s-1-(combination) and Constriction--Pathologic

An 82-year-old man underwent total gastrectomy(D2 lymph node dissection)in August 2006. The pathological findings indicated T4a, N3, M0, Stage IIIC gastric cancer, but adjuvant chemotherapy was not initiated. In October 2009, he presented to the hospital with dyschezia. During colonoscopy, the scope could not pass through the colon, thus indicating rectal stenosis. The biopsy findings indicated the presence of signet ring cell carcinoma, which was determined to be due to the peritoneal dissemination from the gastric cancer. To avoid the need for creating a stoma, radiation therapy(2 Gy×20; total dose, 40 Gy)and chemotherapy(weekly paclitaxel and S-1)were initiated. Rectal stenosis was improved and complete remission was maintained until May 2013.

Topics: Aged, 80 and over; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Chemoradiotherapy; Constriction, Pathologic; Drug Combinations; Humans; Male; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Rectal Diseases; Stomach Neoplasms; Tegafur

S-1 is a key drug for advanced, recurrent gastric cancer. It is difficult to administer S-1 for inoperable gastric cancer with stenosis. We report that a simple suspension method allows administration of S-1 for improved quality of life. The patient was a 65-year-old woman. She consulted a doctor regarding her poor food intake, and had a medical examination with chest-abdominal CT and gastrofiberscopy. She was diagnosed as type 4 gastric cancer with esophageal invasion. It was difficult for her to drink a cup of water due to the stenosis, but we could insert a 6 Fr-Elemental Diet (ED) tube into her stomach. S-1 was dissolved by the simple suspension method. She received combination chemotherapy of S-1 100mg/body (day 1-21) and CDDP 80 mg/body (day 8). After two courses, her intake was much improved; she was able to eat rice porridge and was discharged with improved quality of life. S-1 suspension with ED tube was effective for advanced gastric cancer with stenosis.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Cisplatin; Constriction, Pathologic; Drug Combinations; Female; Humans; Oxonic Acid; Quality of Life; Stomach Neoplasms; Suspensions; Tegafur

We reported a case of unresectable gastric cancer presenting pylorus stenosis treated orally by S-1 therapy in a 72-year-old man who underwent gastrojejunostomy. He was admitted to our hospital complaining of appetite loss and body weight loss. Detailed examination showed gastric cancer with pylorus stenosis. After insertion of the naso-gastric tube with washing, a laparotomy was done. The operative findings revealed sT3, sN2, sP1, sH0 and sM1 (metastases of No. 14a lymph nodes invading the super mesenteric artery and pancreas) as an unresectable case with stage IV. Gastrojejunostomy and Braun anastomosis were made through the antecolic route. After the operation, intake therapy of S-1 was started (80-100 mg/body/dayx28 days). After 2 courses of the therapy, gastrointestinal fiber showed clinically a partial response of the main tumor. After 3 courses of this treatment, the tumor presented multiple liver metastases as a clinically progressive disease state. Paclitaxel therapy was conducted at a dose of 80 mg/body/weekx3 timesx2 courses. The patient had no effective benefits from the treatment and died of the cancer. He had survived 9 months, and the intervals of the intake and home stay were 7.5 months and five months, respectively, after the operation with no side effect of the chemotherapy. Survival was no longer than for patients only operated without S-1 therapy.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Constriction, Pathologic; Drug Administration Routes; Drug Combinations; Gastric Bypass; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Mesenteric Artery, Superior; Neoplasm Invasiveness; Oxonic Acid; Pancreatic Neoplasms; Pylorus; Stomach Neoplasms; Tegafur

We experienced the case of a 62-year-old woman who obtained long-term survival of three years by TS-1+paclitaxel (PTX) administration for gastric cancer postoperative peritoneal metastases. We first performed total gastrectomy, and the diagnosis was T3N2M0, Stage IIIB. Next, we performed chemotherapy by postoperative 5-FU+cisplatin (CDDP) and met in ambulatory. A bowel movement aberration was found during the course at 3 years postoperatively, and close inspection revealed sigmoid colon stenosis by peritoneal metastases. After construction of an artificial anus, we started administration of TS-1+paclitaxel. Chemotherapy was continued on an outpatient basis, and at-home treatment was possible for about 26 months till symptoms aggravated. No grave adverse event occurred except for depilation of grade 1. It was thought that this long-term treatment on an outpatient basis contributed to survival.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Constriction, Pathologic; Drug Administration Schedule; Drug Combinations; Female; Fluorouracil; Humans; Middle Aged; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Sigmoid Diseases; Stomach Neoplasms; Tegafur

A 43-year-old woman who complained of abdominal fullness, appetite loss, and constipation was diagnosed as unresectable advanced schirrhous gastric cancer with left supra-clavicular lymph node metastases, massive ascites, rectal stenosis, and bilateral hydronephrosis due to peritoneal metastases. The biopsy specimen showed a poorly differentiated adenocarcinoma with signet-ring cells. After placement of the bilateral ureteral stents, she was treated with combined chemotherapy of biweekly paclitaxel (120 mg/m2, day 1, day 15) and TS-1 (80 mg/day, days 1-14 with 2-weeks rest). Subjective symptoms were relieved after one course of the chemotherapy. After 3 courses, computed tomography showed markedly reduced supra-clavicular lymph node metastases and no ascites. Radiographic and endoscopic examinations also demonstrated remarkable improvements in compliance of the gastric and rectal walls. These findings suggested that partial response on Response Evaluation Criteria in Solid Tumors (RECIST) was obtained. After the first course, the treatment was continued on an outpatient basis. There were no adverse effects over grade 2 throughout six courses of the chemotherapy. The biweekly paclitaxel and TS-1 chemotherapy may well be an effective treatment for advanced schirrhous gastric cancer with carcinomatous peritonitis.

