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

The present patient was a 53-year-old female diagnosed as gastric cancer with peritoneal dissemination by staging laparoscopy. She was treated with chemotherapy using S-1 (80 mg/body/day) and CDDP (80 mg/body/day, day 8) administered for 3 weeks followed by a drug-free 2 weeks, in five-week courses. Stable disease (SD) was obtained after six courses, and then she underwent second-staging laparoscopy. Because of disappearing peritoneal disseminated nodules both macroscopically and histologically, she underwent curative total gastrectomy with D2 lymph node dissection and reconstruction by the Roux-en Y method. The postoperative pathological findings showed T2 (se) N1M0, stage IIIa and chemotherapy effective evaluation demonstrated Grade 1b. Postoperatively, S-1/CDDP therapy was carried out, after two cycles she suffered from anorexia, and then S-1 only was given. Fourteen months later, peritoneal dissemination developed. Despite changes in the regimen such as docetaxel or CPT-11, she died 23 months after the initial gastrectomy.

Topics: Adenocarcinoma, Scirrhous; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Fatal Outcome; Female; Gastrectomy; Humans; Middle Aged; Neoadjuvant Therapy; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

The prognosis of scirrhous gastric cancer remains poor despite extended surgery or adjuvant or neoadjuvant chemotherapy. A pilot study of S-1 (TS-1; Taiho Pharmaceutical, Tokyo, Japan), an oral 5-fluorouracil derivative, for neoadjuvant chemotherapy unexpectedly showed good response and a promising effect on survival. Therefore, the Japan Clinical Oncology Group conducted a phase II trial to confirm the efficacy of S-1 for neoadjuvant chemotherapy against resectable scirrhous gastric cancer.. Patients were eligible if they had typical scirrhous gastric cancer invading more than half of the stomach, and resectable disease confirmed by laparoscopic staging. The treatment schedule consisted of two courses (each, 4-week administration and 2-week withdrawal) of S-1 (100-120 mg/body per day), followed by radical surgery.. Fifty-five eligible patients were registered. Three completed only one course of the neoadjuvant chemotherapy, whereas 52 completed two courses. Toxicity was acceptable, with a few grade 3 (5.5%) events, but no grade 4 adverse events. The response rate was 32.6% in 43 evaluable patients. Of the 55 patients, 2 refused operation, 1 developed lung metastasis, and 52 underwent laparotomy. The curative resection rate was 80.8%, with acceptable morbidity and no mortality. The survival curve at 2 years' follow up showed a better survival rate than that of the historical controls, but did not reach the expected survival rate.. S-1 neoadjuvant chemotherapy appeared feasible and showed positive effects against scirrhous gastric cancer; however, the survival rate with S-1 did not reach the expected rate required when selecting an agent for a phase III trial to confirm the effectiveness of neoadjuvant chemotherapy against scirrhous gastric cancer.

Topics: Adenocarcinoma, Scirrhous; Adult; Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Combined Modality Therapy; Drug Combinations; Feasibility Studies; Humans; Japan; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Oxonic Acid; Prognosis; Stomach Neoplasms; Survival Rate; Tegafur; Treatment Outcome

This retrospective study aimed to address the therapeutic outcome for scirrhous gastric cancer patients by evaluating the effect of neoadjuvant chemotherapy prior to gastrectomy.. Two cycles of a 3-week regimen of fluoropyrimidine S-1 (40 mg/m(2), orally, twice daily), together with cisplatin (60 mg/m(2), intravenously, day 8), were administered to patients, separated by a 2-week rest period. Surgery was performed 3 weeks later in the neoadjuvant group (n = 27). We retrospectively evaluated overall survival and prognostic factors in these patients.. Univariate analysis showed that positive lavage cytology indicated significantly worse prognoses. In the 15 patients who also underwent curative gastrectomies after S-1 plus cisplatin chemotherapy, the pathological response grade was a significant prognostic factor for 5-year survival. Additionally, lymph node metastasis tended to be an adverse prognostic factor.. After S-1 plus cisplatin neoadjuvant chemotherapy, a grade 2-3 pathological response may predict favorable outcomes in scirrhous gastric cancer patients receiving curative gastrectomy, but further studies are needed to confirm these results.

