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This case involved an 82-year-old man with a history of diabetes mellitus and myocardial infarction. He was undergoing treatment with 2 oral antiplatelet agents. The patient presented to our hospital for carcinomatous pyloric stenosis caused by type 4 advanced gastric cancer. Although distal gastrectomy was planned, preoperative coronary angiography revealed triple- vessel coronary artery disease. Therefore, surgery was performed under management of intra-aortic balloon pumping (IABP)therapy. The patient's hemodynamics at the time of the operation were stable, and no perioperative cardiovascular complications occurred. However, the patient was not able to start an oral diet because of impaired swallowing function. Although he underwent daily swallowing rehabilitation, he died of aspiration pneumonia 40 days postoperatively. There are many reports of cancer resection under IABP management for patients with severe heart disease. Because the perioperative hemodynamics were stable in all 21 reported cases of digestive malignant tumor resections in Japan, an IABP is suggested to be very effective for patients with severe heart disease. However, early death has also occurred, as in the present case. Close attention to the indications for IABP therapy is needed, especially in elderly patients, in consideration of not only cancer and heart disease but also preoperative activities of daily living.

There is no known recommended chemotherapy after radical surgery for gastric cancer for patients who have non-curative disease. We defined positive peritoneal cytology(CY1), resection margin involvement, pathological peritoneal metastasis (pP1)and pN3b as clinical non-curative factors and administered adjuvant chemotherapy with S-1 and docetaxel(DOC) (80 mg/m2 day 1-14 of S-1 for 2 weeks with 40 mg/m2 of DOC on day 1, every 3 weeks). This regimen lasted for 1 year; however, if chemotherapy could be continued after this period, we used S-1 only. We reported the results of 11 cases who received this treatment., Patients: There were 6 total gastrectomies and 5 distal gastrectomies. Clinical non-curative factors were 5 pP1, 5 pN3b, 3 CY1 and 1 resection margin involvement., Results: At the end of adjuvant therapy there were 6 completions, 4 recurrences, and 1 patient with side effects. The main adverse event of Grade 3 or greater was neutropenia (46%). The recurrence rate was 63.6%. Types of relapse included 6 disseminations and 1 patient with lymph node involvement. One-, 3-, and 5-year survival rates were 100%, 72.7% and 72.7%, respectively, and the RFS was 64.0 months., Conclusion: S-1 and DOC adjuvant chemotherapy produced good results and may serve as a therapy of choice for patients with advanced gastric cancer with non-curative factors after a relatively curative resection.

Case: A 69-year-old man was diagnosed with advanced esophageal cancer(well-differentiated squamous cell carcinoma). Neoadjuvant chemotherapy consisting of nedaplatin and 5-fluorouracil(5-FU)was initiated. After two courses of chemotherapy, the patient was judged to have achieved a clinical complete response. The patient then decided against undergoing surgery and opted instead to continue with the chemotherapy, receiving five courses in total. However, the esophageal cancer recurred, and subtotal esophagectomy was performed in January 2011. Squamous cell carcinoma with an adenocarcinoma component, which consisted of poorly differentiated squamous cell carcinoma and tubular adenocarcinoma cells, was observed at the primary site. Metastasis of the cancer to the liver was detected 2 months after surgery. The subsequent administration of four courses of docetaxel to the patient did not result in any beneficial effects, and the patient developed carcinomatous pleurisy and died of this complication in November 2011. The patient survived for a total of 21 months after starting chemotherapy. In this case, the chemotherapy itself may have resulted in the dedifferentiation of a well differentiated squamous cell carcinoma to result in a poorly differentiated squamous cell carcinoma with an adenocarcinoma component.

We report a curative resection of a case with advanced gastric cancer responding remarkably well to combination chemotherapy of docetaxel, cisplatin and S-1. The patient was a 71-year-old man with gastric cancer of Borrmann type 3 accompanied with N3. Staging laparoscopy revealed peritoneal dissemination. He was administered docetaxel intravenously at 40mg/ m2 on day 1, cisplatin intravenously at 60 mg/m2 on day 1, and S-1 orally at 80 mg/m2 on days 1 to 14. This treatment was repeated every 28 days as one course. According to gastroscope and CT findings, a significant tumor reduction was obtained after 4 courses. After 6 courses, a CT scan revealed partial response of the lymph node metastasis, and the serum CEA value was normalized. Curative total gastrectomy was performed. The histological effect of the primary lesion was judged to be grade 2. Combination chemotherapy of S-1, cisplatin and docetaxel can be effective and feasible for advanced gastric cancer.

