[A Hematogenous Metastasis from Scirrhous Gastric Cancer to the Uterus]

A 46-year-old woman was referred to our hospital because of nausea. Endoscopy revealed scirrhous gastric cancer, and abdominalcomputed tomography revealed peritonealdissemination. She was diagnosed with Stage IV gastric cancer and treated with S-1 plus CDDP combination chemotherapy. After 4 courses of chemotherapy, the primary tumor and peritoneal dissemination were considered clinically stable, but the uterus grew rapidly. She was diagnosed as having uterine metastasis based on cervicaland endometrialsmear class V cytology. As the chemotherapy was not effective for the uterine lesions, totalhysterectomy and bilateralsal pingo-oophorectomy were performed. Histological findings showed a poorly differentiated cancer with vascular emboli. Uterine metastases are an important consideration in women with scirrhous gastric cancer, and we recommend palliative hysterectomy for chemotherapy-resistant metastases if the primary tumor and other metastases are controlled.

[A case report of scirrhous gastric cancer with peritoneal dissemination treated effectively with various chemotherapy regimens after laparoscopic distal subtotal gastrectomy]

We report a 44-year-old male patient who was diagnosed with scirrhous gastric cancer with peritoneal dissemination using laparoscopy. The patient underwent a non-curative resection with laparoscopic distal subtotal gastrectomy. In addition, we placed a port into the patient's abdomen for intraperitoneal chemotherapy administration. Postoperatively, we administered capecitabine (per os)+ paclitaxel (intraperitoneally) and, after 2 cycles, the oral anticancer agent 5-FU was given. The patient died of peritonitis carcinomatosa 25 months after the operation. The combined therapies contributed to improve the quality of life, specifically oral ingestion, for 2 years.

[A case of stage IV breast cancer successfully treated over 1 year with eribulin as fourth-line systemic chemotherapy]

A 59-year-old woman with an exudative, reddish bilateral breast tumor and dyspnea visited our hospital. She was diagnosed as having scirrhous carcinoma with metastasis to the liver and pleural effusion, designated as Stage IV, hormone receptor positive, and human epidermal growth factor receptor-2 (HER2) negative. Systemic chemotherapy (3 regimens) and endocrine therapy (5 regimens) were administered for a total of 5 years 7 months. Eribulin was administered as fourth line systemic chemotherapy. The pleural effusion reduced and dyspnea improved. Her status was maintained for 1 year 3 months. This case suggests that eribulin may provide long-term survival and maintenance of quality of life (QOL) in metastatic breast cancer patients.

[Synchronous male bladder cancer and breast cancer - a case report]

A 74-year-old man complained of blood in his urine over a 1-week period beginning in early October 2013, and was examined in the urology department of our hospital. A thorough examination revealed bladder cancer, and surgery was planned after two cycles of preoperative gemcitabine plus cisplatin chemotherapy. A chest computed tomography (CT) performed to evaluate the response to chemotherapy revealed a mass in the right breast. The patient had previously complained about the same site, and mammography and ultrasonography had suggested the possibility of a malignant mammary gland tumor. The results of aspiration cytology were Class V, and based on that finding, a diagnosis of cancer of the right breast was made. In February 2014, we performed a mastectomy, while preserving the pectoral muscles, along with sentinel node biopsy, total cystectomy, urethrectomy, pelvic lymph node dissection, and ureteroileal anastomosis. The histopathological diagnosis of the right breast tumor was invasive ductal carcinoma[scirrhous carcinoma, ly (+), v (-), g (+), f (+), s (+), nuclear grade 1=atypia 2+mitosis 1, EIC (-), ICT (-), NCAT (-)]. A micrometastatic tumor measuring approximately 1mm was observed in the sentinel lymph node. The breast disease was classified as pT1N1mi(sn)M0, Stage IIA, and the tumor was ER (+), PgR (+), HER2/neu (2+), and FISH (-). The bladder cancer was diagnosed as urothelial carcinoma, non-papillary, invasive G2>G3, pT2a; no pelvic lymph node metastases were detected, and it was classified as pT2aN0M0, Stage II. Synchronous male breast cancer and bladder cancer is a very rare condition, and we report the case with a review of the literature.

[A case of acute appendicitis which occurred during chemotherapy for breast cancer]

The patient was a 66-year-old woman with left breast cancer who underwent left segmental mastectomy with sentinel lymph node biopsy. The histopathological diagnosis was estrogen receptor-positive (ER+), progesterone receptor-positive( PgR+), human epidermal growth factor receptor-2-equivocal( HER2()2+)( with no HER2 gene amplification by fluorescence in-situ hybridization analysis) invasive ductal carcinoma (scirrhous carcinoma) with Ki-67 expression of less than 10% (pathological T1c, N0, M0, stage I). The patient requested chemotherapy, and 4 cycles of docetaxel plus cyclophosphamide (TC) were scheduled. Fever and epigastric pain developed on day 13 of cycle 2. On day 22, the patient was examined before the third cycle of TC, and right lower abdominal pain was reported. Computed tomography revealed appendicitis and an intraperitoneal abscess. She was admitted to the hospital and underwent partial ileocecal resection. The patient was discharged on the 12th postoperative day with no further complications. Acute abdomen during chemotherapy for malignant tumors has been reported sporadically in patients with leukemia. A diagnosis of acute abdomen in patients undergoing cancer treatment requires careful assessment of gastrointestinal symptoms such as nausea and vomiting during chemotherapy, fever associated with granulocytopenia, and findings indicative of local inflammation. The patient in this case recovered uneventfully because imaging studies and surgery were performed promptly after presentation.

[A complete response of scirrhous gastric carcinoma treated with trastuzumab combination therapy]

Trastuzumab is the first molecular-target medicine for gastric cancer in acknowledgment of the effectiveness and safety in a randomized controlled trial for the HER2-positive gastric cancer. The HER2-positive rate of gastric cancer tends to be high for a well-differentiated adenocarcinoma. We report a case of HER2-positive scirrhous gastric carcinoma we treated, for whom a complete response was obtained by trastuzumab combination therapy. He was a 62-year-old man. In April, 2006, he was diagnosed with metastatic scirrhous gastric carcinoma(mainly poorly-differentiated adenocarcinoma). We become clear with HER2 strong positive in a pathology tissue and started capecitabine+cisplatin+trastuzumab therapy. We confirmed the disappearance of the lesion at the 10th cycle and judged it to be a complete response. The HER2 of advanced gastric cancer must be screened immediately without asking patients for their background or their clinical and pathologic features.