Topics: Adenocarcinoma, Scirrhous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Kaplan-Meier Estimate; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Staging; Oxonic Acid; Prognosis; Retrospective Studies; Sample Size; Stomach Neoplasms; Tegafur; Treatment Outcome

A 35-year-old female with scirrhous stomach cancer (stage IV) was treated with a combination of 5-aminolevulinic acid (ALA), sodium dichloroacetate (DCA), hyperthermotherapy, and immunotherapy as terminal care. The patient survived for one year and seven months, during which her quality of life was markedly improved and she returned to work. The patient was diagnosed with poorly-differentiated adenocarcinoma and progressive signet-ring cell carcinoma, accompanied by left ovarian metastasis, peritoneal dissemination, and right hydronephrosis stage IV, and treated with combination chemotherapy with tegafur-gimeracil-oteracil potassium (TS-1) and docetaxel. Oral ALA and DCA were concomitantly administered at 50 mg each three times a day (150 mg/day, respectively). In addition, hyperthermotherapy using thermotron was concomitantly performed at 2- to 3-week intervals. Cellular immunotherapy with αβ T- and immature dendritic cells was also performed. The disease did not progress for 11 months, her quality of life was markedly improved, and she was able to return to work. However, the signs of enlargement of the ovarian metastatic lesion were noted later, for which chemotherapy with four cycles of second-line paclitaxel and a half dose of irinotecan and cisplatin as third-line treatment were performed. Combination of ALA/DCA, hyperthermotherapy, and cellular immunotherapy may be a low-invasive palliative therapy superior in maintaining quality of life of tumor-bearing terminally ill individuals.

Topics: Adenocarcinoma, Scirrhous; Adult; Aminolevulinic Acid; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Carcinoma, Signet Ring Cell; Cisplatin; Combined Modality Therapy; Dichloroacetic Acid; Docetaxel; Drug Combinations; Drug Therapy, Combination; Female; Humans; Hyperthermia, Induced; Irinotecan; Ovarian Neoplasms; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Photosensitizing Agents; Prognosis; Silicates; Stomach Neoplasms; Taxoids; Tegafur; Titanium

The case is a sixty-something man with a complication of epigastric abdominal pain. X-ray and endoscopic examination of upper gastrointestinal tract showed a rigidity of the gastric wall and the presence of giant folds on gastric body and fornix. Scirrhous type of gastric cancer was suspected and gastric forceps biopsy was performed at many points under the retreated endoscopic examinations. However, the histologic findings revealed no malignant features. We performed staging laparoscopy, and by peritoneal washing cytology and biopsy of a nodule of abdominal wall, he was diagnosed with advanced gastric carcinoma with peritoneal dissemination. In conclusion, staging laparoscopy is one of the useful methods for diagnosis and determination of the management of scirrhous type gastric carcinoma.

Topics: Adenocarcinoma, Scirrhous; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cisplatin; Drug Combinations; Humans; Laparoscopy; Male; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur

A 67-year-old woman with debilitation and massive ascites was admitted to our hospital and diagnosed with stage IV scirrhous gastric cancer with peritoneal dissemination. After successful nasojejunal tube feeding because of oral intake disability, TS-1 combined with paclitaxel chemotherapy was selected. TS-1 at 80mg/m2 was given daily via nasojejunal tube for 2 weeks, followed by a 1-week rest, and paclitaxel at 50mg/m2 was administered intravenously on day 1 and 8. There were no serious side effects. After 4 cycles, a partial response was observed and percutaneous transesophageal gastrotubing (PTEG) was placed. After the fifth cycle, she was transferred to her home and received chemotherapy in an outpatient clinic. After 7 cycles, the disease progressed, and TS-1 combined with low-dose cisplatin was administered for 3 cycles. However, the patient died 16 weeks after discharge. PTEG was useful not only for a route of TS-1 administration, but also for receiving chemotherapy at home to maintain her quality.

