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A 78-year-old man was diagnosed as HER2-positive unresectable advanced gastric cancer(cT4aN3M1[LYM], Stage Ⅳ). After 2 courses of first-line chemotherapy(S-1 plus oxaliplatin plus trastuzumab), PR was achieved. The treatment could not be continued due to adverse events after 5 courses, thus second-line chemotherapy was conducted. Corresponding to the physical condition. The third-line chemotherapy was also introduced. However, we clinically judged PD because of amount of ascites and chemotherapy was terminated. After that, he has survived for more than 2 years without chemotherapy, and endoscopy and CT showed the disappearance of the tumor, metastatic lymph nodes, and ascites at 41 months after diagnosis. Looking back on the changes in tumor markers, it was possible that he had already achieved CR at the first-line chemotherapy.

A 78-year-old man was diagnosed with lymph node metastasis 2 months after surgery for gastric neuroendocrine carcinoma. He received chemotherapy(CDDP plus CPT-11)and showed partial response(PR)after 3 courses of the regimen. Serum CEA increased 5 months after surgery, thus nab-paclitaxel plus ramucirumab was administered. Although the lymph node kept shrinked after 2 courses of the regimen, the lymph node was detected 12 cm of the size in CT after 5 courses of the regimen. He started to receive nivolumab. The lymph nodes showed PR after 4 courses, and complete response after 6 courses of the regimen for 1 year and 4 months until now.

The study presents the case of a 71-year-old woman who visited a nearby hospital for epigastric pain and weight loss. A CT scan showed a mass in the gallbladder, and the CEA level was high, so she was referred to our hospital for further investigation. Abdominal US, CT, and MRI suggested gallbladder cancer with para-aortic metastasis, and the histological findings on the EUS-FNA confirmed the diagnosis. Since surgical resection was not indicated, chemotherapy was performed(gemcitabine plus cisplatin). After 10 courses of chemotherapy, CT and MRI showed downsizing of para-aortic lymph nodes, and no accumulation of FDG was found on FDG-PET. Confirming the downstaging of cancer, conversion surgery, comprising an extended cholecystectomy and a lymph node resection, was performed. The pathological diagnosis showed no lymph node metastasis. No recurrence was observed after 12 months of surgery. Initially, unresectable gallbladder cancer with para-aortic lymph node metastasis was indicated to be compatible with preoperative chemotherapy and conversion surgery.

A 52-year-old man underwent total gastrectomy for gastric cancer and chemoradiotherapy for thoracic paraaortic lymph node metastasis. He also underwent esophageal stent implantation for stenosis. He was admitted to our hospital with fever and breathing difficulty and was diagnosed with infectious pericarditis. He showed symptoms of shock due to cardiac tamponade. After pericardial drainage, his vital signs improved. When signs of infection are detected in patients with a history of chemoradiotherapy or stent implantation, we should consider infectious pericarditis due to esophageal pericardial fistula and apply immediate drainage of cardiac tamponade.

The patient was a 60-year-old man who underwent distal gastrectomy for gastric cancer. The pathological diagnosis was Stage ⅡB. He received adjuvant chemotherapy(capecitabine plus oxaliplatin: CapeOX)for 6months and the postoperative course was uneventful. One year and 3 months after surgery, he visited the outpatient department for acute lower back pain. Blood tests showed elevated ALP(3,752 U/L), LDH(308 U/L), and CA19-9(69.4 U/mL)levels. Bone scintigraphy showed multiple bone metastases to the femora, ischium, iliac bone, vertebrae, sternum, costae, and scapulae in a super bone scan. The onset of disseminated intravascular coagulation(DIC)was observed later. The patient was diagnosed with disseminated carcinomatosis of the bone marrow. Radiation therapy was performed and anti-RANKL monoclonal antibody was administered for the bone metastases. Recombinant human soluble thrombomodulin was administered for DIC. He received chemotherapy( TS-1 plus cisplatin: SP)but died 4 months after the diagnosis. The prognosis of disseminated carcinomatosis of the bone marrow is extremely poor. We report this case along with a literature review.

Malignant stricture and fistula of the esophagus and tracheobronchus adversely affect the quality of life(QOL)in patients with advanced esophageal cancer. Stenting is one ofthe therapies available for these patients. We investigated the outcomes ofesophagus and tracheobronchial stenting in our institution. Eight patients with advanced esophageal cancer underwent double stenting from 2010 to 2016. Among them, 4 patients underwent double stenting as planned. One patient underwent an emergency tracheal stenting because ofstenosis ofthe trachea caused by esophageal stenting. Three patients underwent tracheobronchial stenting later on because ofan increase in the tumor size after esophageal stenting. Dysphagia score was improved in 5(67.5%)out ofthe 8 patients. Respiratory symptoms were improved in all patients, and 4 patients(50.0%) were discharged. The median survival time after esophageal stenting was 70.5 days. Esophagus and tracheobronchial stenting for advanced esophageal cancer was useful for the improvement of the QOL.