Background: In July 2008, cetuximab treatment for unresectable advanced or recurrent colorectal cancer was approved in Japan, but there have been few reports on this therapy in Japan., Purpose: We retrospectively analyzed the efficacy and safety of cetuximab(Cmab)+irinotecan(CPT-11)for unresectable advanced or recurrent colorectal cancer from October 2008 to April 2010 at 5 centers in the Kanagawa region., Patients and Methods: The number of patients enrolled was 38, all of whom were treated after second-line therapy., Results: The RR was 24%. DCR was 68%. TTF was 105 days and OS was 242 days., Conclusion: At 5 centers, Cmab+CPT-11 was an effective and safe treatment after second-line therapy.

A 63-year-old- female was admitted to our hospital complaining of cough. Based on CT, bone centigram and peripheral blood findings, a diagnosis of gastric carcinoma accompanied by bone marrow metastasis was made. As DIC developed following hospital admission, S-1 and docetaxel(DOC)therapy was initiated(daily oral administration of 80 mg/m(2) S-1 for 14 days and DOC at 40 mg/m(2) on day 1, q3w). Recovery from DIC was achieved. S-1 and DOC therapy is considered to be effective for DIC due to bone marrow metastasis of gastric carcinoma. S-1/DOC is thought to be an effective chemotherapy against progressive gastric carcinoma accompanied by disseminated carcinomatosis bone marrow with DIC.

We analyzed the relationship between Onodera's prognostic nutritional index(PNI), classified by serum albumin level, lymphocyte level, and clinicopathological features, in 46 patients with unresectable or recurrent colorectal cancer being treated with chemotherapy.Onodera 's PNI was distributed between 29.7 and 56.1(average 45.4±6.8 ).Onodera 's PNI showed a significant correlation with performance status and surgery before chemotherapy(p=0.002 and 0.002, respectively).Next, all patients were divided into two groups according to their Onodera's PNI values, based on the receiver operator characteristic curve.We found that Onodera's PNI showed a significant correlation with overall survival times(median survival time, 548 days(Onodera's PNI<47.8 ), 902 days(Onodera's PNI≥47.8 ), p=0.00065 ).This PNI could be a prognostic factor and a very useful objective screening tool for assessing the nutritional condition of those with unresectable or recurrent colorectal cancer being treated with chemotherapy.

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.

Diarrhea is a side effect of a 5-fluorouracil (5-FU) anti-cancer drug-induced intestinal mucosal disorder, which sometimes becomes more severe. Blood diamine oxidase (DAO; EC1. 4. 3. 6) activity is reported to be significantly correlated with activity in the small intestinal mucosal tissue, and to be a reliable indicator of small intestinal mucosal integrity and maturity. Here, we investigated whether blood DAO activity can be a biomarker for the gastrointestinal (GI) mucosal disorder caused by 5-FU anti-cancer drugs, both in rats and humans. From results of the rat study, the degree of jejunal mucosal disorder caused by the 5-FU anti-cancer drug was well correlated with a decrease in blood DAO activity. Clinically, 12 out of 28 patients (43%) administered 5-FU anti-cancer drug suffered from diarrhea. The plasma DAO activity within one week of the onset of diarrhea significantly decreased compared with that before the administration. Furthermore, before drug administration, plasma DAO activity in patients suffering from diarrhea was higher than those in patients without diarrhea. Although DAO activity differs by the individual, it is a useful biomarker for estimating the degree of intestinal mucosal disorder, and possibly for estimating manifestations of diarrhea induced by 5-FU anti-cancer drug administration.