Topics: Adenocarcinoma, Scirrhous; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Fatal Outcome; Female; Gastrostomy; Humans; Intubation, Gastrointestinal; Jejunum; Oxonic Acid; Paclitaxel; Severity of Illness Index; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 55-year-old woman was admitted to our hospital with a complaint of appetite loss and body weight loss. Upper digestive endoscopy showed a giant fold at the greater curvature stomach and diffused edematous gastric mucosa. Abdominal contrast CT demonstrated a significant thickening of the gastric wall and a large number of lymph node swelling. A clinical finding was Stage IIIB (T3N2M0) Type 4 gastric cancer of poorly differentiated adenocarcinoma. Total gastrectomy, splenectomy and D2 lymph node dissection were performed. Although there was no peritoneal dissemination, peritoneal lavage cytology was positive. After the operation, S-1 alone chemotherapy was administered for four years. No recurrence had occurred for about seven years and eight months after resection. However, the patient was pointed out the signs of recurrence (ascites and induration) by CT. Now, S-1 alone chemotherapy was performed again, and the patient has been in good health.

Topics: Adenocarcinoma, Scirrhous; Antimetabolites, Antineoplastic; Drug Combinations; Female; Gastrectomy; Humans; Lymph Node Excision; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Peritoneal Lavage; Splenectomy; Stomach Neoplasms; Tegafur; Time Factors

We report a long-term survival case treated by chemotherapy with new anticancer drugs such as S-1, CPT-11 and docetaxel after bilateral overiectomy for bilateral ovarian metastases of progressive gastric cancer. A 68-year-old female, who had undergone total gastrectomy with D2 lymphadenectomy for scirrhous gastric cancer of Stage IIIA, was admitted because of ovarian metastasis. Laparoscopic bilateral ovariectomy was performed for ovarian metastases of the gastric cancer (Krukenberg tumor) 6 months after gastrectomy. Seven months after gastrectomy, 11-course of S-1 treatment (80 mg/m2) for bilateral ovarian metastases of the gastric cancer was administered. CT scan revealed mediastinal lymphadenopathy 2 years and 5 months after gastrectomy. Then, the drug was changed to docetaxel (60 mg/m2). After 9-course of docetaxel treatment, the mediastinal lymphadenopathy disappeared. For a treatment of grade 3 neuropathy, a 12-course CPT-11 was started after gastrectomy 3 years and 6 months ago. CT scan and PET-CT showed no new metastasis in 4 years and 10 months after gastrectomy.

Topics: Adenocarcinoma, Scirrhous; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Camptothecin; Docetaxel; Drug Combinations; Female; Gastrectomy; Humans; Irinotecan; Krukenberg Tumor; Ovarian Neoplasms; Ovariectomy; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur

Preoperative intra-peritoneal chemotherapy (IPC) for scirrhous gastric cancer (SGC) has been performed and followed after laparoscopic diagnosis of peritoneal metastasis (P) or washing cytology (CY) in our hospital. Between 2002 and 2005, 15 SGC patients were treated with 3 times of IPC using CDDP (50 mg/body) before operation (CDDP group). Between 2006 and 2008, 9 SGC patients were treated with IPC using docetaxel: DOC (40 mg/m2) and treated with systemic chemotherapy using S-1 (80 mg/m2) before operation (DOC group). Cases with P (+) or CY (+) were detected in 80% in CDDP group and in 89% in DOC group. Gastrectomy was performed in 67% of CDDP group and in 56% of DOC group. All of the 15 patients died in CDDP group but 4 of 9 were still alive in DOC group. The median survival time of DOC group (22 months) was longer than that of CDDP group (10 months, p=0.123). Thus, preoperative IPC using DOC combined with systemic chemotherapy using S-1 should be effective treatment for SGC.

