s-1-(combination) and Peritonitis

A 68-year-old woman was diagnosed with advanced gastric cancer with a type 3 deep ulcer of the middle stomach by endoscopy. An abdominal computed tomography scan revealed multiple lymph node metastases and peritoneal disseminations. The clinical stage was determined to be T4a(SE), N2P1M1(PER), H0 and stage IV . A gastrectomy was scheduled after 2 courses of S-1 plus oxaliplatin(SOX)with curative intent. On day 3 after initiatingSOX therapy, the patient complained of severe abdominal pain. Because the abdominal CT scan showed intra-abdominal free air and a defect in the gastric wall, we performed an emergency total gastrectomy. The defect in the gastric wall was about 1 cm in diameter and was located in the anterior wall of the lower body, consistent with the center of the tumor. The operative findings suggested that the perforation was caused by chemotherapy-induced necrosis of gastric cancer cells. The patient was discharged 16 days after surgery and received post-operative chemotherapy. Our findings suggest that the risk of gastric perforation should be considered when administeringchemotherapy to patients with advanced gastric cancer and a deep ulcer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritonitis; Stomach Diseases; Stomach Neoplasms; Tegafur; Time Factors; Treatment Outcome

Carcinomatous peritonitis may develop after operation for gastric cancer. As ascites are difficult to control, especially for gastric cancer postoperative carcinomatous peritonitis, many cases are difficult to treat. The present case was a female patient with carcinomatous peritonitis that occurred 2 years post-surgery. Administration of docetaxel (DOC)and S-1 combination therapy achieved a complete response. However, she had a relapse of carcinomatous peritonitis 3 years post-surgery. She underwent bypass operation, followed by DOC and S-1 combination therapy again. She achieved a good quality of life for more than two years. As side effects in patients worsen with the repeated exposure to chemotherapy, continuing the same treatment is difficult. Therefore, we changed the therapy method to irinotecan(CPT-11)/cisplatin(CDDP)therapy, weekly paclitaxel(PTX)and methotrexate(MTX)/5-fluorouracil(5-FU)therapy, and bypass operation when necessary. Rapid progression of her condition was sequentially suppressed, allowing her to continue her everyday life. Overall, this treatment method provided survival benefits of approximately four years following the recurrence of carcinomatous peritonitis.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Combined Modality Therapy; Drug Combinations; Fatal Outcome; Female; Fluorouracil; Gastrectomy; Humans; Irinotecan; Methotrexate; Middle Aged; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Peritonitis; Stomach Neoplasms; Tegafur; Time Factors

We report two cases of advanced gastric cancer. The first was a 77-year-old man who had experienced distal gastrectomy about 35 years ago. He complained of abdominal bloating, and a gastrointestinal scope showed that he had advanced gastric cancer. CT scan revealed massive ascites. Dissemination of the peritoneum was suspected, and chemotherapy using S-1 (80mg/m², biweekly)plus paclitaxel (50mg/m², on days 1 and 8) was selected, He had no major side effects and the ascites disappeared. He was able to receive 18 courses on an outpatient basis. The second case was a 79-year-old man who had total gastrectomy performed 1 year ago. Invasion to the diaphragm and lymph node metastasis were detected. We selected S-1 (80 mg/m²)as adjuvant chemotherapy but that caused severe fatigue. Eventually he refused the drug. Six month later, he had abdominal bloating and CT scan revealed that he had massive ascites. UFT-E (1. 5 g/body) was administered and paclitaxe (l 50 mg/m²) was added. The ascites disappeared and he has had a stable life. DIF (S-1, UFT) plus paclitaxel is considered to be a useful chemotherapy combination against advanced gastric cancer that has peritoneal dissemination or ascites, even for older patients.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Ascites; Dihydrouracil Dehydrogenase (NADP); Drug Combinations; Humans; Male; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Peritonitis; Quality of Life; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

We report two cases of advanced gastric cancer successfully treated with combination S-1 and docetaxel (DOC) therapy. Case 1: A 43-year-old woman underwent radical total gastrectomy for advanced type 4 gastric cancer one and a half years ago. She was diagnosed as peritonitis carcinomatosa with much ascites, so the following combination chemotherapy was started. Case 2: A 53-year-old man underwent palliative gastrectomy for advanced type 3 gastric cancer with multiple lymph node metastases involving Virchow's metastases. After surgery, he received the following combination chemotherapy: DOC at the starting dose of 40 mg/m2 by iv infusion over 1 hour on day 1 and S-1 at the full dose of 80 mg/m2 daily for two weeks every three weeks. After administration of this combination therapy, the Case 1 gastric cancer with much ascites and the Case 2 gastric cancer with multiple lymph nodes metastases had entirely disappeared. Thereafter the 2 cases received therapy with S-1 alone. No recurrence in Case 1 has been seen with S-1 chemotherapy. Case 2 revealed a few lymph node swellings in the abdominal cavity, so he is undergoing combination therapy of DOC and S-1. The combination DOC and S-1 show a high degree of safety and can be a new tool for the management of advanced gastric cancer with peritoneal dissemination and Virchow's metastases.