Chemotherapy is performed for the recurrence of gastric cancer in many cases. We report a case of recurrent lymph node metastasis successfully treated with chemoradiotherapy and chemotherapy. A man in his 60s underwent total gastrectomy and D2 dissection in 2009. The pathological diagnosis was poorly differentiated adenocarcinoma, T4a, int, INF b, ly2, v2, LN#2: 2/3, #3: 1/4, #7, 8, and 9: 3/4, stage III B. Although we administered S-1/UFT as postoperative adjuvant chemotherapy, a strong rash appeared and the patient ceased chemotherapy. Eight months later, the rash had disappeared. We started chemotherapy with paclitaxel(PAC). CT performed 1 year postoperatively showed celiac lymph node(#9)metastasis. Chemoradiotherapy( RT+PAC)and additional CPT-11(98mg)and CDDP(49mg)treatment were administered. The lymph node (#9)was cicatrized after 8 cycles. Forty-two months after the end of treatment, the patient has had no recurrence. It is thought that chemoradiotherapy is an effective cure for local recurrence of gastric cancer.

An 80-year-old woman was treated with low anterior resection and D3 lymph node dissection for rectal carcinoid in August 2007. Pathological diagnosis was a tumor 23 × 22 mm in size with muscularis propria invasion, ly1, v0, n1 (No. 251[1/12]). Partial hepatectomy was performed for liver metastasis in March 2010 and September 2011. In June 2013, an isolated tumor of 17 mm in diameter was detected between the inferior vena cava and the stomach using abdominal ultrasonography. The tumor was diagnosed as pancreatic head lymph node metastasis using abdominal enhanced computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and positron emission tomography (PET); fluorodeoxyglucose (FDG) uptake was noted at the site of the tumor, but not at other parts of the body. Curative resection was the chosen treatment option. Open surgery was performed in September 2013, and a tumor 30 mm in diameter located at the ventral side of the inferior vena cava, lateral side of the portal vein, and cranial side of duodenum was resected. No surrounding tissue infiltration was found. Pathological analysis of the resected specimen indicated lymph node metastasis of the rectal carcinoid. The patient has been disease free for 9 months after surgery.

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.

A 63-year-old man visited our clinic with a chief complaint of a left axillary mass, and after a series of examinations, gastric cancer was diagnosed. Histopathological examination revealed a human epidermal growth factor receptor (HER)-2- positive( immunohistochemistry[ IHC], 2+; fluorescence in situ hybridization[ FISH], positive) poorly differentiated adenocarcinoma, and SPT therapy( S-1 at 120 mg/m2/day+cisplatin[ CDDP] at 60 mg/m2+trastuzumab at 8 mg/kg) was initiated. The primary lesion and swollen lymph nodes initially decreased markedly in size; however, the lymph node swelling worsened at 186 days( 6.2 months) after the initiation of treatment. Progressive disease( PD) was diagnosed, and SPT therapy was terminated. One cycle of S-1+docetaxel was administered as second-line therapy, but the regimen was changed to docetaxel monotherapy due to adverse effects. After 5 cycles of this treatment, the primary lesion had decreased in size and the lymphadenopathy disappeared. Positron emission tomography( PET)-computed tomography (CT) revealed fluorodeoxyglucose( F18)( FDG) accumulation only in the primary lesion, and therefore, with the patient's informed consent distal gastrectomy was performed approximately 14 months after the first treatment. The postoperative diagnosis was gastric cancer fStage IA (T1a, N0, and M0). Here, we discuss a case of HER2-positive gastric cancer with references. Among the advanced recurrent gastric cancers tested between April 2011 and February 2013, 16.4% (11/67) were HER2-positive.

We report herein a long-term survival case of liver metastasis after distal gastrectomy for gastric cancer. A 72-year-old woman, whom we performed distal gastrectomy with D2 lymph node dissection for type 2 gastric cancer at age 66, was diagnosed as pT2N1M0, stage II. No adjuvant therapy was performed. Liver metastasis was found 1 year and 7 months after surgery. PTX plus CPT-11 was performed. Six courses of therapy were done, and found cCR in the liver metastasis. A total of 23 courses of therapy were done. A recurrence of liver metastasis was found, transcatheter arterial chemoembolization (TACE), radiofrequency ablation( RFA)and operation were performed. She received S-1 plus CDDP, and cCR has been maintained for 6 years and 11 months after gastrectomy (5 years and 4 months after liver metastasis) suggesting that the interdisciplinary therapy was effective.

