s-1-(combination) and Neoplasm-Seeding

Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a useful and relatively safe tool for the diagnosis and staging of pancreatic cancer. However, there have recently been several reports of tumor seeding after EUS-FNA of adenocarcinomas. A 78-year-old man was admitted to our hospital due to upper gastric pain. Examinations revealed a 20 mm mass in the pancreatic body, for which EUS-FNA was performed. The cytology of the lesion was adenocarcinoma, and the stage of the cancer was T3N0M0. The patient underwent surgery with curative intent, followed by adjuvant chemotherapy with S-1. An enlarging gastric submucosal tumor was found on gastroscopy at 28 mo after surgery accompanied by a rising level of CA19-9. Biopsy result was adenocarcinoma, consistent with a pancreatic primary tumor. Tumor seeding after EUS-FNA was strongly suspected. The patient underwent surgical resection of the gastric tumor with curative intent. The pathological result of the resected gastric specimen was adenocarcinoma with a perfectly matched mucin special stain result with the previously resected pancreatic cancer. This is the first case report of tumor seeding after EUS-FNA which was surgically resected and inspected pathologically.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Biopsy; Chemotherapy, Adjuvant; Drug Combinations; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Gastrectomy; Humans; Male; Neoplasm Seeding; Neoplasm Staging; Oxonic Acid; Pancreatectomy; Pancreatic Neoplasms; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

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 62-year-old man reported to our hospital with serious complaints of abdominal pain, vomiting, and weight loss. An endoscopic examination detected a type 2 tumor of the descending limb of the duodenum. With a diagnosis of adenocarcinoma based on the biopsy finding, the patient was subjected to surgery. Laparotomy revealed the presence of a duodenal tumor disseminating to the omentum at the site where the transverse colon is attached. Pancreatoduodenectomy and partial resection of the transverse colon were carried out. CT conducted 6 months after surgery did not show any signs of tumor recurrence; but one year later, extensive tumor dissemination was noted on the hepatic surface. Upon consultation with the patient, a regimen of 80 mg/day of TS-1 given for 4 weeks followed by 2 weeks of a drug-free period was initiated. Six months later, the growth of tumor became arrested, improving his QOL. Nine months later, the tumor growth was progressive and the patient died two years after operation. The patient could gain long-term survival after operation. The TS-1 regimen applied in the present case may constitute a therapeutic strategy to be considered for similar conditions in future.

Topics: Antimetabolites, Antineoplastic; Colectomy; Drug Combinations; Duodenal Neoplasms; Humans; Liver; Male; Middle Aged; Neoplasm Seeding; Omentum; Oxonic Acid; Pancreaticoduodenectomy; Pyridines; Tegafur

In vitro chemosensitivity test using a collagen-gel method was done on 165 primary gastric cancers. All of 5-FU, CBDCA, CDDP and docetaxel showed a high sensitivity. The effects of per oral (po) administration of TS-1, a combination of po TS-1 and intraperitoneal (ip) administration of CDDP, ip 5-FU and ip docetaxel, were evaluated in athymic mice bearing peritoneal dissemination of a gastric cancer cell line (MKN-45-P that shows a high rate of metastasis to the peritoneal cavity of nude mice). Nude mice were inoculated by ip with 10(7) MKN-45-P cells. No survival benefit was obtained after po administration of TS-1 (12 mg/kg) alone or ip CDDP alone. However, a combination of po TS-1 (8 mg/kg x 10 days, from day 3) and ip CDDP (3.5 mg/kg, day 6 and 13) showed a significant survival improvement than that of po TS-1 or ip CDDP treatment alone. ip administration of 30 mg/kg (3 times/week x 3 weeks) or 15 mg/kg (6 times/week x 3 weeks) of 5-FU significantly improved the survival of mice bearing MKN-45-P. 5-FU concentration of ascites after ip administration of 30 mg/kg of 5-FU was 600-fold higher than po administration of 12 mg/kg of TS-1 at peak level. ip injections of docetaxel of 8 mg/kg, and 2 mg/kg improved the survival of 4 and 1 mice, respectively, and they were tumor-free on day 90. Survival of mice treated with ip injection of CBDCA (100 mg/kg, on day 3, or 50 mg/ kg on day 3 and 10) was significantly better than the control group. These results suggest the potential of po TS-1 + ip CDDP, ip 5-FU, ip docetaxel and ip CBDCA administration for the treatment of peritoneal dissemination of gastric cancer.

Topics: Animals; Antimetabolites, Antineoplastic; Antineoplastic Agents; Carboplatin; Cisplatin; Docetaxel; Drug Combinations; Drug Screening Assays, Antitumor; Fluorouracil; Infusions, Parenteral; Mice; Mice, Nude; Neoplasm Seeding; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Stomach Neoplasms; Taxoids; Tegafur

A patient is a 35-year-old man. By a diagnosis of descending colon cancer, descending colon ablative operation and D1 lymph node dissection were performed on April 22, 2004. It was P3H0N1SE, Stage IV in perioperative findings. Abdominal CT showed peritoneal dissemination of 1.7 cm at the right under the abdominal wall wound and 1.2 cm in the rectovesical pouch on May 18, 2004. CPT-11 + TS-1 combination chemotherapy was started on June 22nd. In the five weeks of the combination chemotherapy, continuous infusion of CPT-11 (150 mg/body day 1 and 15) was twice administered, and oral administration of TS-1 (120 mg/body/day) was given for 3 weeks (day 1-21). Peritoneal dissemination disappeared after the two-course end, and we judged it as CR. Furthermore, we were certain that we obtained CR after the three course end. The adverse event was only neutropenia of grade 1. The fourth course was not administered, but recurrence has not been observed. Abdominal CT showed no recurrence on March 3, 2005 since the combination chemotherapy ended 6 months ago.

Topics: Administration, Oral; Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colonic Neoplasms; Drug Combinations; Humans; Infusions, Intravenous; Irinotecan; Male; Neoplasm Seeding; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Tegafur