Topics: Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Ascites; Docetaxel; Drug Combinations; Female; Gastrectomy; Humans; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Peritonitis; Stomach Neoplasms; Taxoids; Tegafur

The present patient was a 66-year-old male with sudden upper abdominal pain. The patient was diagnosed with perforated peritonitis at another hospital, and an emergency laparotomy was performed to confirm upper gastrointestinal tract perforation. A perforated lesion of approximately 1 cm in diameter was found on the anterior wall at the gastric upper body. The area surrounding the lesion was tumor-like. Malignancy was suspected; however, considering the patient's general status, greater omentum grafts were opted for. The patient was diagnosed with typeIII gastric cancer by gastroendoscopy postoperatively. A second surgery was performed after one month, but during laparotomy peritonitis carcinomatosa and metastastic nodules were found around the abdominal aorta. S-1/CDDP therapy was started on the 14th day after second surgery. After three courses of treatment, the tumor was found to have smoothened, wall consolidation was improved, and a third surgery was performed. During laparotomy, there were no other medical findings that raised suspicion of peritoneal dissemination or liver metastasis. It was concluded that radical surgery was possible, and distal gastrectomy(D2+a)was performed. Pathological examination revealed that poorly differentiated adenocarcinoma. The lower and muscle layers of the serous membrane and nodules around the abdominal aorta showed the disappearance of cancer cells. But the peritonitis carcinomatosa during second surgery had pathologically / changed the fibrosis tissue at the third surgery.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Gastroscopy; Humans; Male; Oxonic Acid; Peritoneal Neoplasms; Peritonitis; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 59-year-old man diagnosed as gastric cancer with peritonitis carcinomatosa was treated with paclitaxel and TS-1; 60 mg/m(2)/day of paclitaxel was given on days 1 and 8, and 60-80 mg/m(2)/day of TS-1 was given for 2 weeks. Six courses of combination therapy were administered, and the ascites disappeared completely. Because multiple bone metastases occurred, we attempted combination therapy with cisplatin and irinotecan hydrochloride; 50 or 30 mg/m(2)/day of cisplatin was given on day 1 or day 15, and 70 mg/m(2)/day of irinotecam hydrochloride was given on days 1 and 15. The patient achieved a remarkable response, however, intrameningeal dissemination occurred and he died from rapidly progressive meningitis carcinomatosa.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Drug Combinations; Fatal Outcome; Humans; Male; Meningitis; Middle Aged; Oxonic Acid; Paclitaxel; Peritonitis; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Two unresectable advanced gastric cancer cases with peritoneal metastases were successfully treated by the combination therapy of S-1 and paclitaxel. S-1 (1.25m(2): 80 mg/day, 1.25m(2)-1.50m(2)<:120 mg/day) was administered orally for 14 consecutive days followed by 14 days rest and a 2-hour infusion of paclitaxel (50 mg/m(2)) was administered on day 1 and 15 of each course. Treatment was repeated every 4 weeks unless disease progression or severe adverse effects were observed. Case 1: 65-year-old male (performance status: PS 3) with type 1 gastric cancer with malignant ascites. Case 2: 66-year-old male (PS3) with peritoneal metastases whose primary gastric lesion was surgically resected. Partial response was obtained in the former and complete response in the latter. Combination therapy of S-1 and paclitaxel can be highly recommended for patients with inoperable gastric cancer with poor PS.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Drug Administration Schedule; Drug Combinations; Humans; Male; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Peritonitis; Stomach Neoplasms; Tegafur

The prognosis for advanced pancreatic cancer with peritoneal dissemination is extremely poor, and no effective standard therapy has been established. We present a case of a very old patient whose QOL improved shortly after administration of only S-1 to treat advanced pancreatic cancer with peritoneal dissemination. A 85-year-old man presented to our hospital with anorexia and loss of weight. CT scanning showed severe ascites and a low-density area 2 cm wide at the tail of the pancreas. Ascitic cytology revealed adenocarcinoma and carcinomatous peritonitis due to pancreatic cancer. Considering his general condition due to old age, the regimen for oral S-1 (80 mg/body/day) was set at 4 consecutive weeks of administration followed by a 2-week rest period. His abdominal circumference decreased and his appetite improved by 14 days following commencement of the therapy. The blood examination one month following commencement showed a significant decrease in the tumor marker. There was no adverse drug reaction. Six months later CT scanning showed that the ascites had disappeared and that the low-density area at the tail of the pancreas had become less obvious. The tumor marker and biochemical parameters were within standard ranges. Twelve months since the therapy began: there still has been no adverse drug reaction and his QOL has been good. He is receiving the therapy as an outpatient. This case suggests that S-1 is a safe and effective drug for very elderly patients.