Topics: Adenocarcinoma, Scirrhous; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Docetaxel; Drug Combinations; Humans; Infusions, Parenteral; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur

Case 1: A 77-year-old female with scirrhous gastric cancer was diagnosed as c4T3N1H0M0P0CY1/stage IV, and S-1/docetaxel combined therapy was carried out. The wall thickness of stomach improved after 11 courses. Case 2: A 48-year-old female with scirrhous gastric cancer was diagnosed as c4T3N1H0M0P0CY1/stage IV, and S-1/CDDP/paclitaxel combined therapy was carried out. The wall thickness of stomach improved after 5 courses. Case 3: A 37-year-old man with scirrhous gastric cancer was diagnosed as c4T3N0H0M0P1CY1/stage IV, and S-1/CDDP/paclitaxel combined therapy was carried out. The wall thickness of stomach improved after 5 courses. In all cases, CY and P negativity was confirmed in second-look staging laparoscopy and curative surgery was carried out.

Topics: Adenocarcinoma, Scirrhous; Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Docetaxel; Drug Combinations; Female; Humans; Laparoscopy; Male; Middle Aged; Oxonic Acid; Second-Look Surgery; Stomach Neoplasms; Taxoids; Tegafur

A 46-year-old woman was diagnosed with complaints of bilateral breast tumor with massive ascites retention. The patient was examined as scirrhous carcinoma by lacteal gland inspection and dysplastic cell by ascites cytotechnology. We diagnosed her case to be bilateral breast cancer with peritonitis carcinomatosa, lymph node metastases and bony metastases. In addition to that, gastric metastasis was diagnosed by the result of widespread irregular gastric mucosa, which was inspected through upper gastrointestinal endoscope. The patient was treated with S-1 and paclitaxel and has achieved a remarkable response. The patient's tumor, gastric metastasis, and ascites were disappeared almost completely.

Topics: Adenocarcinoma, Scirrhous; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Drug Combinations; Female; Humans; Middle Aged; Oxonic Acid; Paclitaxel; Peritonitis; Stomach Neoplasms; Tegafur

A 71-year-old male, who complicated of abdominal distension, was diagnosed as scirrhous gastric cancer. We treated him with the oral anticancer drug S-1 and achieved long-term stable disease over three years.

Topics: Adenocarcinoma, Scirrhous; Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Gastroscopy; Humans; Male; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed

Type 4 gastric cancer has a poor prognosis compared with other types of advanced gastric cancer because of the high incidence of peritoneal metastasis which causes intestinal obstruction, hydronephrosis, or obstructive jaundice. Surgical treatment is often only palliative, and systematic chemotherapy is considered to be important for long survival. S-1 showed a higher response rate for undifferentiated-type adenocarcinoma, and S-1 alone or its combination regimens demonstrated greater anti-tumor effects and longer survival time for gastric linitis plastica compared with conventional 5-FU regimens in our historical control study (response rate: S-1/non S-1 57.9%/27.9%, p<0.01; MST: S-1/non S-1 402 days/213 days, p<0.01). S-1 regimens may also improve the survival in patients with type 4 gastric cancer in neoadjuvant or adjuvant settings, but further prospective studies are warranted to prove its significance. Paclitaxel also has a high response rate for undifferentiated-type adenocarcinoma, and can be expected to show high efficacy for peritoneal dissemination. Irinotecan should not be administered in case of intestinal obstruction because its toxicity may be increased. However,survival of patients with type 4 gastric cancer may improve with the availability of active agents like S-1, taxanes, irinotecan as reported in colorectal cancer. Therefore,irinotecan should be administered carefully before intestinal obstruction occurs.

Topics: Adenocarcinoma, Scirrhous; Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Drug Administration Schedule; Drug Combinations; Female; Fluorouracil; Humans; Irinotecan; Male; Methotrexate; Middle Aged; Oxonic Acid; Paclitaxel; Prognosis; Stomach Neoplasms; Survival Rate; Tegafur

An inhibitory-effect of a selective cyclooxygenase-2 (COX-2) inhibitor on peritoneal metastasis of scirrhous gastric carcinoma was investigated in vivo. Peritoneal metastasis had developed after intraperitoneal inoculation of scirrhous gastric cancer cells, OCUM-2MD3, in nude mice. COX-2 inhibitor and/or S-1 were administered orally in nude mice with peritoneal metastasis. Oral administration of COX-2 inhibitor and S-1 significantly prolonged survival rates of these nude mice, compared with either alone. These findings suggested that combining S-1 and COX-2 inhibitor administration obtain a synergistic inhibitory-effect on the peritoneal metastasis of scirrhous gastric carcinoma.

