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A 57-year-old woman was admitted to our hospital for treatment of gastric cancer presenting as a type 2 tumor in the lower third of the stomach. According to pre-therapeutic imaging examinations and laparoscopy, she was diagnosed with advanced gastric cancer, cT4a(SE)N2M0, Stage Ⅲ. Therefore, neoadjuvant chemotherapy was planned, and she received the SOX regimen. After 3 courses of chemotherapy, post-therapeutic imaging examinations showed that the primary gastric tumor and metastatic lymph nodes had reduced in size. We performed distal gastrectomy with D2 lymphadenectomy. Final pathological examinations demonstrated that no viable tumor cells remained in the resected stomach and dissected lymph nodes (Grade 3). SOX may be useful as neoadjuvant chemotherapy to improve prognosis in patients with advanced gastric cancer. Herein, we report a case of advanced gastric cancer with pathological complete response after neoadjuvant chemotherapy with the SOX regimen.

A 51-year-old man who had undergone distal gastrectomy for gastric cancer was admitted in Kagoshima University Hospital under the diagnosis of anastomotic recurrence of gastric cancer. From abdominal CT results, the recurred tumor was suspected to invade into the pancreas with regional node metastases. Because of the intense radicality of surgical intervention, we planned 3 courses of docetaxel, cisplatin, and S-1 triplet therapy(DCS therapy). After the chemotherapy, the recurred tumor and lymph node metastases shrunk drastically. Segmental gastrectomy with lymph node dissection was performed with curative intent. Final pathology revealed complete regression of both the recurred tumor and lymph node metastases. The patient's postoperative course was uneventful without tumor relapse. DCS therapy seems to be suitable to obtain drastic tumor regression before surgical intervention as a neoadjuvant chemotherapy for locally advanced gastric cancer.

A 67-year-old man who was hospitalized at a mental hospital because of schizophrenia was admitted to our hospital with a complaint of dysphagia and vomiting. He was found to have advanced cancer in the middle thoracic esophagus. With the cooperation of a radiologist, a psychiatrist, and a nurse, we successfully performed chemoradiation therapy with S-1 and CDDP. The patient had adverse events of esophagitis and anuria during chemoradiation therapy. However, such adverse events were well controlled through the cooperation with a palliative care team and a urologist. Finally, we were able to enforce chemoradiation therapy with S-1 and CDDP without interruption.

A 66-year-old man was diagnosed with synchronous early esophageal cancer and advanced gastric cancer. He received CDDP-based combination chemotherapy (docetaxcel, CDDP, and TS-1). During chemotherapy for gastric cancer, he suddenly developed septic shock, requiring intensive treatment with antibiotics, intravenous immunoglobulin, circulatory and respiratory care, and hemoperfusion with a polymyxin B column. He also had disseminated intravascular coagulation (DIC), complicated by sepsis. Recombinant human soluble thrombomodulin (rTM) was administered to treat DIC. The intensive treatments described above allowed the patient to recover from septic shock and DIC several days later. Early and adequate treatment could be used to rescue a compromised cancer-bearing patient from septic shock following chemotherapy.

A 68-year-old woman was diagnosed with advanced esophageal cancer with lymph node metastasis, for which she received neoadjuvant chemoradiotherapy. During therapy, she had loss of appetite and weight; therefore, we inserted a nasal feeding tube for her nutrition, after which, she gained weight soon. After therapy, she had a high fever with lymphocytopenia and was diagnosed with cytomegalovirus infection because of significantly high CMV antigenemia. Ganciclovir was administered immediately, and she recovered soon. Two months later, we performed esophagectomy, and she recovered without complications. Immediate diagnosis of CMV infection, ganciclovir administration, and nutrition through a feeding tube were useful for the esophageal cancer patient in this report who had immunosuppression and malnutrition during chemoradiation.

A 70-year-old woman was diagnosed with synchronous advanced esophageal cancer and early renal cancer. During chemoradiation therapy for the esophageal cancer, she suffered from septic shock due to pneumonia. She got worse despite the administration of antibiotics and gglobulin. On the following day, she was diagnosed with septic disseminated intravascular coagulation(DIC)on the basis of the diagnostic criterion for acute DIC. Recombinant human soluble thrombomodulin(rTM) was administered to treat the DIC. The patient responded promptly to rTM treatment and recovered from the DIC in just 1 day. rTM is thought to be an effective drug for sepsis-induced DIC during chemoradiation therapy.