Topics: Adenocarcinoma; Administration, Oral; Aged, 80 and over; Antimetabolites, Antineoplastic; Drug Combinations; Humans; Male; Oxonic Acid; Pancreatic Neoplasms; Peritoneum; Peritonitis; Quality of Life; 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

Goblet cell carcinoid of the appendix is a rare neoplasm and clinically tends to take a malignant course. Most cases are young and early stage, and the surgical strategy is available. But appropriate chemotherapy for inoperable cases with peritoneal dissemination is not established. A 77-year-old woman with a past history of appendectomy was admitted to our hospital complaining of abdominal fullness. Abdominal computed tomography showed massive ascites and slight contrast enhancement of appendix. A tumor was found by colonoscopic examination at the orifice of vermiform and was diagnosed pathologically as goblet cell carcinoid of the appendix. Laparoscopy showed multiple peritoneal dissemination. We performed intraperitoneal paclitaxel(PTX)administration at 70 mg/m(2) week without any resection of the tumor. Ascites were reduced immediately, but drug-induced interstitial pneumonia occurred due to PTX. After steroid therapy, we switched to systemic S-1 therapy. For about one year, her tumor was controlled but became worse thirteen months after diagnosis and died. It is thought that intraabdominal paclitaxel administration and systemic S-1 therapy can be one of appropriate forms of chemotherapy for inoperable peritoneal carcinomatosis from goblet cell carcinoid of appendix.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoid Tumor; Colonic Neoplasms; Colonoscopy; Drug Combinations; Female; Humans; Injections, Intraperitoneal; Oxonic Acid; Paclitaxel; Peritonitis; Tegafur; Tomography, X-Ray Computed; Treatment Failure

A 57-year-old woman with a pancreatic body tumor was admitted to our hospital. She was diagnosed with unresectable advanced pancreatic cancer (stage IVb) due to portal vein invasion, arterial invasion, retro peritoneal invasion and lymphnode metastases, so radiation therapy (50 Gy/25 Fr) with concurrent arterial infusion of gemcitabine (GEM) was carried out. After the chemo-radiation therapy, her arterial infusion treatment of GEM was continued in our outpatient clinic for 3 months until she was complicated with ascites due to peritoneal dissemination. Peritonitis carcinomatosa was controlled by S-1 oral administration with intraperitoneal infusion of MMC and CDDP. For 18 months after discharge, she has maintained good quality of life without any adverse effects by a continuous dose of S-1 at our outpatient clinic.

Topics: Antimetabolites, Antineoplastic; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Infusions, Intra-Arterial; Lymphatic Metastasis; Middle Aged; Neoplasm Invasiveness; Oxonic Acid; Pancreatic Neoplasms; Peritoneal Cavity; Peritonitis; Quality of Life; 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

A 69-year-old female patient underwent total gastrectomy with a D2 lymph node dissection. Her final findings were of pT2, pN0, sP0, sH0, sM0 and Stage IB. After thirty-five months from the operation, peritoneal recurrence with ascites, bilateral hydronephrosis and stenosis of colon was found. TS-1 (80 mg/day/body) was administered for four weeks followed by a 2-week rest after DJ stents were inserted into bilateral ureters. At the end of two courses of TS-1, ascites disappeared and the decrease of tumor marker was observed. During the seventh course, symptoms such as abdominal fullness and ascites became worse. She underwent a weekly administration of paclitaxel (90 mg/body) as a second-line chemotherapy. This regimen was continued for three weeks followed by a 1-week rest. After four courses of paclitaxel, ascites disappeared and the tumor marker was gradually reduced. However, multiple bone metastases were found during the eighth course, and she died about two years after the recurrence. The toxic events were mucositis (grade 1) in TS-1, and alopecia (grade 2) and leukopenia (grade 1) in paclitaxel. No major adverse effects were observed. Although the prognosis of recurrent gastric cancer with peritoneal dissemination was extremely poor, this case might suggest a possibility that intensive therapies are useful in maintaining the quality of life and improving survival.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Combined Modality Therapy; Drug Combinations; Female; Gastrectomy; Humans; Hydronephrosis; Lymph Node Excision; Neoplasm Recurrence, Local; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Peritonitis; Pyridines; Stents; Stomach Neoplasms; Tegafur

A 62-year-old man with carcinomatous ascites more than 5 years after early gastric cancer operation was admitted to our hospital because of suspected pancreatic cancer, and was diagnosed with a relapse of the gastric cancer. TS-1 was administered at a dose of 120 mg/day. At the end of 1 course a partial response of a decrease of tumor markers and ascites and improvement of QOL was achieved, and the patient was followed in the outpatient clinic. The current case suggests that TS-1 may have a potent therapeutic efficacy in cases of gastric cancer relapse with carcinomatous ascites.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Ascites; Drug Administration Schedule; Drug Combinations; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Peritonitis; Pyridines; Stomach Neoplasms; 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

Medical treatment with TS-1 was performed in patients with gastric cancer with peritonitis carcinomatosa. The median survival time for the patients who underwent distal or total gastrectomy was 14.0 months, and that for the patients who underwent exploratory laparotomy was 9.3 months. Compared with other medical care, the anti-cancer drug TS-1 enabled prolonged survival time and shortened hospitalization. Since TS-1 had few side effects, it was useful to patients suffering from gastric cancer with peritonitis carcinomatosa.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Length of Stay; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Peritonitis; Pyridines; Stomach Neoplasms; Survival Analysis; Tegafur