Topics: Adenocarcinoma, Scirrhous; Animals; Antimetabolites, Antineoplastic; Benzenesulfonates; Cyclooxygenase 2 Inhibitors; Drug Combinations; Drug Synergism; Drug Therapy, Combination; Female; Humans; Mice; Mice, Inbred BALB C; Mice, Nude; Oxazoles; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Survival Rate; Tegafur; Tumor Cells, Cultured

A 72-year-old female with scirrhous-type advanced gastric cancer was treated with TS-1/CDDP as neoadjuvant chemotherapy. TS-1 (80 mg/m(2)/day) was orally administered for 3 weeks and CDDP (60 mg/m(2)) was administered by intravenous drip on day 8. Partial response (PR) was obtained after the first course, and total gastrectomy was performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and a few regional lymph node metastases (3/67). The patient has now been in good health without a recurrence for 1 year and 9 months after surgery.

Topics: Adenocarcinoma, Scirrhous; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Lymph Nodes; Lymphatic Metastasis; Neoadjuvant Therapy; Oxonic Acid; Pyridines; Remission Induction; Stomach Neoplasms; Tegafur

We have experienced three gastric carcinoma cases successfully treated by the combination therapy of docetaxel and TS-1. Case 1: 66-year-old male with advanced gastric cancer invading the pancreas with metastasis to the liver and left neck lymph nodes. Case 2: 50-year-old female with scirrhous gastric carcinoma causing huge amount of malignant ascites. Case 3: 59-year-old male with recurrent gastric cancer of the remnant stomach presenting with obstruction and vessel involvement. Primary and metastatic diseases of these patients were remarkably improved with the combination therapy, indicating that the combination therapy of docetaxel and TS-1 can be a new therapeutic tool for advanced and recurrent gastric cancer patients.

Topics: Adenocarcinoma, Scirrhous; Aged; Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Taxoids; Tegafur

We examined 198 cases of primary scirrhous type 4 gastric cancer at our department from 1984 to 2003. Of these, 139 cases underwent gastrectomy. The essential cause of inoperability was peritoneal dissemination with malignant abdominal abscises. The incidence of peritoneal dissemination was 48.2% of all resected cases. The 5-year survival rate of all resected cases was 12% and that of non-resectable cases was 0%. One of the 59 nonresectable cases who responded remarkably to treatment by TS-1/paclitaxel combination chemotherapy obtained survival of 12 months. Six cases with peritoneal dissemination were treated by chemotherapy with cisplatin and etoposide infused intra-peritoneally and 2 of them were diagnosed as P 0 after 4 weeks. One case with type 4 gastric cancer who had right hydronephrosis and malignant abdominal ascites underwent curative resection after successful treatment with TS-1. We have selected the way of conventional chemotherapy for inoperable type 4 gastric cancers, but the prognosis is still poor. It is thought necessary to improve survival by newly developed anticancer agents such as TS-1, etoposide and taxanes. Immuno-cellular therapy with autologous tumor cell stimulated lymphocyte may be examined as a neo-adjuvant therapy as well as chemotherapy.

