primary lesion and the liver metastasis were reduced in size, and the paraaortic lymph-nodes disappeared. Subsequently, a distal gastrectomy (D 0, curability C) was performed. The patient has been receiving postoperative chemotherapy using TS-1 and paclitaxel as an outpatient for 2.3 years. Although there is not enough evidence to support the benefit of surgical cytoreduction, chemotherapy combined with surgical cytoreduction would improve the survival time without deterioration of quality of life (QOL) in patients with advanced gastric cancer. This combined therapy should be considered as one of the promising strategies for advanced gastric cancer.

Topics: Adenocarcinoma, Mucinous; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Irinotecan; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Oxonic Acid; Quality of Life; Stomach Neoplasms; Survivors; Tegafur

We herein report the case of a patient with mucinous gastric carcinoma with peritoneal dissemination that disappeared after neoadjuvant chemotherapy with S-1 alone. The patient has survived for over 23 months after surgery, without recurrence. A 60-year old man was referred to our hospital because of an advanced gastric cancer, detected by upper gastrointestinal endoscopy at another hospital. Staging laparoscopy was performed on October 25, 2002, and revealed massive peritoneal dissemination. Two courses of neoadjuvant chemotherapy with S-1 were administered, at 120 mg/day for 28 days, as one course. Total gastrectomy, with D2 lymph node dissection, was performed on January 24, 2003. The peritoneal dissemination had macroscopically disappeared and the cytology of the peritoneal lavage fluid was class III. His final diagnosis was gastric carcinoma, MLU, type 3, T2(SS), P0, H0, M0, N3, CY0, stage IV.

Topics: Adenocarcinoma, Mucinous; Antimetabolites, Antineoplastic; Drug Combinations; Gastrectomy; Humans; Lymph Node Excision; Male; Middle Aged; Neoadjuvant Therapy; Oxonic Acid; Pyridines; Stomach Neoplasms; Survival Analysis; Tegafur

S-1 is an oral fluoropyrimidine reported to be most active for gastric cancer. However, few studies have documented a complete response (CR) of lung metastasis to S-1 treatment. We describe a 66-year-old woman in whom S-1 induced complete regression of lung metastasis from gastric cancer, that had been refractory to another oral fluoropyrimidine, 5'-deoxy-5-fluorouridine (5'-DFUR). After preoperative chemotherapy with a combination of etoposide, adriamycin and cisplatin and with methotrexate plus 5-fluorouracil, the patient underwent a total gastrectomy with lower esophagectomy for advanced diffuse-type gastric cancer with invasion of the esophagus in May 1993. She received postoperative adjuvant chemotherapy with 5'-DFUR (600 mg/day) for 3 years. However, a solitary metastasis to the left lung was detected in November 1996 and she underwent partial resection of the left lung. Chemotherapy with 5'-DFUR was reinitiated after operation, but re-metastasis to the left lung with elevation of the serum carcinoembryonic antigen (CEA) level was diagnosed in June 1999. Treatment with S-1 was started in August. S-1 was given orally in a dose of 100 mg/day for 28 consecutive days, followed by a 14-day recovery; treatment was repeated every 6 weeks. The metastatic lesion in the left lung completely regressed after two courses of S-1 and the serum CEA level returned to the normal range. The patient received a total of 10 courses of S-1. The dose of S-1 was reduced to 80 mg/day from the sixth course because of grade 2 skin rash. Pharmacokinetic studies after administration of S-1 revealed high and prolonged plasma 5-FU levels. Nearly 4 years have passed since complete regression of the lung metastasis. This may be the first report to document a prolonged complete response of lung metastasis from gastric cancer induced by single-agent chemotherapy with S-1.

Topics: Adenocarcinoma, Mucinous; Administration, Oral; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Administration Schedule; Drug Combinations; Esophagectomy; Female; Floxuridine; Fluorouracil; Gastrectomy; Humans; Lung Neoplasms; Middle Aged; Oxonic Acid; Pyridines; Radiography, Thoracic; Remission Induction; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

We encountered a patient in whom TS-1/cisplatin (CDDP) combination chemotherapy was effective. The cancer became operable, and complete disappearance of liver metastasis was histopathologically confirmed. The patient was a 65-year-old man who presented with complaints of epigastric discomfort and anorexia. Based on upper GI endoscopy and abdominal CT, type 1 gastric cancer associated with liver and abdominal lymph node metastases was diagnosed. The cancer was judged to be inoperable, and chemotherapy with a combination of TS-1 and CDDP was initiated. One course of treatment consisted of administration of 120 mg/day of TS-1 for 21 days followed by 14 days of withdrawal, and administration of 100 mg/body/day of CDDP on day 8 (80 mg/body/day in the second course). After two courses of treatment, the primary lesion and the liver and lymph node metastatic lesions decreased in size (reduction ratios were 42.3%, 90.5% and 85.2%, respectively). The tumor marker values became normal. Subsequently, the cancer was judged to have become operable. After consultation with the patient, total gastrectomy, splenectomy, partial hepatectomy, and D3 dissection were performed, and curability B was achieved. The only adverse event of Grade 2 or more severity observed during drug administration was anorexia. Liver metastasis was judged from pathological findings to have disappeared. The postoperative course was uneventful and the patient was discharged from the hospital. To date, there have been no signs of recurrence. TS-1/CDDP therapy is believed to provide effective treatment against liver metastasis and lymph node metastasis of gastric cancer.

Topics: Adenocarcinoma, Mucinous; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Pyridines; Remission Induction; Splenectomy; Stomach Neoplasms; Tegafur