[A case of metastatic breast cancer with bilateral hydronephrosis effectively treated with capecitabine]

A 54-year-old female was diagnosed with invasive ductal carcinoma (pT3N1M0, Stage IIIA, estrogen receptor positive [ER (+)], progesterone receptor positive [PgR (+)], human epidermal growth factor receptor type 2 [HER2] score 0) and was treated by preoperative chemotherapy with weekly paclitaxel followed by 5-fluorouracil(5-FU) plus epirubicin plus cyclophosphamide regimen(FEC). Partial mastectomy with axillary dissection was performed. The pathological examination disclosed that the tumor was scirrhous carcinoma, and a pathological partial response was achieved by chemotherapy. Multiple bone metastases were detected 18 months after the surgery during treatment with letrozole as adjuvant therapy. Retroperitoneal metastases with hydronephrosis and a lung metastasis were detected 28 months after the surgery, even though exemestane and zoledronate were administrated after detection of the bone metastases. Chemotherapy with capecitabine was started and she recovered from hydronephrosis 4 months after the start of treatment. After 32 months from the first treatment with capecitabine, the patient is presently alive without hydronephrosis due to continued chemotherapy.

Polymeric micelles incorporating (1,2-diaminocyclohexane)platinum (II) suppress the growth of orthotopic scirrhous gastric tumors and their lymph node metastasis

Nano-scaled drug carriers have great potential for the treatment of solid tumors. Nevertheless, hypovascularity and fibrosis in some types of solid tumors have been demonstrated to reduce the penetration and accumulation of nano-scaled drug carriers. Diffuse-type scirrhous gastric cancers present such characteristics as well as frequent metastasis to the lymph nodes; therefore, it remains a great challenge to eradicate scirrhous gastric cancers based on the drug targeting using nanocarriers. Herein, we demonstrated that polymeric micelles with 30-nm diameter incorporating (1,2-diaminocyclohexane)platinum(II) (DACHPt), the parent complex of the anticancer drug oxaliplatin, efficiently penetrated and accumulated in an orthotopic scirrhous gastric cancer model, leading to the inhibition of the tumor growth. Moreover, the elevated localization of systemically injected DACHPt-loaded micelles in metastastic lymph nodes reduced the metastatic tumor growth. These results suggest DACHPt-loaded micelles as a promising nanocarrier for the treatment of scirrhous gastric cancers and their lymphatic metastases.

[A case report of scirrhous gastric carcinoma diagnosed by staging laparoscopy]

The case is a sixty-something man with a complication of epigastric abdominal pain. X-ray and endoscopic examination of upper gastrointestinal tract showed a rigidity of the gastric wall and the presence of giant folds on gastric body and fornix. Scirrhous type of gastric cancer was suspected and gastric forceps biopsy was performed at many points under the retreated endoscopic examinations. However, the histologic findings revealed no malignant features. We performed staging laparoscopy, and by peritoneal washing cytology and biopsy of a nodule of abdominal wall, he was diagnosed with advanced gastric carcinoma with peritoneal dissemination. In conclusion, staging laparoscopy is one of the useful methods for diagnosis and determination of the management of scirrhous type gastric carcinoma.

[Two cases of HER2-positive advanced or metastatic breast cancer, responding to lapatinib and capecitabine]

The first patient was a 59-year-old woman who was diagnosed with invasive scirrhous carcinoma. The tumor was estrogen receptor (ER)-positive, progesterone receptor (PgR)-positive, and human epidermal growth factor receptor 2 (HER2)-positive. The patient was treated with adjuvant chemotherapy and endocrine therapy after surgery. Liver metastases developed 5 years after surgery. She was treated with trastuzumab combined with vinorelbine, paclitaxel, or docetaxel. The liver metastases increased in size, 9 years after surgery, and she was treated with lapatinib and capecitabine. The efficacy of chemotherapy was judged as a partial response. The second patient was a 74-year-old woman who was diagnosed with invasive ductal carcinoma in 2005. The tumor was ER-negative, PgR-positive, and HER2-positive; she was treated with trastuzumab and paclitaxel. She developed dyspnea in January 2010. Chest radiograph showed increased lung metastases and left pleural effusion; she was treated with lapatinib and capecitabine. Lung metastases decreased and left pleural effusion disappeared after the first cycle of chemotherapy. The efficacy of chemotherapy was judged as a partial response.

[A case of scirrhous gastric carcinoma with peritoneal dissemination which was treated by curative gastrectomy after S-1/CDDP chemotherapy]

The present patient was a 53-year-old female diagnosed as gastric cancer with peritoneal dissemination by staging laparoscopy. She was treated with chemotherapy using S-1 (80 mg/body/day) and CDDP (80 mg/body/day, day 8) administered for 3 weeks followed by a drug-free 2 weeks, in five-week courses. Stable disease (SD) was obtained after six courses, and then she underwent second-staging laparoscopy. Because of disappearing peritoneal disseminated nodules both macroscopically and histologically, she underwent curative total gastrectomy with D2 lymph node dissection and reconstruction by the Roux-en Y method. The postoperative pathological findings showed T2 (se) N1M0, stage IIIa and chemotherapy effective evaluation demonstrated Grade 1b. Postoperatively, S-1/CDDP therapy was carried out, after two cycles she suffered from anorexia, and then S-1 only was given. Fourteen months later, peritoneal dissemination developed. Despite changes in the regimen such as docetaxel or CPT-11, she died 23 months after the initial gastrectomy.

[Efficacy of FEC and trastuzumab/docetaxel combination therapy for metastatic breast cancer]

A 56-year-old female visited our department due to bleeding from a mass in her left breast in November 2007. There was a tumor (diameter, 5 cm) accompanied by ulcer formation and fixation to the pectoral muscle, centering on the left breast Carea. CT examination showed multiple lung metastasis and liver metastasis. Core needle biopsy demonstrated scirrhous carcinoma. The tumor was positive for ER and strongly positive for HER2. After 4 courses of FEC100, 10 courses of trastuzumab / docetaxel combination therapy were performed for a total of 30 weeks. After the therapy, the breast tumor decreased in size, and the lung and liver metastatic lesions disappeared, showing a partial response (PR). FDG-PET examination revealed no abnormal accumulation. In February 2009, left mastectomy was performed. Pathological examination revealed Grade 2b and only a slight residue of cancer cells. This patient with advanced breast cancer accompanied by distant metastasis responded to trastuzumab/docetaxel combination therapy.

[A case of bilateral breast cancer and metastatic gastric cancer with peritonitis carcinomatosa successfully treated with a combination therapy of S-1 and paclitaxel]

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.