The patient was a 74-year-old woman who was diagnosed with advanced breast cancer, T4aN0M0, stage IV. She was placed on chemotherapy of weekly paclitaxel (PTX) (60 mg/m(2) day 1, 8, 15 with 1 course consisting of 28 days). We used dexamethasone (8 mg/body) as premedication for chemotherapy every time. Three courses were performed with no severe adverse reaction. On the fourth course, day 8, she complained of nausea, vomiting, paroxysmal cough and fecal incontinence after a few minutes of dexamethasone administration. Her blood pressure dropped to a minimum of 64 mmHg (systolic pressure) and she soon became drowsy. We diagnosed the anaphylaxis-like reaction for dexamethasone, immediately discontinued dexamethasone infusion, and treated her successfully. Forty minutes after the episode had occurred, she recovered. The few reports on anaphylaxis or anaphylaxis-like reaction to dexamethasone must be taken into account when we use these drugs.

A 69-year-old woman had been treated with insulin for diabetes over the last 8 years. Distal gastrectomy (D2) was undertaken for StageIV stomach cancer. CA19-9 showed marked increases after surgery, but returned to normal after administering S-1. After 12 cycles, the treatment was discontinued due to hepatic disorders, and the clinical course was monitored. Weekly paclitaxel therapy was initiated as second-line therapy when CA19-9 rose again to 467 U/mL. Marked efficacy was noted after completion of one cycle. A total of 23 cycles were conducted. CA19-9 returned to normal, and the patient remains recurrence-free. In the treatment with paclitaxel, pre-treatment with dexamethasone (20 mg each time) is made to prevent hypersensitivity reactions. Since the total dose becomes too large in weekly treatment, however, treatment was initiated at 12 mg in our patient, and the dose was reduced stepwise to 8 mg, 4 mg and 2 mg. At the same time, the dose of insulin at bedtime and before breakfast the following morning was increased in increments of 2 units. This made it possible to maintain good control of blood glucose levels and minimize changes in HbA1c. This experience suggests that the dosage regimen needs refinements in diabetic patients such as a reduction in the dose of steroids and increases in the dose of insulin in long-term treatment.

A 56-year-old man was hospitalized for anemia with appetite loss and body weight loss. He was diagnosed as advanced sigmoid colon cancer which invaded the rectal colon (Ra) and prostate (SI, N 0, P 0, H 0, M (-), cStage IIIa). We administered neoadjuvant chemoradiotherapy for fear of non-curative resection of the sigmoid colon and rectum after colostomy was performed. He was given radiation of the whole pelvis at a total dose of 39 .6 Gy (1.8 Gy x 22 times) combined with chemotherapy using continuous intravenous 5-FU (500 mg x 22 times). Two weeks after the chemoradiation, we administered chemotherapy (FOLFOX 4). Resectable resection was confirmed on Computed Tomography. We were able to conduct a low anterior resection of sigmoid colon and rectum. Postoperative histopathological examination of the resected sigmoid colon and rectum revealed no remnant cancer tissue. Neo-adjuvant chemoradiotherapy is considered to be effective for a study of non-curative resection of rectum.

An 83-year-old male with Stage IV gastric cancer of performance status 1 (PS 1) was treated with fluoropyrimidine (TS-1) since January 2003 in our department. As the patient exhibited decreased renal function due to his age, we set the basic dose at 80% of the recommended dose of 80 mg/body/week. We administered 11 four-week cycles, each with a two-week drug-free washout period, and six two-week cycles, each with a two-week drug free washout period. The first cycle of chemotherapy ameliorated the subjective symptoms; the level of a tumor marker then returned to normal, and the ascites disappeared. The patient's condition was maintained at a favorable PS level without any subjective symptoms for approximately 20 months. In late September 2004, however, an exacerbation of the primary foci was confirmed by routine endoscopic examination. As second-line chemotherapy, we initiated weekly administration of paclitaxel (PTX). Due to the patient's age and high PS level (PS 2) at the time of intervention, we utilized a reduced dose of 70 mg/body/dose. After a short premedication period, the patient was administered PTX intravenously for one hour once a week for three weeks, then given a one-week drug-free washout period (one cycle). After the first cycle of PTX administration, all subjective symptoms disappeared, the PS level returned to zero,and the patient was discharged. In total, four cycles of the PTX regimen were given. Throughout the treatment period, we did not observe any significant adverse events (grade 2 or higher). Treatment achieved a favorable PS level. To design an effective chemotherapy regimen for elderly patients, it is important to establish an effective dose and dosing method based on the patient's chronologic age and a thorough evaluation of the patient's systemic conditions, including the PS level.

The patient was a 74-year-old female. Type 1 undifferentiated carcinoma (non-small cell type) was detected in the middle of the thoracic esophagus in August 1999. Although the lesion was diagnosed as T2, N0, and Stage II, the patient was judged to be a poor risk, inoperable case because of a complex past history of renal and respiratory dysfunctions, and dysbasia. Intravenous administration of nedaplatin at 15.8 mg/m2 and 5-FU 590.6 mg/m2 were carried out for 5 consecutive days as chemotherapy. The second cycle of chemotherapy was performed with nedaplatin reduced to 11.8 mg/m2 on the basis of the adverse reactions observed after the first cycle, and PR was attained. As for radiotherapy, additional extracorporeal irradiation was judged to be too dangerous from her history, so endoesophageal brachytherapy alone was added, and CR was obtained. The patient has maintained a CR for more than 2 years after discharge. In this poor risk case with a highly malignant undifferentiated carcinoma, an "individualization strategy" was effective.

A 63-year-old male with advanced esophageal cancer was admitted to our hospital. He received neoadjuvant chemotherapy with intravenous cisplatin and fluorouracil (5-FU), and underwent resection of the esophagus and placement of a gastric tube. Two months later, multiple metastases appeared in the right lobe of the liver. Intermittent arterial infusion chemotherapy with cisplatin and 5-FU were performed. To selectively infuse the drugs into the right hepatic artery, the left hepatic artery was embolized. Treatment had a marked effect in the right lobe, but new lesions were subsequently discovered in the left lobe. The patient died of pleuritis 27 days after the end of cisplatin infusion and 12 months after surgery. In total, 465 mg of cisplatin and 20 mg of nedaplatin were administered. At autopsy, tissue samples were collected to measure the platinum concentration. The result showed the highest value to be in the right lobe, 4.8 times as high as that in the left lobe. It is suggested that the concentration of platinum in tissue is correlated with the anticancer effect of cisplatin to the tissue, despite of the traditional view that the tissue concentration and the effect are not related.

Unlabelled: Gastric cancers that produce alpha feto protein (AFP) usually have a poor prognosis. We report an AFP-producing gastric cancer that showed a partial response to low-dose CPT-11 and low-dose cisplatin combination chemotherapy. AFP-producing gastric cancers successfully treated with chemotherapy have been reported, but to our knowledge this is the first report of successful treatment with low-dose CPT-11 and low-dose cisplatin combination chemotherapy., Case: A 49 year-old woman who had gastric cardiac cancer with esophageal invasion was admitted to our institution. Since AFP-positive cells were demonstrated immunohistochemically in biopsy specimens and levels of AFP in serum were high, AFP-producing cancer was diagnosed. Because of metastasis to Virchow's node and the paraaortic lymph nodes, the tumor was considered unresectable. The patient's poor general condition necessitated chemotherapy with low toxicity and high efficacy. She was treated with low-dose CPT-11 and low-dose cisplatin combination chemotherapy. After two cycles of this treatment, the tumor volume and the serum levels of AFP had decreased markedly. The only side effect of the treatment was leukopenia.

The effects of intra arterial infusion therapy using CDDP for patients with thoracic esophageal cancer were investigated. From June 1984 to December 1988, 25 of 146 resected patients with thoracic esophageal cancer underwent preoperative therapy in our institute. All of these patients it was suspected preoperatively that their chief lesion had invaded to the aorta, trachea or main bronchi. Preoperative radio-chemotherapy with intra arterial infusion therapy was given to 10 of 25 patients (A group), and without intra arterial infusion therapy to 15 of 25 patients (B group). CDDP 75 mg was infused into the proper esophageal artery. In A group, 7 of 10 (70%) showed moderately or marked effects in histologic study, although in B group, only 4 of 15 (27%) did so. As for long-term results, the 2-year survival rates were 50% in A group and 13% in B group (Kaplan-Meier method. Preoperative intra arterial infusion therapy using CDDP with radio-chemotherapy showed markedly better effects in histologic study and survival rates than preoperative radio-chemotherapy without intra arterial infusion therapy. We consider that this therapy is very useful for controlling the local lesion in advanced esophageal cancer.