s-1-(combination) and Jaundice--Obstructive

A 62-year-old man presented with pruritus caused by obstructive jaundice. He was diagnosed with carcinoma of the ampulla of Vater and underwent pylorus-preserving pancreaticoduodenectomy. Histologic examination revealed signet-ring cell carcinoma without nodal metastasis. The patient underwent a partial resection of the small bowel for small bowel obstruction 38 months after the initial resection. Histologic examination disclosed signet-ring cell carcinoma at the surface of the resected small bowel, and the diagnosis of peritoneal recurrence was confirmed. He received oral S-1(100 mg/day) every other day for 14 months until bowel obstruction caused by peritoneal carcinomatosis became apparent. The patient died of the disease 58 months after the initial resection.

Topics: Ampulla of Vater; Antimetabolites, Antineoplastic; Carcinoma, Signet Ring Cell; Drug Combinations; Duodenal Neoplasms; Humans; Intestinal Obstruction; Jaundice, Obstructive; Male; Middle Aged; Oxonic Acid; Pancreaticoduodenectomy; Tegafur

Here, we report 2 patients with gastric cancer and peritoneal dissemination who were successfully treated with chemotherapy after undergoing treatment for an oncologic emergency caused by peritoneal dissemination. Case 1 involved obstruction of the sigmoid colon caused by peritoneal dissemination. After urgent colostomy, S-1/IP IV paclitaxel chemotherapy was introduced. The patient continued the therapy for 2 years and 2 months. Case 2 involved acute renal failure due to bilateral ureter obstruction and obstructive jaundice caused by peritoneal dissemination. This patient underwent emergency treatment consisting of Double-J ureteral stent insertion and endoscopic nasobiliary drainage. He was successfully started on chemotherapy with S-1/oxaliplatin/IP paclitaxel. He continued the therapy for 8 months without symptoms. Aggressive treatment might be effective for advanced gastric cancer showing oncologic emergency.

Topics: Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Ileus; Jaundice, Obstructive; Male; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Stomach Neoplasms; Tegafur

A man in his 60s was admitted with obstructive jaundice. A hypovascular tumor, 55 mm in diameter, was detected in the pancreas head on imaging. The superior mesenteric vein showed severe stenosis bilaterally and the roots of all branches were invaded by the tumor. The tumor was diagnosed as unresectable pancreatic cancer, and chemotherapy of gemcitabine and S-1 was administered, resulting in a remarkable reduction of the tumor size. Following 7 courses of chemotherapy, a subtotal stomach-preserving pancreatoduodenectomy was carried out. Microscopic examination revealed no residual cancer cells in the resected specimen, indicating that pathological complete remission was obtained. Although some reports suggest that surgical treatment for patients with initially unresectable pancreas cancer who show excellent response to chemotherapy may improve the prognosis, further studies are needed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Jaundice, Obstructive; Male; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Tegafur

A 55-year-old woman was found to have a type-4 lesion centered on the greater curvature of the lower portion of her stomach during an upper gastrointestinal endoscopic examination.A diagnosis of inoperable advanced gastric carcinoma [type 4, tub 2/por, T3 (SE), N3, H0, P1, cStage IV], complicated by pyloric stenosis, liver dysfunction, and obstructive jaundice untreatable by bile drainage, was made.After obtaining the informed consent of the patient and her family and explain- ing that under the circumstances surgery was not indicated, chemotherapy [S-1 (granules) 80 mg/m2, CDDP 60 mg/m2] was selected. After starting treatment, an improvement in liver dysfunction and jaundice was observed, and at the start of the second course, the patient had become capable of oral feeding.The patient was discharged after completion of the second course. No choices associated with evidence exist for treatment of patients with inoperable advanced gastric cancer (complicated by obstructive jaundice), who are not elderly and have good performance status (PS).We report this case in which improvement of activity of daily living (ADL) was achieved relatively safely by treatment with S-1/CDDP, together with a brief discussion based on the literature.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Female; Humans; Jaundice, Obstructive; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur

The patient was a 53-year-old male who was admitted on an emergency basis with obstructive jaundice. He was diagnosed as having advanced ampullary carcinoma(T4 N0 H1, Stage IV b). To reduce the degree of obstructive jaundice, a self-expandable metallic stent was placed in the area of the biliary obstruction. Immediately after relief from obstructive jaundice, combination chemotherapy of S-1 and gemcitabine was given. Subsequently, CA19-9, the tumormarker level was reduced, the metastatic liver tumor disappeared, and the size of the primary lesion was remarkably reduced. Therefore, a curative surgical resection was done. This is a very instructive case for developing effective chemotherapy options to treat biliary tract cancers involving ampullary carcinoma.

Topics: Ampulla of Vater; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Duodenal Neoplasms; Gemcitabine; Humans; Jaundice, Obstructive; Male; Middle Aged; Oxonic Acid; Tegafur

A 70-year-old man was hospitalized for obstructive jaundice. Endoscopic examination disclosed Borrmann type 3 advanced gastric cancer from ECJ to the middle corpus. Laparoscopic examination demonstrated the disseminated nodules at hepatic hilum. After percutaneous biliay drainage, we implanted an expandable metallic stent utilizing this fistula and started combination chemotherapy with S-1 and CDDP. Although a partial response was achieved at endoscopic examination after 4 cycles, gastric and biliary legions gradually showed tolerance to S-1 and CDDP. We attempted 3 cycles of weekly paclitaxel as second-line. However, paclitaxel was not effective, the patient died of cancer growth 12 months after the first admission. According to combination with IVR and chemotherapy, we treated effectively the patient suffering from far-advanced gastric cancer with peritoneal dissemination and obstructive jaundice.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Combinations; Humans; Jaundice, Obstructive; Male; Neoplasm Seeding; Oxonic Acid; Peritoneal Neoplasms; Radiography, Interventional; Stomach Neoplasms; Tegafur