[A case of inflammatory breast cancer responding to anastrozole]

A case is 61 years old woman. In February 2008, she was aware of swelling, skin redness and edema in her left breast and visited our hospital. We diagnosed it as inflammatory breast cancer with positive hormone receptor (ER+, PgR+) and unexpression of HER2 (HercepTest 1 +). We started preoperative chemotherapy with weekly paclitaxel followed by FEC100, but we canceled chemotherapy because she developed cerebral infarction when we administered paclitaxel twice. Then, hormonotherapy using anastrozole (Arimidex) was therefore attempted. Three months later, treatment with anastrozole alone reduced the swelling, skin redness and edema in her left breast. After eight months of administration, the breast swelling, skin redness and edema were completely disappeared. MRI revealed the disappearance of the enhanced area. Then mastectomy with auxiliary dissection was performed.

[Intra-peritoneal chemotherapy for scirrhous gastric cancer]

Preoperative intra-peritoneal chemotherapy (IPC) for scirrhous gastric cancer (SGC) has been performed and followed after laparoscopic diagnosis of peritoneal metastasis (P) or washing cytology (CY) in our hospital. Between 2002 and 2005, 15 SGC patients were treated with 3 times of IPC using CDDP (50 mg/body) before operation (CDDP group). Between 2006 and 2008, 9 SGC patients were treated with IPC using docetaxel: DOC (40 mg/m2) and treated with systemic chemotherapy using S-1 (80 mg/m2) before operation (DOC group). Cases with P (+) or CY (+) were detected in 80% in CDDP group and in 89% in DOC group. Gastrectomy was performed in 67% of CDDP group and in 56% of DOC group. All of the 15 patients died in CDDP group but 4 of 9 were still alive in DOC group. The median survival time of DOC group (22 months) was longer than that of CDDP group (10 months, p=0.123). Thus, preoperative IPC using DOC combined with systemic chemotherapy using S-1 should be effective treatment for SGC.

[A case of stage IV breast cancer with large cancer ulcer responding to combination therapy of capecitabine and medroxyprogesterone acetate and cyclophosphamide]

A 53-year-old woman suffering from nausea and vomiting was admitted to our hospital. There was a large ulcer from her left anterior chest to her right side chest. After pathological examination from the ulcer, she was diagnosed as breast cancer, scirrhous carcinoma. The estrogen and progesterone receptors were positive in the tumor. HER2 score was 1+ in the tumor. The stage was T4bNxM1(OTH). Uterine metastases of the breast cancer caused obstructive nephropathy. Ureteral obstruction was treated by urinary tract catheter. After improvement of renal failure, chemotherapy with 5-FU+epirubicin+cyclophosphamide (FEC) and docetaxel was performed. The efficacy was judged as stable disease (SD). For third-line chemotherapy, she was then treated with oral combination chemoendocrine therapy with capecitabine and medroxyprogesterone acetate. After the combination chemoendocrine therapy, the local tumor was remarkably reduced. With added cyclophosphamide, the partial response (PR) continued for 19 months. She died of peritonitis carcinomatosa and pleuritis carcinomatosa. No adverse reactions occurred with the combination chemoendocrine therapy. It is suggested that this oral combination chemoendocrine therapy may be useful with consideration for treatment effectiveness and the quality of life of the patient.

A novel transforming growth factor beta receptor kinase inhibitor, A-77, prevents the peritoneal dissemination of scirrhous gastric carcinoma

PURPOSE

Transforming growth factor beta receptor (TGFbeta-R) is reported to correlate with the malignant potential of scirrhous gastric carcinoma. The aim of the current study is to clarify the possibility of molecular target therapy with a TGFbeta-R inhibitor, A-77, for the treatment of peritoneal dissemination of scirrhous gastric cancer.

EXPERIMENTAL DESIGN

Three scirrhous gastric cancer cell lines and two fibroblasts were used. For in vivo experiments, the A-77 was administered i.p. to mouse models of peritoneal dissemination. The influences of A-77 on the adhesion ability, invasion ability, and the expression of adhesion molecules were examined in vitro.

RESULTS

The A-77 administration resulted in a significantly (P < 0.01) better prognosis for the mice with peritoneal dissemination (median survival time, 51 days), compared with the control (median survival time, 25 days). A-77 therefore significantly (P < 0.01) decreased the weight and number of metastatic nodes. The adhesive ability and invasion ability of cancer cells were significantly decreased by A-77. A-77 decreased the expression of alpha(2), alpha(3), and alpha(5) integrins in gastric cancer cells. The histologic findings showed the degree of fibrosis to be less in the tumors treated by A-77. A-77 decreased the growth of fibroblast and invasion-stimulating activity of fibroblasts on cancer cells.

CONCLUSION

The TGFbeta-R inhibitor, A-77, decreased the expression of integrins in cancer cells and the proliferation of fibroblasts, which resulted in the decreased adhesive and invasive abilities of scirrhous gastric cancer cells to peritoneum. A-77 is thus considered to be useful for the inhibition of peritoneal dissemination of scirrhous gastric carcinoma.

[A case of long survival of a scirrhous gastric cancer patient with esophageal invasion and peritoneal dissemination through chemotherapy and palliative surgery]

We report a case of advanced scirrhous gastric cancer treated by operation and chemotherapy for over four years. The patient was a 54-year-old female who had suffered from gastric cancer with esophageal invasion. She underwent total gastrectomy with D2 dissection. Operative findings revealed peritoneal dissemination, and it resulted in non-curative resection. After surgery, combination chemotherapy with low-dose CDDP administered intraperitoneally and S-1, combination chemotherapy with paclitaxel and 5-FU, and then combination chemotherapy with docetaxel and S-1 were sequentially performed. She also underwent palliative surgery for intestinal obstruction resulting from carcinomatous peritonitis. She achieved long survival with good quality of life (QOL) by multidisciplinary therapy of chemotherapy and surgical operation.

[A case of scirrhous gastric cancer with peritoneal dissemination acquiring stable disease over three years by treatment with oral anticancer drug S-1]

A 71-year-old male, who complicated of abdominal distension, was diagnosed as scirrhous gastric cancer. We treated him with the oral anticancer drug S-1 and achieved long-term stable disease over three years.

Retrospective analysis of prognosis for scirrhous-type gastric cancer: one institution's experience

BACKGROUND

Scirrhous gastric cancer is biologically aggressive, and the prognosis is poor even with curative surgery. We compared outcomes with different therapies in order to identify prognostic factors.

METHODS

Records for 83 patients, who were treated between 1991 and 2004, were evaluated for survival and stage, treatment, and clinicopathological factors.