Topics: Adenocarcinoma, Scirrhous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Etoposide; Female; Gastrectomy; Humans; Immunotherapy; Male; Middle Aged; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Pyridines; Stomach Neoplasms; Survival Rate; Tegafur

Complete loss of malignant ascites by combination chemotherapy of TS-1+paclitaxel was experienced. The case was a 56-year-old woman who was diagnosed with inoperable scirrhous gastric cancer with malignant ascites. The administered regimen of chemotherapy was TS-1 100 mg/day (80 mg/m2) for 2 weeks. Paclitaxel 60 mg/day (50 mg/m2) on day 1 and 8 of TS-1 intake, followed by 2-weeks rest. Partial response was confirmed by gastrography and gastrofiberscope after 3 courses were performed. Furthermore, computed tomography (CT) showed complete loss of malignant ascites. Adverse reactions were grade 3 leukopenia and grade 2 nausea, vomiting and diarrhea. This result indicates the possibility of combination chemotherapy of TS-1+paclitaxel becoming an effective option in treating inoperable scirrhous gastric cancer.

Topics: Adenocarcinoma, Scirrhous; Antineoplastic Combined Chemotherapy Protocols; Ascitic Fluid; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Oxonic Acid; Paclitaxel; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

A 66-year-old male with massive ascites was diagnosed as advanced gastric scirrhous cancer at Musashino Red Cross Hospital. We detected the adenomatous cancer cells from his ascites, and an X-ray photograph of his stomach showed less capability of expansion in the upper gastrointestinal series. We attempted treatment with oral anticancer drug TS-1 with the patient's consent and achieved a long-term response of two years or more.

Topics: Adenocarcinoma, Scirrhous; Aged; Antimetabolites, Antineoplastic; Drug Combinations; Humans; Male; Oxonic Acid; Pyridines; Radiography, Abdominal; Remission Induction; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

We conducted a pilot study using S-1 (TS-1), a novel oral derivative of 5-fluorouracil, as neoadjuvant chemotherapy for potentially resectable scirrhous gastric cancer. The neoadjuvant chemotherapy consisted of two courses (each, 4-week administration and 2-week withdrawal) of S-1 at 100-120 mg/body per day. Five patients were enrolled in this pilot study and underwent resection. The response rate for the neoadjuvant chemotherapy was 60% (three partial response [PR]; two stable disease [SD]). Three of the five patients received curative resection; the other two patients received noncurative resection because of localized peritoneal dissemination and positive results on cytological examination of the abdominal washing. No toxicity of grade 3 or more was exhibited during the two courses of chemotherapy. Pathological examination of the resected specimens revealed a marked reduction in the distribution of viable cancer cells in the stomach in the three patients with PR. In one of these patients, pathological findings suggestive of the possibility of disappearance of the cancer cells in the perigastric and paraaortic lymph nodes were noted. Because of the unexpectedly high response to S-1, we consider that the efficacy of S-1 as neoadjuvant chemotherapy for scirrhous gastric cancer should be verified by phase II and III trials.

Topics: Adenocarcinoma, Scirrhous; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Digestive System Surgical Procedures; Drug Combinations; Humans; Japan; Laparoscopy; Neoadjuvant Therapy; Neoplasm Staging; Oxonic Acid; Pilot Projects; Pyridines; Stomach Neoplasms; Tegafur; Treatment Outcome

A 79-year-old male was diagnosed as having a scirrhous cancer of the stomach. Carcinomatous peritonitis was suspected on abdominal CT examination and the CA19-9 showed a high level of 95 U/ml. The patient was treated with combined chemotherapy of TS-1 and CDDP. TS-1 (100 mg/day) was administered for 14 days followed by 14 days rest as one course. CDDP was administered in 24-h continuous intravenous infusion on day 8. This treatment was done every 4 weeks regularly. After 5 courses, X-ray and endoscopy examinations revealed disappearance of cancerous lesions in the stomach with an improvement in the extensibility. No cancer cell were confirmed by endoscopic biopsy, nor did a CT-scan detect carcinomatous peritonitis. The CA19-9 decreased within the normal limit. Ten months after chemotherapy was started, the patient was very healthy without a recurrence of cancer. This combined chemotherapy has administered in 8 courses, and during this period no high grade toxicities (WHO grade 3 or 4) occurred. This TS-1/CDDP chemotherapy was effective for scirrhous gastric cancer and might be administered safely even for aged patients.