We retrospectively analyzed 20 patients with advanced gastric cancer treated with chemoradiation(CRT). The patients consisted of 16 males and 4 females, 17(85%)of whom received intensive chemotherapy prior to CRT. Radiation was administered concurrently at 40 to 55 Gy according to the purpose of treatment. Sixteen patients received low dose CDDP and S-1. Of 8 patients who had measurable disease, one obtained CR and 3 obtained PR by the CRT. Fifteen percent of the distinct adverse effects of CRT were grade 3 leucopenia and 30% of them were grade 3 nausea. The 2-year-survival of patients who received CRT with curative intent was 91%, significantly higher than the percentage of those with palliative intent. Four patients who received R0 surgery following CRT are postoperatively healthy without symptoms of relapse. In conclusion, even though, 75% of the patients were already given chemotherapy prior to CRT, good outcomes were achieved unexpectedly. The combination of CRT and surgery may be a useful tool for chemo-resistant, locally advanced gastric cancer.

A 78-year-old man who had hepatitis C was examined by computed tomography(CT)because of prostate cancer, and was found to have a liver tumor 8. 0 cm in size at S4/S8. The view of the liver tumor was enhanced by CTHA image and washed out by CTAP image. It was suspected to have invaded the RHV and MHV. The pathological examination of the liver biopsy sample revealed cholangiocellular carcinoma or cholangiolocellular carcinoma. Hepatic arterial infusion chemotherapy with gemcitabine and cisplatin was performed. The size of the tumor reduced to 6. 0 cm and the invasion to the RHV was no longer evident. Hepatic resection for the middle two segments was performed after 3 months of chemotherapy. After a histological examination of the resected specimen, the patient was given the final diagnosis of cholangiolocellular carcinoma. Over 50% of the tumor was estimated as necrosis by chemotherapy, indicating that the gemcitabine and cisplatin regimen was remarkably effective. The patient is alive with no evidence of recurrence.

A 67-year-old male was admitted to Kagoshima University Hospital and received distal gastrectomy with D1 lymph node dissection under the diagnosis of early gastric cancer. Five years later, a retroperitoneal tumor 12 cm in diameter was detected by abdominal CT. Although the tumor was curatively resected, rapid recurrence was identified in the same retroperitoneal space. Chemoradiation therapy (radiation 50 Gy and bleomycin) for residual tumor was performed, but the tumor rapidly grew. The patient was given cisplatin (CDDP) and gemcitabine (GEM) following CPT-11 treatment. The recurred tumor was remarkably shrunken and completely regressed after eight courses of the chemotherapy. The retroperitoneal tumor was finally diagnosed as lymph node relapse from undifferentiated gastric cancer. This rare case of undifferentiated gastric cancer showed a complete lymph node response following combination chemotherapy of CDDP and GEM. Combination chemotherapeutic regime with CDDP and GEM seems to be useful for treatment of undifferentiated gastric cancer.

A 56-year-old man with abnormal chest X-P and stool occult bleeding was admitted. Colonoscopy detected rectal cancer and sigmoid al polyps. The biopsy results suggested that the rectal lesion was well- to moderately-differentiated adenocarcinoma and the sigmoidal polyp contained well -differentiated adenocarcinoma. CT scan revealed multiple lung, liver and lymph node metastasis. We judged the case to be inoperable and decided to start systemic chemotherapy (FOLFOX4). After treatment with chemotherapy, the tumor shrank and metastatic lesions disappeared. Low anterior resection was done, and final pathological examination revealed a complete response of the main tumor by treating with FOLFOX4.

A 64 -year-old female received oral S-1 chemotherapy followed by mFOLFOX6 chemotherapy for postoperative liver and lung metastasis of sigmoid colon cancer. The tumor progression was observed after twelve courses of mFOLFOX6 chemotherapy, and then FOLFIRI+bevacizumab chemotherapy was performed. After two courses of FOLFIRI+bevacizumab chemotherapy, leucopenia was observed. The chemotherapy was then discontinued and G-CSF was administered. Two days later she complained of high fever and dry cough, and was admitted to the hospital. A diffuse ground-glass appearance of bilateral lung was observed on chest X-ray and CT. Drug-induced interstitial pneumonitis was suspected, and Pneumocystis carini pneumonia was considered in the differential diagnosis. Oral administration of prednisolone and sulfamethoxazole/trimethoprim did not improve the symptoms, so steroid pulse therapy was performed. Steroid pulse therapy improved respiratory symptoms, but CT findings did not change remarkably. After nine weeks in the hospital, she was discharged with home oxygen therapy. Interstitial pneumonitis induced by FOLFIRI+bevacizumab chemotherapy is rare, but the number of cases may increase with increased use of this regimen. The possibility of interstitial pneumonitis should always be considered when the patient presents with a respiratory disorder while receiving systemic chemotherapy.