RESULTS

Cumulative 5-year overall survival was 10.2% for all 83 patients, including 27 (32.5%) patients with stage II/III disease and 56 (67.4%) with stage IV disease. The 5-year overall survival rate and median survival time for patients with stage II/III disease after curative surgery were 24.3% and 1150 days. For patients with stage IV disease, 2-year and 5-year survival rates after initial surgery were 13.7% and 0% and median survival was 250 days. In contrast, preoperative chemotherapy for advanced, unresectable disease produced 2-year and 3-year overall survival rates of 53.6% and 26.8% and medican survival was 910 days.

CONCLUSION

Aggressive surgery alone does not seem to improve outcome, but preoperative chemotherapy might be beneficial and should be investigated further.

[Therapeutic strategy for type 4 gastric cancer from the clinical oncologist standpoint]

Type 4 gastric cancer has a poor prognosis compared with other types of advanced gastric cancer because of the high incidence of peritoneal metastasis which causes intestinal obstruction, hydronephrosis, or obstructive jaundice. Surgical treatment is often only palliative, and systematic chemotherapy is considered to be important for long survival. S-1 showed a higher response rate for undifferentiated-type adenocarcinoma, and S-1 alone or its combination regimens demonstrated greater anti-tumor effects and longer survival time for gastric linitis plastica compared with conventional 5-FU regimens in our historical control study (response rate: S-1/non S-1 57.9%/27.9%, p<0.01; MST: S-1/non S-1 402 days/213 days, p<0.01). S-1 regimens may also improve the survival in patients with type 4 gastric cancer in neoadjuvant or adjuvant settings, but further prospective studies are warranted to prove its significance. Paclitaxel also has a high response rate for undifferentiated-type adenocarcinoma, and can be expected to show high efficacy for peritoneal dissemination. Irinotecan should not be administered in case of intestinal obstruction because its toxicity may be increased. However,survival of patients with type 4 gastric cancer may improve with the availability of active agents like S-1, taxanes, irinotecan as reported in colorectal cancer. Therefore,irinotecan should be administered carefully before intestinal obstruction occurs.

[Treatment strategy for the type IV gastric cancer--from the standpoint of the surgery]

From the standpoint of the surgery, the treatment strategy for the type IV gastric cancer (GC) was studied. Recently, the resected rate of type IV GC has been increasing, though the number of operated GC patients is decreasing. The five-year survival rate was about 20% in all and around 30% in the curatively resected pts. As a result of examination of our pts with type 4 GC, multimodality therapy including neoadjuvant chemotherapy and extended surgery is recommended for pts with P 0/CY 0 or P 0/CY 1 but without other remaining GC lesions. Palliative gastrectomy and postoperative chemotherapy are recommended if performed safely to prevent such symptoms in spite of unresectable metastasis for pts with urgent symptoms such as bleeding, stricture, pain or malnutrition. For pts with P 2/P 3 but without passage disturbance, intensive chemotherapy is selected. But the propriety for selection of reduction surgery for pts with P 2/P 3 is controversial. The results of the prospective randomized controlled study of reduction surgery in non-curative advanced gastric cancer by the Gastric Cancer Surgical Study Group in Japan Clinical Oncology Group (JCOG) are expected.

[A case of scirrhous gastric cancer with peritoneal metastases successfully treated by combined chemotherapy of biweekly paclitaxel and TS-1 followed by curative resection]

The patient was a 50-year-old male with advanced gastric cancer. Laparoscopy showed peritoneal metastases. We thought a complete resection would be difficult, so he was given neoadjuvant chemotherapy combined with paclitaxel (200 mg, day 1, 15) and TS-1 (120 mg/day, for days 1-14 with a 2-week rest). After 3 courses of this neoadjuvant chemotherapy, the tumor decreased in size. Laparoscopy showed no peritoneal metastasis, and thus a total gastrectomy with splenectomy and D 2 lymph node dissection was performed. The pathological diagnosis was sig, LM, type 4, pT 3 (SE), sci, INFgamma, ly 0, v 0, pN 0, pPM (-), pDM (-), and the antitumor efficacy of this therapy was Grade 0 histologically. Combined chemotherapy of biweekly paclitaxel and TS-1 was thought to be an effective neoadjuvant chemotherapy for advanced gastric cancer in this case.

A case of scirrhous gastric cancer with peritonitis carcinomatosa controlled by TS-1® + paclitaxel for 36 mo after diagnosis

A 34-year-old female complaining of abdominal fullness was diagnosed as scirrhous gastric cancer (type 4’) with peritonitis carcinomatosa in July 2002. A combined chemotherapy regimen was selected to control massive ascites; TS-1^® 80 mg/m² was given orally on d 1-14, 22-35, and paclitaxel 50 mg/m² was administered intravenously on d 1, 8, 22 and 29. After 2 courses of this regimen, the primary tumor was markedly reduced, and ascites completely vanished. Alopecia (grade 1, since d 30), leukocytopenia (grade 2, on d 34) and anemia (grade 2, on d 34) were the only adverse events throughout the following courses. The chemotherapy was effective for 28 mo, and then it was discontinued upon the patient’s own request, and she survived for 36 mo after diagnosis.

[A case of progressive gastric carcinoma accompanied by disseminated carcinomatosis of bone marrow due to bone metastasis with DIC recovery by joint administration of 5-FU and paclitaxel]

A 54-year-old male visited our hospital with the chief complaint of anorexia. Based on various tests, a diagnosis of scirrhous gastric carcinoma accompanied by bone metastasis and liver metastasis was made. As DIC developed following hospital admission, 5-FU and PTX therapy (5-FU at 600 mg/m(2), 24-hour continuous infusion, day 1-5 and PTX at 80 mg/m(2), iv, day 8, 15, 22) were administered. Although primary foci, bone metastasis, and liver metastasis were observed by image diagnostic procedures, recovery from DIC was achieved. 5-FU+PTX therapy is considered to be effective for DIC due to bone metastasis of gastric carcinoma.

A novel molecular targeting compound as K-samII/FGF-R2 phosphorylation inhibitor, Ki23057, for Scirrhous gastric cancer

BACKGROUND & AIMS

Scirrhous gastric carcinoma carries the highest mortality of all gastric cancers. The poor prognosis is reported to be associated with K-samII amplification, which encodes fibroblast growth factor receptor type 2 (FGF-R2). Ki23057, a newly developed small molecule-acting K-samII/FGF-R2 autophosphorylation inhibitor, is a tyrosine kinase inhibitor that competes with adenosine triphosphate for the binding site. The aim of the current study is to clarify the possibility of molecular target therapy with Ki23057 for treating scirrhous gastric cancer.