A 65-year-old female who complained of appetite loss and upper abdominal pain was diagnosed as unresectable advanced gastric cancer with pyloric stenosis and obstructive jaundice by peritoneal and lymph node metastases. After endoscopic balloon dilatation and endoscopic biliary drainage, S-1(80 mg/m(2)/day, days 1-14 with 1 week rest)/pacli- taxel(PTX)(50 mg/m(2)/day, day 1, day 8)combination therapy was done. After one course of the chemotherapy, subjective symptoms were relieved and oral intake was increased. Computed tomography showed that the volume of gastric wall, the size of paraaortic lymph node, and the amount of pleural effusion and ascites were decreased. Grade 1 alopecia, vasculitis and grade 2 neutropenia were observed as adverse reactions to the treatment. S-1/PTX combination therapy after endoscopic intervention was effective in this case of advanced gastric cancer with pyloric stenosis and obstructive jaundice.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biliary Tract Diseases; Catheterization; Drug Combinations; Endoscopes; Female; Humans; Jaundice, Obstructive; Neoplasm Staging; Oxonic Acid; Paclitaxel; Pyloric Stenosis; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 60-year-old man, who had been admitted to another hospital with complaints of constipation, abdominal fullness and appetite loss, was referred to our hospital for further examination and therapy. The patient was diagnosed as advanced gastric cancer (type-3) with multiple liver metastasis and obstructive jaundice. He was treated with combination therapy of paclitaxel and TS-1 (60 mg/m(2)/day of paclitaxel was iv administered on day 1 and 8, and TS-1 of 80 mg/m(2)/day was orally administered for 2 weeks followed by one drug-free week), and showed a remarkable response. However, because of ascites, elevated serum CEA level and resistance in the liver metastasis and gastric region, we attempted two courses of combination therapy with high-dose CPT-11 and cisplatin (70 mg/m(2)/day of CPT-11 was administered iv on day 1 and 15, and 80 mg/m(2)/day of cisplatin on day 1 followed by two drug-free weeks) which showed a remarkable response. Two courses of combination therapy with low-dose CPT-11 and cisplatin (60 mg/m(2)/day of CPT-11 and 30 mg/m(2)/day of cisplatin were administered iv on day 1 and 15 followed by two drug-free weeks) on an outpatient basis. However, the patient showed resistance to the latter combination therapy, increased ascites due to suspicious peritonitis carcinomatosa and obvious re-growth of the metastatic tumors in the liver. He died on May 23, 2006, about ten months after initial diagnosis. We reported a case of successful treatment of combination chemotherapy for advanced gastric cancer with obstructive jaundice due to progressive multiple metastatic tumors in the liver and obtained comparative long-term survival maintaining high quality of life.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Irinotecan; Jaundice, Obstructive; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Survivors; Tegafur

The patient diagnosed as recurrent pancreatic cancer was treated with UFT combined gemcitabine (GEM) chemotherapy. After one cycle of therapy, the anti-tumor effect was progressive disease with obstructive jaundice and enlargement of lymph node metastasis and liver metastasis. The chemotherapy was changed to TS-1 combined GEM chemotherapy and resulted in partial response. Only grade 3 leukopenia was observed as an adverse effect. Some cases may be effectively treated by TS-1 combined chemotherapy after treatment failure of UFT combined GEM chemotherapy. This therapy is simple and possible to continue safely on an ambulatory basis while maintaining quality of life.

Topics: Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Administration Schedule; Drug Combinations; Female; Gemcitabine; Humans; Jaundice, Obstructive; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Pancreatic Neoplasms; Pyridines; Quality of Life; Remission Induction; Tegafur; Uracil

TS-1/CPT-11 combination therapy was carried out in a case of advanced gastric cancer with liver and lymph node metastases and obstructive jaundice after percutaneous transhepatic cholangio drainage (PTCD). Regression of the primary carcinoma and reduction in size of metastases were observed. Grade 1 fatigue and grade 2 neutropenia were noted as adverse reactions to the treatment. TS-1/CPT-11 combination therapy was useful in this case of advanced gastric cancer with liver and lymph node metastases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biliary Tract; Camptothecin; Combined Modality Therapy; Drainage; Drug Administration Schedule; Drug Combinations; Gastroscopy; Humans; Irinotecan; Jaundice, Obstructive; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We administered oral TS-1 alone for locally advanced pancreatic cancer that did not respond to gemcitabine (GEM). A 56-year-old man was admitted to our hospital because of obstructive jaundice due to stage III pancreatic head cancer. We performed chemotherapy using GEM at a dose of 1,000 mg/m(2) after reduction of jaundice by PTCD and stenting. Once the tumor was reduced, enlargement was confirmed after 8 months, and cholangitis appeared due to stent obstruction. After PTCD and stenting (stent in stent) were performed again,we administered oral TS-1 alone at a dose of 100 mg/body. We achieved antitumor activity again using TS-1. It is suggested that TS-1 is a useful second-line agent for pancreatic cancer.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Administration Schedule; Drug Combinations; Gemcitabine; Humans; Jaundice, Obstructive; Male; Oxonic Acid; Pancreatic Neoplasms; Pyridines; Stents; Tegafur