A patient is a 62-year-old man who was presented by epigastralgia. He was pointed out super advanced gastric cancer with paraaortic lymph node metastasis and pancreatic invasion by gastrointestinal endoscopy (GIS) and computed tomography (CT). We diagnosed as cT4N3M0, and started with chemotherapy as follows. S-1 (120 mg/day) was orally administered for 3 weeks followed by 2-week rest as one course, and CDDP (90 mg/body)was administered by intravenous drip on day 8. Partial response was indicated after 6 courses of this procedure. We changed the procedure to S-1 single treatment for 2 weeks followed by 2-week rest. After 12-course of this procedure, he was attacked by brain infarction, the procedure was interrupted for about 8 months. After rehabilitation, an S-1 single treatment was restarted. The main tumor and metastatic lymph node appeared no change before the interruption of S-1 single treatment. So, we considered that complete response was continued. S-1+CDDP and S-1 single regimen appears to be effective for super advanced gastric cancer.

A 40s male was performed proximal gastrectomy with D1+alpha dissection and interposition reconstruction for type 1 esophago-gastric junctional cancer in January 2002. Pathological findings were as follows: pap, se, ly0, v0, n1 (#3, 1/9) stage IIIA, curability B. Adjuvant chemotherapy by 5'-DFUR (800 mg/day) was done for 1 year. Bilateral pulmonary metastasis was detected in left S6 (3.8 cm) and right S10 (3 cm) in February 2006. After S-1 (120 mg/day) was administered for 4 courses, right pulmonary metastasis had become scar, and the other was remained and growing. S-1 (100 mg/ day 1-21)+CPT-11 (120 mg div day 1, 15) was done for 6 courses. However, the tumor was growing. As no other lesions but left pulmonary metastasis in S10, radical thoracoscopic left lower lobectomy with ND1 lymph node dissection was performed. Pathological finding was pulmonary metastasis from gastric cancer with no lymph node metastasis. There were no recurrences observed in May 2009 since gastrectomy was done 7 years ago, and 3 years since pulmonary metastasis was detected.

The first case is a man in his 30s with gastric cancer, of which clinical finding was T3N0M0P0M0 (Stage II), underwent a distal gastrectomy with D2 lymphadenectomy. CY1 was detected during the operation and the final findings was T3N2M0H0P0CY1 (Stage IV). After the operation, we administered 120 mg/day of S-1 for 38 months and the patient remains alive for 6 years and 2 months. The second case is a man in his 20s with gastric cancer, of which clinical finding was T3N0M0P0M0 (Stage IIIa), underwent a distal gastrectomy with D2 lymphadenectomy. CY1 was detected during the operation and the final findings was T3N2M0H0P0CY1 (Stage IV). After the operation, we administered 120 mg/day of S-1 for 13 months and the patient remains alive for 6 years and 2 months. A combination gastrectomy with D2 lymphadenectomy and postoperative chemotherapy was considered to be a radical treatment for CY1, Stage IV 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.

The patient was a male in the sixties who received interferon therapy against hepatitis C. At first, the patient was pointed to having an increased alpha fetoprotein (AFP) level of 1104 ng/ml. Partial hepatectomy was performed against hepatocellular carcinoma (HCC) (segment 3, 44 mm in diameter) and diagnosed by further exams. The serum AFP level decreased to a normal range after hepatectomy for the time being. A rapid elevation of serum AFP level (11,293 ng/ml) was observed nine months after the surgery. No evidence of recurrence in the intra- and extra hepatic organs such as adrenal gland, lung, bone, and brain except for intra abdominal solitary lymph node metastasis was observed. Then the metastatic lymph node was removed surgically. After the removal of the lymph node, the serum AFP level decreased within a normal limit immediately. This patient currently survives without the disease for 30 months after the initial operation, and for 19 months after a resection of the meatastatic lymph node.