METHODS

Five human gastric cancer cell lines were used. OCUM-2MD3 and OCUM-8 were derived from scirrhous carcinomas. MKN-7, MKN-45, and MKN-74 cells were derived from nonscirrhous carcinomas. In vitro effects of Ki23057 on cell growth were determined by calculating the number of cancer cells. The influences of Ki23057 on the mitogen-activated protein kinase and phosphatidylinositol 3 kinase signaling pathways and the apoptosis pathway in the gastric cancer cells were also examined. For in vivo experiments, the Ki23057 was administered orally to mouse models of peritoneal dissemination.

RESULTS

K-samII amplification was found in OCUM-2MD3 and OCUM-8 cells but not in MKN-7, MKN-45, or MKN-74 cells. Ki23057 significantly inhibited the proliferation of scirrhous cancer cells but not nonscirrhous gastric carcinoma cells. Ki23057 decreased phosphorylation of K-samII/FGF-R2, extracellular signal-regulated kinase, and Akt and increased apoptosis in scirrhous cancer lines. The oral Ki23057 administration significantly (P < .001) prolonged survival of mice with peritoneal dissemination following injection of OCUM-2MD3 scirrhous cancer cells.

CONCLUSIONS

A novel K-samII/FGF-R2 phosphorylation inhibitor, Ki23057, appears therapeutically promising in scirrhous gastric carcinoma with K-samII amplification.

[A case of advanced gastric cancer with malignant ascites responding to weekly paclitaxel therapy]

A 54-year-old woman with scirrhous gastric cancer in the upper third area was admitted to our hospital. She was diagnosed with advanced gastric cancer that was inoperable due to peritoneal metastasis, so weekly paclitaxel (PTX) therapy was carried out. After 2 courses, malignant ascites completely disappeared and bilateral hydronephrosis improved. After 4 courses, no ascites or hydronephrosis were seen. Only neutropenia (grade 2) and alopecia (grade 1) were observed as adverse events during the therapy, but no major adverse events were noted. We also investigated the concentration of paclitaxel in ascites. Two hours after intravenous injection of PTX, the concentration of PTX in ascites rose over the reported cytotoxic dose of PTX, and this available concentration was maintained after 48 hours. Weekly paclitaxel therapy is suggested to be one of the safe and useful treatments for advanced gastric cancer with malignant ascites.

[Palliative chemotherapy and CUP-syndrome: medical intentions versus patients' attitudes in decision making]

The following case report is about a 55 year old male patient with CUP-syndrome. After developing a malignant bowel obstruction he received five cycles of a palliative chemotherapy with oxaliplatin and irinotecan. The focus is on medical intentions and goals concerning palliative chemotherapy and on discussing patients' attitudes towards chemotherapy. Communication is identified as fundamental skill in shared decision making. On the one hand it improves Patients' satisfaction and palliative care and on the other hand it reduces psychological and existential suffering. In tumors of unknown primary site regimens with different combinations of Platin, Taxol, Etoposide, Irinotecan and Gemcitabine showed responses up to 46% and a survival benefit with an overall median survival up to 12 months and even long term survival.

Randomized controlled trial of the effect of hysterectomy or LNG-IUS use on bone mineral density: a five-year follow-up

A 72-year-old female with scirrhous-type advanced gastric cancer was treated with TS-1/CDDP as neoadjuvant chemotherapy. TS-1 (80 mg/m(2)/day) was orally administered for 3 weeks and CDDP (60 mg/m(2)) was administered by intravenous drip on day 8. Partial response (PR) was obtained after the first course, and total gastrectomy was performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and a few regional lymph node metastases (3/67). The patient has now been in good health without a recurrence for 1 year and 9 months after surgery.

[A case of recurrent gastric cancer with improvement of obstructive symptoms caused by carcinomatous peritonitis and prolonged survival by chemotherapy with combined use of Paclitaxel and 5-FU]

A 29-year-old male underwent Cur B surgery including total gastrectomy, pancreaticoduodenectomy, transverse colectomy, and D 2 dissection for scirrhous gastric carcinoma accompanied by duodenal and pancreatic infiltration. Thereafter, the patient suffered from recurrence with development of ileus caused by carcinomatous peritonitis. Ileus tube was inserted, followed by conservative therapy without ingestion. But, as the symptoms aggravated without any alleviation, an emergency surgical procedure was conducted. As disseminated changes were observed in the entire region of the abdominal cavity of the epigastric region, ileus by-pass procedure and ileostomy were performed. Though ileus symptoms were improved, peroral intake was difficult,and the ileus tube had to be left in place. Thereafter, chemotherapy with combined use of paclitaxel and 5-FU was initiated, and peroral intake become possible. The Ileus tube could be removed after improvement of obstructive symptoms. The patient was treated at the outpatient clinic with nutritional help of HPN, but died 14 months after the recurrence.

A synergic inhibitory-effect of combination with selective cyclooxygenase-2 inhibitor and S-1 on the peritoneal metastasis for scirrhous gastric cancer cells

An inhibitory-effect of a selective cyclooxygenase-2 (COX-2) inhibitor on peritoneal metastasis of scirrhous gastric carcinoma was investigated in vivo. Peritoneal metastasis had developed after intraperitoneal inoculation of scirrhous gastric cancer cells, OCUM-2MD3, in nude mice. COX-2 inhibitor and/or S-1 were administered orally in nude mice with peritoneal metastasis. Oral administration of COX-2 inhibitor and S-1 significantly prolonged survival rates of these nude mice, compared with either alone. These findings suggested that combining S-1 and COX-2 inhibitor administration obtain a synergistic inhibitory-effect on the peritoneal metastasis of scirrhous gastric carcinoma.

[Proptosis as the first sign of recurrent scirrhous breast carcinoma]

OBJECTIVE

To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome.

CASE REPORT

The case of a 61-year-old woman, diagnosed and treated seven years ago for a scirrhous breast carcinoma is presented. She complained of blurred vision and proptosis of the left eye and these symptoms were the first manifestation of tumor relapse.

DISCUSSION

When orbital inflammation is detected in an adult female patient, a full medical history must be obtained and physical examination performed, as orbital metastases have been reported to be the initial manifestation of malignancy in 30 to 50% of cases.

[A case of curatively resected schirrous gastric cancer effectively treated by combined chemotherapy of weekly paclitaxel (PTX) and CDDP]

The patient was a 40-year-old woman who had unresectable advanced gastric cancer with invasion of liver and dissemination to the peritoneal wall. Neoadjuvant chemotherapy consisting of paclitaxel (PTX) and CDDP was performed. PTX (80 mg/m2), and CDDP (25 mg/m2) was administered weekly on day 1, 8 and 15 as one cycle. After four cycles of PTX/CDDP administration,invasion of liver and gastric tumor had decreased to almost normal size, and total gastrectomy was performed. After operation, the patient was treated with six courses of PTX/CDDP and survived without recurrence as of this writing. PTX/CDDP was associated with few adverse events in hospital visits, and thought to be an effective chemotherapy against advanced gastric cancer.

[A case of advanced gastric cancer with direct invasion of the transverse colon responding to paclitaxel/5'-DFUR combined therapy]

A 50-year-old man was diagnosed with non-resectable scirrhous gastric cancer of antrum accompanied with colon ileus due to direct invasion of the transverse colon. As the ileus improved after cecostomy, chemotherapy with TS-1/cisplatin(CDDP) was performed. Because of no response, 4 cycles of paclitaxel (PTX)/doxifluridine (5'-DFUR) therapy was performed as second-line chemotherapy. Since the stenosis of transverse colon dilated completely and the tumor disappeared, we performed total gastrectomy and right hemicolectomy, and could resect completely. Though 2 cycles of PTX/5'-DFUR therapy was performed postoperatively and the patient's postoperative condition was good, he was suffering from carcinomatous peritonitis complicated by ileus and obstructive jaundice 4 months after operation. He died 1 year after the first medical examination, but his QOL was fairly good for 10 months. PTX/5'-DFUR therapy, which has only slight complications, may be useful for patients with recurrent gastric cancer who had been treated with 5-FU administration as first-line chemotherapy. But the future problem was how to control dissemination after surgery in a resectable case after chemotherapy.

[Intraperitoneal chemotherapy in gastric cancer patients with peritoneal dissemination]

Peritoneal dissemination is one of the non-curative factors in gastric cancer and colon cancer. Although many treatments have been conducted for peritoneal dissemination, no standard chemotherapy has yet been established. For sometime we had used continuous hyperthermic peritoneal perfusion (CHPP)for peritoneal dissemination in gastric cancer and colon cancer. CHPP has a marked survival benefit for scirrhous type gastric cancer patients without liver metastasis. Patients with prophylactic CHPP have significantly better prognoses than those without prophylactic CHPP, and therapeutic CHPP has a survival benefit for gastric cancer patients with slight to moderate peritoneal dissemination (P 1-2). But CHPP has no significant prognostic benefit for gastric cancer patients with severe peritoneal dissemination (P 3). Therefore, a new cancer treatment is needed for those patients. On the other hand, many kinds of anticancer agents, including cisplatin, via intraperitoneal (ip) administration have been tried thus far for peritoneal dissemination therapy. Especially, intraperitoneal taxane anticancer agent is very effective for the treatment and local control of severe peritoneal dissemination in gastric cancer. A phase I/II study of taxane anticancer agents via ip administration should be tried in gastric cancer patients with peritoneal dissemination.

[Peritoneal dissemination of scirrhous type 4 gastric cancers]

We examined 198 cases of primary scirrhous type 4 gastric cancer at our department from 1984 to 2003. Of these, 139 cases underwent gastrectomy. The essential cause of inoperability was peritoneal dissemination with malignant abdominal abscises. The incidence of peritoneal dissemination was 48.2% of all resected cases. The 5-year survival rate of all resected cases was 12% and that of non-resectable cases was 0%. One of the 59 nonresectable cases who responded remarkably to treatment by TS-1/paclitaxel combination chemotherapy obtained survival of 12 months. Six cases with peritoneal dissemination were treated by chemotherapy with cisplatin and etoposide infused intra-peritoneally and 2 of them were diagnosed as P 0 after 4 weeks. One case with type 4 gastric cancer who had right hydronephrosis and malignant abdominal ascites underwent curative resection after successful treatment with TS-1. We have selected the way of conventional chemotherapy for inoperable type 4 gastric cancers, but the prognosis is still poor. It is thought necessary to improve survival by newly developed anticancer agents such as TS-1, etoposide and taxanes. Immuno-cellular therapy with autologous tumor cell stimulated lymphocyte may be examined as a neo-adjuvant therapy as well as chemotherapy.

Inhibitory effect of a selective cyclooxygenase inhibitor on the invasion-stimulating activity of orthotopic fibroblasts for scirrhous gastric cancer cells

The cyclooxygenase (COX)-2 inhibitor has been reported to impede the progression of gastric cancer, but underlying mechanisms remain unclear. We therefore investigated the effect of a COX-2 inhibitor, JTE-522, on the ability of orthotopic fibroblasts to stimulate invasion of scirrhous gastric carcinoma cells. The human scirrhous gastric cancer cell lines OCUM-2D or OCUM-2M, and human gastric fibroblasts (NF-21) were cultured in the absence or presence of JTE-522 at various concentrations. Cancer cells were then assayed for invasiveness in vitro by invasion assay. The effect of prostaglandins (PG) on growth factor production in NF-21 cells was examined by ELISA. Finally, the effects of orally administrated JTE-522 on orthotopically transplanted tumors were examined in nude mice. NF-21 cells stimulated invasion by OCUM-2D cells, an effect suppressed by JTE-522 at 5 x 10(-6) M. Hepatocyte growth factor (HGF) and PGE2 production by NF-21 cells were suppressed by JTE-522 (P < 0.01). PGE2 stimulated HGF production by NF-21 cells in a dose-dependent manner. JTE-522 significantly suppressed orthotopic tumor growth and lymph node metastasis, and also decreased HGF expression by fibroblasts within the gastric tumor. In conclusion, we found that gastric fibroblasts stimulated invasiveness in scirrhous gastric cancer cells, whereas a selective COX-2 inhibitor inhibited this paracrine effect by decreasing fibroblast PGE2 production, resulting in downregulation of HGF production.

Clinical application of immunoreactivity of dihydropyrimidine dehydrogenase (DPD) in gastric scirrhous carcinoma treated with S-1, a new DPD inhibitory fluoropyrimidine

BACKGROUND

A highly specific antibody against recombinant human dihydropyrimidine dehydrogenase (DPD) has been developed to immunohistochemically assess DPD expression in tumors. A new oral DPD inhibitory fluoropyrimidine (DIF), S-1, is reportedly effective against gastric scirrhous carcinoma.

PATIENTS AND METHODS

In this study, the relationship between immunoreactivity to DPD in biopsy specimens and the effects of chemotherapy were investigated in 61 patients treated with first-line fluoropyrimidine-based chemotherapy (S-1:DIF, 5-FU:non-DIF) for gastric scirrhous carcinoma.

RESULTS

The response rate was significantly higher in patients with DPD-positive tumors than in those with DPD-negative tumors in the S-1 group (45.5%, 10.0%: p < 0.05), as compared to the 5-FU group (0%, 5.6%: p = 0.398). According to the median survival time, there was no significant difference between patients with DPD-positive tumors (364 days) and those with DPD-negative tumors (406 days; p = 0.626) in either the S-1 group or the 5-FU group (181 days and 256 days, respectively; p = 0.543).

CONCLUSION

This study indicates that S-1 may be effective even in gastric scirrhous carcinoma with a high level of DPD activity.

[A case of anthracycline and taxane-resistant breast cancer with life-thereatening multiple liver metastases responding to oral combination chemotherapy by UFT, cyclophosphamide and medroxyprogesterone acetate]

A 53-year-old woman presented with an advanced right breast cancer together with skin manifestations and massive axillary lymph node metastases, as well as distant metastases in the lung and the liver. The patient received surgery after 6 courses of chemotherapy with epirubicine and intravenous cyclophosphamide (80/600 mg/m2). A weekly paclitaxel regimen (80 mg/m2) was started because the tumor markers increased soon after surgery. Despite chemotherapy, no response was confirmed, then weekly docetaxel (35 mg/m2) was started. Although the tumor markers decreased after administration of docetaxel, severe liver disfunction appeared and did not improve after cessation of docetaxel. Computed tomography (CT) revealed numerous metastatic nodules in the bilateral lobes of the liver. UFT (400 mg/day) and cyclophosphamide (100 mg/day) were administered for 4 weeks followed by 2 weeks cessation and then combined with continuous medroxyprogesterone acetate (800 mg/day). Liver function tests were normalized 3 months after, and the massive metastatic liver tumors disappeared completely. Lung metastasis also subsided. In spite of these good responses, tumor markers did not normalize and skin nodules appeared around the surgical site. Administration was stopped 36 weeks after initiation of the treatment.

[A case of advanced breast cancer markedly responding to chemo-endocrine therapy with only slight alopecia]

We report a case of good response to chemo-endocrine therapy with slight alopecia. A 55-year-old woman was diagnosed as advanced breast cancer with T4c, N3, M1, Stage IV, who was left cervical node-positive. She received 4 cycles of CTF (cyclophosphamide 100 mg/body/day 1-14, THP 30 mg/body/days 1,8, and 5-FU 750 mg/body/days 1, 8 4 wq) therapy in addition to oral tamoxifen (20 mg/body) administration. After this treatment, the primary tumor was markedly reduced (PR), and only slight alopecia was observed. Generally, 3 cycles of CAF (CEF) therapy induced severe alopecia (grade 3). But this CTF regimen caused grade 1 alopecia. Most women have strong resistance to alopecia. It seems that the quality of life for breast cancer patients was affected by the extent of the alopecia. Therefore, CTF therapy should be considered effective for advanced breast cancer patients while reducing the extent of alopecia.

Laparoscopic-Assisted Intraperitoneal Chemotherapy for Patients with Scirrhous Gastric Cancer

BACKGROUND

The prognosis for patients with scirrhous gastric cancer (SGC) is extremely poor. To improve the patients' prognosis, laparoscopic-assisted intraperitoneal chemotherapy (IPC) was introduced for SGC. In this study, we analyzed whether IPC reduced the number of cancer cells in the peritoneal cavity of patients or changed the gene expression levels of cytokines in the peritoneal cavity. We also investigated whether IPC improved the prognosis of patients with SGC.

METHODS

Total RNA was extracted from 50 ml of peritoneal wash from 11 SGC patients before and after cisplatin-based IPC. The gene expression levels of survivin, c-myc, transforming growth factor-beta (TGF-beta), interleukin-2 (IL-2), IL-6, and IL-12 were analyzed using real-time reverse transcription-polymerase chain reaction (RT-PCR) assays. Also, carcinoembrionic antigen (CEA) messenger RNA (mRNA) was used to identify the number of gastric cancer cells in peritoneal washes by the real-time RT-PCR method. The gene expression levels of cytokines and the number of cancer cells in the peritoneal cavity were compared before and after cisplatin-based IPC treatment.

RESULTS

Before IPC, the gene expression of IL-2 from peritoneal washes of patients was significantly suppressed compared to the controls (p = 0.029); however, other gene expression levels did not differ. In 7 cases, more than 90% of the cancer cells were removed from the peritoneal cavity after cisplatin-based IPC. These 7 cases were named the IPC effective group, and the remaining 4 cases were named the IPC ineffective group. In the IPC effective group, elevated IL-2 and IL-6 genes were detected in 5 (71%) and in 6 (86%) after IPC. The correlation between IPC effectiveness and elevated gene expression after IPC (IL-2: p = 0.137, and IL-6: p = 0.044) was observed. However, the 50% survival period of the IPC effective group (9 months) was not different from that of that of the IPC ineffective group (6 months, p = 0.267).

CONCLUSION

IPC effectiveness may correlate with elevation of gene expression of inflammatory cytokines, such as IL-2 and IL-6 in the peritoneal cavity after IPC. However, the prognostic benefits of IPC for SGC patients remain unclear.

[Three advanced gastric cancer patients successfully treated by combination therapy of docetaxel and TS-1]

We have experienced three gastric carcinoma cases successfully treated by the combination therapy of docetaxel and TS-1. Case 1: 66-year-old male with advanced gastric cancer invading the pancreas with metastasis to the liver and left neck lymph nodes. Case 2: 50-year-old female with scirrhous gastric carcinoma causing huge amount of malignant ascites. Case 3: 59-year-old male with recurrent gastric cancer of the remnant stomach presenting with obstruction and vessel involvement. Primary and metastatic diseases of these patients were remarkably improved with the combination therapy, indicating that the combination therapy of docetaxel and TS-1 can be a new therapeutic tool for advanced and recurrent gastric cancer patients.

[A case of non-curatively resected scirrhous gastric cancer successfully treated over 2 years with weekly administration of paclitaxel]

We report a patient with far-advanced gastric cancer treated by weekly administration of paclitaxel (TXL) over 2 years. The patient was a 66-year-old female with peritoneal metastasis and remarkable lymph node metastasis of scirrhous gastric cancer. She underwent a non-curative resection with total gastrectomy and splenectomy in May 2002. Postoperative chemotherapy with TS-1 (80 mg/body) was performed. Due to grade 4 neutropenia and grade 2 anorexia, this treatment could not be continued. Three months after surgery, the tumor marker (CA19-9) had elevated to an abnormal level. Alternatively, TXL was administered at a weekly dose of 70 mg/m2 for 3 weeks followed by 6 weeks rest from September 2002. The tumor marker (CA19-9) gradually decreased to the normal level. Because of the long rest interval, 10 courses of treatment could be continued, and the patient has been alive over 2 years with the cancer controlled. There have been few effective chemotherapies for gastric cancer with peritoneal metastasis. Weekly paclitaxel therapy is considered to be effective for the treatment of advanced scirrhous gastric cancer with peritoneal metastasis.

[Significance of tissue thymidine phosphorylase and dihydropyrimidine dehydrogenase activities in ovarian cancer]

Thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) are important enzymes in the pyrimidine salvage pathway. In the meantime, TP and DPD are a converting enzyme of 5'-DFUR to 5-FU and the major catabolic enzyme of 5-FU, respectively. Because little is known about their protein expressions in ovarian cancers, we investigated TP and DPD protein expressions quantitatively in 24 ovarian cancers and their normal counterparts by ELISA. Higher TP expression was observed in ovarian cancers than in normal ovaries. The higher expression was also correlated with the histological grade and clinical stage. No relation was observed between the expression of DPD and the clinical and pathological parameters. The higher TP/DPD ratio, which appears to be a predictor of 5-fluorouracil sensitivity, was observed in ovarian cancers than in normal counterparts. In univariate analysis, a higher TP/DPD ratio was found to be a predictor of progression-free survival in ovarian cancer patients. This would suggest that capecitabine and 5'-DFUR are potential candidates for ovarian cancer chemotherapy.

[Docetaxel (TXT), epirubicin (EPI) and doxifluridine (5'-DFUR) combination neoadjuvant chemotherapy for outpatients with locally advanced breast cancer]

We evaluated the safety and efficacy of neoadjuvant chemotherapy with docetaxel (TXT), epirubicin (EPI) and doxifluridine (5'-DFUR) in 5 patients with locally advanced breast cancer on an outpatient basis. Their mean age was 49.6 years, and preoperative stages were IIa: one case, IIb: two; and IlIb: two; respectively. The regimen consisted of 5'-DFUR (800 mg/day) orally for 14 consecutive days, and TXT (60 or 70 mg/m2) and EPI (50 or 60 mg/m2) intravenously on day 8. It was repeated 4 times every 3 weeks. Although the results revealed leucopenia and neutropenia of more than grade 3 in 4/5 patients, no other adverse events were observed. The use of G-CSF was necessary to maintain this regimen, and the patients could be treated on an outpatient basis. Breast conserving therapy was performed in two patients. Pathological findings revealed Grade 2 and 3 cytological degeneration in two and one patients, respectively, and parasternal lymph node metastasis in one, but no axillary lymph node metastasis. These findings suggested satisfactory effects of this neoadjuvant chemotherapy regimen. This combination chemotherapy without severe adverse events would be an alternative choice of neoadjuvant chemotherapy on an outpatient basis.

[A case of advanced gastric cancer acquired long-term response two years or more by treatment with oral anticancer drug TS-1]

A 66-year-old male with massive ascites was diagnosed as advanced gastric scirrhous cancer at Musashino Red Cross Hospital. We detected the adenomatous cancer cells from his ascites, and an X-ray photograph of his stomach showed less capability of expansion in the upper gastrointestinal series. We attempted treatment with oral anticancer drug TS-1 with the patient's consent and achieved a long-term response of two years or more.

[Successful combination therapy with 5'-DFUR and MPA for breast cancer with spinal and vertebral metastases]

We report a case of breast cancer with spinal and vertebral lesions. A 49-year-old premenopausal woman with a left breast tumor was admitted to our hospital for acute weakness of the lower limbs and dysuria. She could neither stand nor walk. The tumor in the left breast was 5.0 cm in diameter with skin ulcer, and it was diagnosed as breast cancer. Magnetic resonance (MR) image showed multiple vertebral and spinal metastases from breast cancer. Chemotherapy, consisting of cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) was initiated. Her symptoms dramatically changed for the better. She became able to walk and urinate. We performed palliative mastectomy after 3 cycles of CAF therapy. Histopathological findings of breast tumor showed scirrhous carcinoma. Although the estrogen and progesterone receptor status of primary tumor was negative, chemo-endocrine therapy, consisting of medroxyprogesterone acetate (MPA) and doxifluridine (5'-DFUR) was given as daily therapy, and vertebral and spinal lesions were reduced. Her condition has remained stable for 4 years. For patients with metastatic breast cancer, complete remission is uncommon, and disease stabilization is a reasonable goal of successful therapy. In this respect, therapy with CAF, followed by MPA and 5'-DFUR, was successful in the patient.

[Weekly paclitaxel therapy is useful for gastric carcinoma as second-line chemotherapy]

The patient was a 58-year-old man who suffered from non-resectable gastric cancer, staged intraoperatively for peritoneal dissemination and paraaorta lymph node metastasis at another hospital in December 2002. He was initially treated with TS-1 as an outpatient. However, he was readmitted on March 4, 2003 for hematuria, general fatigue, jaundice and dyspnea. He was diagnosed with gastric cancer duodenum invasion, obstructive jaundice and lymphangitis carcinomatosa, and began weekly TXL as second-line chemotherapy on March 26. TXL (70 mg/ m2) was infused once a week for 3 weeks followed by a 1-week interval as one cycle. One week after the first infusion therapy, the jaundice and dyspnea were greatly improved. CT scan showed the lymphangitis carcinomatosa had disappeared and paraaorta lymph node metastasis was reduced to 60% after one cycle of the treatment. The toxic events were leukopenia (grade 1) and alopecia (grade 1).

[A case of scirrhous carcinoma of the stomach with malignant pleural and peritoneal carcinomatosis responding to the local administration of docetaxel (TXT)]

We report the case of a 34-year-old woman who underwent total gastrectomy for scirrhous carcinoma in the stomach (T4, N0, H0, CY1, P1, Stage IV). Despite adjuvant chemotherapy with TS-1 and/or CDDP, ascites caused by peritoneal carcinomatosis increased four months after gastrectomy. Therefore, intraperitoneal administration of docetaxel (TXT) at a dosage of 45 mg/m2 was applied. This therapy successfully maintained her good quality of life by inhibiting the increase of ascites without any severe adverse side effects for more than six months. When the left effusion from pleural carcinomatosis appeared nine months after the surgery, the intrathoracic administration of TXT succeeded in inhibiting the increase of pleural effusion over five months or more. In this case, intraperitoneal and intrapleural administrations of TXT were effective and temporarily improved the patient's quality of life without any side effects. We thought that the local administration of TXT was a useful treatment without severe toxicities for malignant pleural effusion and ascites in scirrhous carcinoma of the stomach.