A 75-year-old woman underwent resection of gastrointestinal stromal tumor (GIST) of small intestine in 1999. In January 2006, she suffered liver dysfunction and abdominal CT revealed she had a large liver metastasis. At first the tumor in the right lobe progressed to the medial segment and seemed unresectable. She twice underwent transarterial embolization and treatment with 400mg/day of imatinib mesylate. Then percutaneous transhepatic portal embolization was performed. As a result, liver metastasis markedly decreased in size, and extended right lobectomy of the liver was performed in June 2006. A large portion of the liver metastasis showed necrosis, but histopathological examination revealed focal remnants of viable tumor cells. In March 2007, radiofrequency ablation was performed for recurrence of remnant liver. The patient has been treated by imatinib mesylate and is alive with no evidence of tumor recurrence.

A 46-year-old female was admitted to Kagoshima University Hospital with a complaint of epigastralgia and dysphasia. Gastrointestinal scopy revealed advanced gastric cancer in the upper third of the stomach. Pathological diagnosis of the biopsy specimen was moderately-differentiated adenocarcinoma. Abdominal CT suggested multiple liver metastases, so a combination of biweekly paclitaxel(PTX)and S-1 was started. After five courses of this regimen, the liver metastases and primary tumor were remarkably regressed. PTX was discontinued because of a grade 3 adverse effect of numbness. Nevertheless S-1 monotherapy for liver metastases resulted in a complete response. She has been well without tumor re-growth for 4 years. The combination of PTX and S-1 may be an effective regimen for gastric cancer with liver metastases.

We evaluated efficacy of biweekly paclitaxel and S-1 for advanced gastric cancer patients with liver metastases. A total of 14 patients had multiple liver metastases. None of whom received chemotherapy before the current regimen. The patients were given 80 mg-130 mg/m(2) of paclitaxel every two weeks and 80 mg of S-1 during the first two weeks. Chemotherapeutic efficacy for liver metastases was 50%. The 3-year-survival rate of the 14 patients was 50%, which was significantly higher than that of historical control patients (p<0.01). Two patients received gastrectomy with curative intent. Histological exploration revealed disappearance of liver metastases. In conclusion, biweekly paclitaxel+S-1 regimen was one of the promising therapies for advanced gastric cancer patients with liver metastases.

A 49-year-old male was admitted to Sendai Saiseikai Hospital with a complaint of upper abdominal pain. Perforative rectal cancer was diagnosed, and an emergency laparotomy was done. Transient colostomy and drainage for peritonitis were performed. Preoperatively rectal cancer was assessed to invade the sacral bone and prostate. A total of 50 Gy radiation therapy with low dose CDDP+5-FU chemotherapy was conducted for five weeks. Remarkable shrinkage of the tumor was found, and elective surgery for curative intent was done on April 2000. The tumor seemed to invade the adjacent tissues such as prostate and urine bladder, so extensive resection of the urine bladder and sacral bone was done in addition to abdominal perineal resection. Pathological exploration showed complete regression of the tumor and no tumor invasion to the prostate and sacral bone. He is well without tumor relapse. Once complete regression of the rectal cancer by chemo-radiation therapy has been achieved, relapse of the tumor was reported to be rare. Preoperative chemo-radiation therapy is an effective tool to control the advanced rectal cancer.

In the present article, we report the results of phase I/II combination chemotherapy study of biweekly paclitaxel and S-1 administration in patients with advanced gastric cancer. In the phase I study, we could determine the recommended dose for the phase II study with paclitaxel and S-1 to be 120 mg/m2 and 80 mg/m2, respectively. The side effect was not so severe. The overall response was 53%. In conclusion, biweekly paclitaxel and S-1 administration can be safely combined for the treatment of advanced gastric cancer. This combined therapy represents a novel and active treatment regimen with low toxicity and can be defined as safe and effective. Now we are analyzing the result of the phase II study.