The patient was a 55-year-old female who underwent an abdomino-perineal resection for advanced lower rectal cancer. The tumor was a well differentiated adenocarcinoma, type 2 in the Japanese classification of colorectal carcinoma, and was measured 2.3 cm in size. Histologically, the tumor was considered to be stage IIIb (mp, n3(+), P0, H0, M(-)). She received adjuvant chemotherapy with 5'-DFUR. After 13 months from the surgery, the patient developed a hip pain. After 16 months from the surgery, a pelvic MRI scan revealed a 3 cm tumor in the perineum. Biopsy from the tumor revealed adenocarcinoma. Consequently, we diagnosed local recurrence in the perineum. Chemotherapy with CPT-11 (230 mg/body) and 5'-DFUR (800 mg/body) was administered for 2 cycles. Because the tumor was enlarged, high-dose rate interstitial brachytherapy was given to the recurrent site at a total dose of 54 Gy/9 fractions/5 days. There were no severe complications. CEA was decreased within normal range from a maximum of 9.3. No progress was detected on CT and MRI, and the hip pain had disappeared. The tumor marker is within normal range for about 2 years and QOL was improved. Hence, high dose rate interstitial brachytherapy appears to be effective for locally recurrent rectal cancer.

The patient was a 69-year-old male. He had a 2-year history of subcutaneous tumor in the left axilla. Biopsy of the tumor showed the features of metastatic adenocarcinoma. FDG PET to check the primary lesion revealed the collection of an ileocecal junction and left axilla. After CT scan and colonoscopy, we diagnosed cecal cancer and metastasis of the axillary lymph nodes from it. He underwent ileocecal resection and a wide local resection of the axillary tumor. Histopathological examination showed the axillary tumor was different from the cecal cancer. Axillary tumor was diagnosed not as metastasis of axillary lymph nodes from cecal cancer but apocrine adenocarcinoma.

A 54-year-old woman complained of dyspnea, due to complete obstruction of the left main bronchus caused by recurrent esophageal carcinoma, was transferred to our department about two months after curative resection (with preoperative chemotherapy for T4 cancer) in July 2004. She suddenly developed a severe shortness of breath with anxiety, and arterial blood gas analysis revealed a PaO2 of 25 mmHg (FiO2 1.0). The presence of pulmonary embolism was diagnosed by pulmonary perfusion scintigraphy. Thrombolytic therapy with urokinase was started to keep the air way. Fogarty catheter and bronchoscopic Nd-YAG laser treatment was performed. After that, an expandable metallic stent (EMS) was placed at the site of obstruction without any troubles, and there was a striking improvement in her condition of respiration and atelectasis. The radiation therapy was initiated and completed safely. The tumor lesion had disappeared on CT scan after the radiation therapy (a total dose of 50 Gy). We experienced a case that could be rescued from an advanced respiratory failure caused by one side air way obstruction and another side's blood circulation disorder.

The patient was a 64-year-old female who underwent an abdomino-perineal resection for advanced lower rectal carcinoma. The tumor was a mucinous adenocarcinoma, type 2 in the Japanese classification of colorectal carcinoma, and was measured 4.5 cm in size. Histologically, the tumor was considered to be stage II (a2, n1, P0, H0). She received adjuvant chemotherapy with 5-FU/LV. After 7 months from the surgery, the patient developed a hip pain. Pelvic CT scan revealed a 4.5 x 6.0 cm mass anterior to the sacrum. Consequently, a diagnosis of local recurrence with sacrum invasion was made. An operation, involving tissue expander placement in the pelvis and pelvic floor was made by dexon mesh, was performed. Radiotherapy was given to the pelvic region at a total dose of 65 Gy (given 2.5 or 3 Gy each x 25 fragments). Chemotherapy with CPT-11 (100 mg/body) and 5'-DFUR (800 mg/body) was administered for 3 cycles. CEA (ng/ml) was decreased within a normal range from maximum 13.8. No progression was detected on CT, and Hip pain had disappeared. Abscess in the pelvis by tumor necrosis was managed conservatively. In this case, tumor marker is within a normal range over 2 years and QOL was improved, suggesting that chemoradiation with a tissue expander may be effective.

This case is about a male in his 50's. In May 2004, he consulted a nearby doctor with abdominal pain and was pointed out a huge mass in the liver. He was diagnosed as hepatocellular carcinoma over 10 cm in diameter with chronic hepatitis type B. Because the tumor concurred with intra-hepatic metastasis along with lymph node metastasis, we planned transhepatic arterial embolization (TAE) as a first choice of treatment and performed twice. However, because of the tail inside part of the tumor was supplied from the gastroduodenal artery (GDA) and right gastroepiploic artery (RGEA) which were nutrient arteries, an effective TAE was impossible. The enhancement lesion that seemed viable was shown by enhanced CT. Therefore, a wrapping therapy (surgical decollateralization+silicon membrane sheeting) was performed under laparotomy for the purpose of cutting off blood supply to the part of the viable lesion in August of the same year. The tail inside part of the tumor that seemed viable fell into necrosis by wrapping alone, and the serum PIVKA-II level decreased within normal limit. As of ten months after the treatment, the patient is still alive without aggravation.