Topics: Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Ascites; Carcinoma, Signet Ring Cell; Constriction, Pathologic; Drug Administration Schedule; Drug Combinations; Female; Humans; Lymphatic Metastasis; Oxonic Acid; Paclitaxel; Peritonitis; Pyridines; Rectal Diseases; Stomach Neoplasms; Tegafur

The patient, a 40-year-old woman, underwent total gastrectomy and excision of the pancreatic tail, spleen and gallbladder for gastric cancer in September 2000. The lesion was judged to be P1, SE, H0, N2 and Stage IV and the patient was managed on a regular schedule as an outpatient. In September 2004, she passed blood-stained feces and rectal palpation detected a hard nodule at the anterior rectal wall. A fiber optic examination of the sigmoid colon detected an ulcerous lesion with a hemorrhage at the anterior rectal wall. A biopsy revealed the lesion to be Group V poorly differentiated adenocarcinoma. Starting in October 2004, 100 mg/day of TS-1 was administered for 3 weeks; intravenous drip infusion of 100 mg/body of CDDP was conducted in the second week for a period of 24 hours. After 3 courses of this regimen, a fiber optic examination of the colon conducted in February 2005 no longer detected the rectal tumor, leaving only a cicatrix. Upon a CT examination, the para-aortic lymph nodes that had been enlarged were notably reduced in size and an improvement was eminent in the hypertrophic rectal wall. The patient no longer experienced constipation or melena. Her clinical course is being observed while an oral administration of 100 mg/day of TS-1 continues.

Topics: Adenocarcinoma; Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cholecystectomy; Cisplatin; Constriction, Pathologic; Drug Combinations; Female; Gastrectomy; Humans; Oxonic Acid; Pancreatectomy; Pyridines; Rectal Diseases; Rectal Neoplasms; Splenectomy; Stomach Neoplasms; Tegafur

TS-1 is reported to be beneficial for advanced gastric cancer, but there is no report on its use for advanced gallbladder cancer. The present patient was a 64-year-old woman with advanced gallbladder cancer with severe biliary tract stenosis. The primary tumor was located in the neck of the gallbladder and peripancreatic lymph node metastasis was detected. TS-1 100 mg/day was administered orally for 21 days and CDDP 30 mg/day on days 1, 8 by drip infusion. Grade 4 neutropenia was observed in the first cycle, and TS-1 alone was used for further treatment. After 2 courses, primary tumor showed PR and lymph node metastasis had disappeared. Biliary stenosis was remarkably improved. We conclude that TS-1 might be beneficial in the treatment of advanced gallbladder cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biliary Tract Diseases; Cisplatin; Constriction, Pathologic; Drug Administration Schedule; Drug Combinations; Female; Gallbladder Neoplasms; Humans; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Pyridines; Tegafur

The patient was a 44-year-old woman who had unresectable advanced gastric cancer with peritoneal dissemination and navel metastasis (Sister Mary Joseph metastasis). The lesion was considered surgically incurable, so she was placed on neoadjuvant chemotherapy consisting of biweekly TXL (100 mg/m2/day 1, 15) and TS-1 (80 mg/m2/day 1-14) and 2 weeks rest. Before chemotherapy, she could not eat anything because of poor expansion of the stomach and ascites. After the 1st course she could eat half the volume of a normal meal. The only side effect of this treatment was pigmentation of the skin and alopecia. After the 2nd course, she returned home and chemotherapy was continued on an outpatient basis. After the 5th course, the stenosis of colon and ascites had disappeared in a barium enema and CT scan, respectively. The poor expansion of the stomach was slightly improved. She was considered to have responded and underwent total gastrectomy with D2 and transverse colectomy and splenectomy. There were no clear nodules indicating peritoneal dissemination in the intra-operative findings. Intra-operative cytological examination was negative. The depth of the cancer invasion was limited to the subserosal layer and there was no invasion to the colon histologically. There was no lymph node metastasis, but there were a small number of cancer cells obtained diffusely in the omentum and mesocolon. There was no findings of recurrence 5 months later. Biweekly TXL and TS-1 therapy was thought to be an effective chemotherapy against advanced gastric cancer.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colectomy; Colonic Diseases; Constriction, Pathologic; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Peritonitis; Pyridines; Splenectomy; Stomach Neoplasms; Tegafur; Umbilicus