Adenosquamous carcinoma of the esophagus is an uncommon type of esophageal tumor. In the present case, a 54-year-old man without symptoms was diagnosed with esophageal squamous cell carcinoma, based on endoscopic examination of a biopsy specimen. Endoscopy and barium roentgenography revealed a superficial plateau-type lesion, 2 cm in length, in the lower esophagus. Esophagectomy with lymphadenectomy was performed via a right thoraco-abdominal approach. The histological diagnosis was adenosquamous carcinoma with no lymph node metastasis. Three years after the surgery, multiple liver metastases were detected by computed tomography. The patient was treated with a combination of low-dose 5-fluorouracil(350 mg/body/day) and low-dose cisplatin (7 mg/body/day). Because the first course of chemotherapy was very effective and the number of liver metastases was reduced,a further 6 courses were administered. After 6 courses of chemotherapy, no liver metastases were detected. Based on the present findings, we recommend low-dose 5-fluorouracil/cisplatin therapy for liver metastasis from esophageal adenosquamous carcinoma.

A 74-year-old male was admitted to Sendai Saiseikai Hospital with a complaint of upper abdominal pain. Gastrointestinal fibroscopy showed type 2 gastric cancer in the lower third of the stomach,and distal gastrectomy and D 2 lymph node dissection were performed. Metastatic lymph node 8 a had severely infiltrated the pancreas, and pancreatoduodenectomy was required to complete the curative surgery. However, because of preoperative complications of interstitial pneumonia, metastatic node 8 a remained untreated. Postoperatively, radiation therapy (38 Gy plus a boost of 18 Gy) for residual lymph node metastasis was performed over a one-month period. The metastatic node underwent complete regression following radiation therapy, and the patient was discharged without any adverse effects. He received TS-1 medication as postoperative adjuvant therapy. Four years have passed since the complete regression of the lymph node,and the patient has shown no signs of relapse. Therefore, our case suggests that postoperative radiation therapy can be a useful tool for treatment of residual lymph node metastasis in gastric cancer.

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.

Twenty-one patients with hematopoietic malignancies including 6 previously untreated, 9 pretreated, and in relapse, 5 in complete remission and one in partial remission all were treated with PL-AC. The patients consisted of 12 acute myelocytic leukemias, 4 acute monocytic leukemias, 2 acute lymphocytic leukemias, one erythroleukemia, one malignant lymphoma and one chronic monocytic leukemia. PL-AC was given orally at a dosage of 50-1200 mg daily. Mean total dosage was 4.74 g (0.6-15.25), and the mean administration period was 3.43 days (1-122). days Responses were observed in 4 out of 9 pretreated patients by a decrease of blast cells in the peripheral blood. Partial remission was obtained in one case which lasted 8 months. Out of 5 previously untreated acute leukemias, one partial remission and 4 hematological responses were observed. The plasma concentration of Ara-C was maximal at 3 hours and was not detectable after 12 hours. Side effects observed were nausea in 5 patients vomiting in one patient and liver dysfunction in one patient. These side effects however were not so severe as to stop drug administration. PL-AC may be administered in doses ranged 150-250 mg for 2-3 weeks without any severe side effects, and with some clinical effects.

Forty-six cases with hematological malignancies were treated with vindesine sulfate (VDS); a new semisynthetic vinca alkaloid. Six cases with ALL, 5 cases CML in blastic crisis, 3 Hodgkin's disease (HD) and 4 non-Hodgkin's lymphoma (NHL) were treated with VDS alone. Five out of 6 cases ALL, 2 out of 5 CML in blastic crisis were induced into partial remission with VDS alone. All of 3 HD, and 4 NHL were induced in complete remission (CR) or partial remission (PR). Out of 5 cases AML in CR who received VDS as the maintenance therapy in combination with cyclophosphamide, 6-MP and prednisone, one case relapsed during the treatment, but other four cases maintained CR for 4 to 24 months. One case of APL in relapse, which was treated with VDS and 6-MP, reinduced into CR after one month. Out of 16 cases with malignant lymphoma treated by combination chemotherapy including VDS, eleven cases entered in CR or PR. Out of four cases in which the disease became refractory to vincristine (VCR) or vinblastine (VLB) clinically, two achieved PR. VDS was administered intravenously with 3 mg/body/week. When undesirable effect such as leucocytopenia was observed, the dose was reduced to 2-2.5 mg/body/week or 3 mg/body/2 weeks or month. Neurotoxicity (i.e. Paresthesia 21.7%), alopecia (21.7%), leucocytopenia (19.6%), constipation (10.9%) and fever (6.5%) were main side effects of VDS. The neurotoxicity of VDS, however, seemed far less intensive than VCR.