Topics: Adenocarcinoma, Scirrhous; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Male; Oxonic Acid; Pyridines; Remission Induction; Stomach Neoplasms; Tegafur

A 54-year-old patient with scirrhous type 3 gastric cancer having bulky N2 and para-aorta lymph node metastases was treated by combined chemotherapy of TS-1 and CDDP. Before treatment, CEA was 28.4 mg/ml. TS-1 (120 mg/day) administered for 14 days followed by 14 days rest was one course. CDDP (80 mg/m2) was administered by 24 hour continuous intravenous infusion at day 8 after the start of TS-1. After 2 courses of treatment, the level of CEA decreased to 1.4 mg/ml and the primary legion with lymph node metastases had decreased significantly. After 5 courses, endoscopic examination revealed complete disappearance of the primary tumor with no cancer cells detected by endoscopic biopsy. A CT scan also showed complete disappearance of all lymph node metastases. No severe adverse effects (NCI-CTC grade 3 of 4) were observed with this therapy. TS-1/CDDP chemotherapy is considered very effective for scirrhous gastric cancer with far advanced lymph node metastases.

Topics: Adenocarcinoma, Scirrhous; Antineoplastic Combined Chemotherapy Protocols; Aorta; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Infusions, Intravenous; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Remission Induction; Stomach Neoplasms; Tegafur

It is believed that multiple hepatic metastases from stomach cancer are highly refractory, and resistant to clinical treatment. In the present study, TS-1 neoadjuvant therapy administered orally in a single course brought about CR in the hepatic metastatic foci and PR in the primary foci, thus enabling grade A radical extirpation in a case of advanced stomach cancer. The patient continued to be treated on an ambulatory basis. His peri- and post-operative courses were satisfactory and the treatment was completed without the development of adverse effects.

Topics: Adenocarcinoma, Scirrhous; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 67-year-old woman with anorexia and weight loss was referred to our hospital with a diagnosis of type 4 gastric cancer. Since metastases to the liver, left adrenal gland, and Douglas' pouch were detected in addition to ascites and bilateral hydronephrosis, the tumor was judged unresectable and systemic chemotherapy with TS-1 was begun. Symptoms began to improve after the first course, and the patient was discharged and followed as an outpatient. An upper GI series showed improvement of the primary lesion, and cancer cells became undetectable under biopsy. At the end of the third course, computed tomography confirmed that metastases to the liver, the lymph nodes, and the adrenal gland had disappeared. The ascites diminished significantly, and hydronephrosis began to ameliorate. The effectiveness of the drug continued until the end of the eleventh course, and the patient is currently in her seventeenth month as an outpatient. This case shows the effectiveness of TS-1 against scirrhous type gastric cancer, a cancer generally considered resistant to chemotherapy. Furthermore, treatment on an outpatient basis has greatly improved her quality of life.

Topics: Adenocarcinoma, Scirrhous; Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Fluorouracil; Humans; Neoplasm Metastasis; Oxonic Acid; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

We have treated a case of hepatic metastasis of gastric cancer that has responded well to TS-1. The patient was a 68-year-old male, who underwent distal gastrectomy for gastric cancer. After surgery 5'-deoxy-5-fluorouridine (5'-DFUR) 800 mg/day was administered orally for two months. Grade 4 diarrhea appeared, so administration of 5'-DFUR was discontinued. Afterward the patient was followed with no chemotherapy. Liver metastasis (S6, 3 cm in diameter) was found at twelve months after surgery. 5'-DFUR (800 mg/day) was administered orally everyday. Grade 3 diarrhea appeared and metastasis showed NC after four weeks. 5'-DFUR administration was discontinued. Seventeen days later TS-1 (80 mg/day) was administered orally everyday for 2 weeks, followed by 1 week rest, as one course. Two courses of TS-1 administration resulted in a marked reduction of the liver metastasis, for a PR (75% reduction). After 3 courses, the liver metastasis showed CR. The patient is alive without recurrence after 12 courses. This TS-1 administration regimen was effective and tolerable for a patient with liver metastasis from gastric cancer.

Topics: Adenocarcinoma, Scirrhous; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur