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We report a case of long-term survival after combination chemotherapy and surgical resection of a cancer of unknown primary site[ CUPs]. A septuagenarian female was identified as having high blood levels of carcinoembryonic antigen (CEA) during follow-up monitoring of asthma. Endoscopy and imaging studies including computed tomography (CT) and positron emission tomography (PET)-CT revealed a malignant lymph node adjacent to the abdominal aorta; however, no other lesion was detected. Therefore, we performed CT-guided biopsy and diagnosed the lesion to be a lymph node metastasis of poorly differentiated adenocarcinoma. As we considered this as a systemic disease, the patient received 2 courses of combination chemotherapy with 5-fluorouracil( 5-FU)/cisplatin( CDDP) and achieved a partial response (PR). Later, the patient received S-1 therapy as second-line chemotherapy and S-1/irinotecan( CPT-11) as third-line chemotherapy in an outpatient clinic. However, the tumor continued to grow, and therefore, we decided to perform surgical resection. Histopathological examination of the resected specimen yielded a diagnosis of metastatic adenocarcinoma of the lymph node. The patient has been well without any signs of recurrence for more than 9 years since surgery. As CUPs is generally associated with poor prognosis, this case raises the possibility that combination therapy might improve convalescence.

Only a partial benefit of adjuvant chemotherapy administered after curative resection of colorectal cancer (CRC) metastases has been demonstrated. We report here our experience of 7 cases that were administered FOLFOX4 regimen as adjuvant chemotherapy after a curative resection of liver metastases from CRC. Five patients received 6 cycles of FOLFOX4 after prophylactic hepatic arterial infusion of 5-FU, and 2 remaining patients simply received 8 cycles of FOLFOX4. All patients completed the planned cycles of FOLFOX4 without any dose reduction of oxaliplatin. No patients developed a severe adverse effect greater than grade 2 except for grade 3 neutropenia observed in 4 cases. Although lung metastases occurred in 2 cases 28.1 and 21.3 months after liver resection, respectively, all patients are alive after a median follow up of 23.5 months. Our experience indicates that adjuvant chemotherapy with six to eight cycles of FOLFOX4 regimen is safe with a high dose intensity of oxaliplatin and expected to provide a survival benefit.

The patient was a 75-year-old woman, who was diagnosed with type 3 gastric cancer. Total gastrectomy with D2-#10 lymph node dissection and partial hepatic resection was performed. Histological findings showed it to be stage IV (pT2N1M0P0CY0H1) and AFP producing gastric cancer. After the operation, liver metastasis was found, and RFA, partial hepatic resections, hepatic intra-arterial infusion chemotherapy (5-FU, CDDP), intravenous chemotherapy (docetaxel, paclitaxel, CPT-11) were applied. Although liver metastasis was disappeared, paraaortic lymph node recurrence appeared, and chemotherapy was not effective. Radiation therapy (2 Gy/day, total 50 Gy) for paraaortic lymph node metastasis was performed. The metastatic node underwent complete remission following a radiation therapy. Three years and six months passed since the first operation, and the patient has shown no signs of relapse. Therefore, our case suggests radiation therapy could be an effective treatment modality for the lymph node metastasis in AFP producing gastric cancer.

A 69-year-old man was diagnosed with squamous cell carcinoma of the lung, and underwent right upper lobectomy in October 2000. Histological findings were as follows: 2.5 cm in diameter, moderately differentiated squamous cell carcinoma of the lung, ly0, v0, n0, pT1N0M0, stage IA. No adjuvant therapies were performed. Multiple lung metastases were detected on CT scan in June 2001, and four cycles of chemotherapy with cisplatin+vindesine (day 1: cisplatin 100 mg/body, days 1, 8 and 15: vindesine 3 mg/body) were performed. The metastases were completely disappeared on CT scan in December 2001. No relapse has been seen for six years and two months.