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We evaluated a surgical resection and chemo-endocrine therapy and prognosis for patients with local recurrence or axillary lymph node metastasis of breast cancer. Twenty-one patients with local recurrence or axillary lymph node metastasis without a distant metastasis were enrolled in this study. Thirteen of the 21 patients underwent a surgical resection. Resection of recurrent lesion in residual breast after breast conserving therapy for six of the 13 patients, axillary lymph node dissection (ALND) for four, and resection of thoracic wall lesion for three were performed. Five of the patients who underwent resection of residual breast lesion, four of the patients who underwent ALND and two of the patients who underwent resection of thoracic wall lesion have survived. One of the patients who underwent resection of residual breast lesion and one of the patients who underwent resection of thoracic wall lesion were dead. In eight non-operable patients, five were dead and three have survived. Median recurrence free interval was 24 months in operable patients and 27 months in non-operable patients. Median survival time after recurrence was 29 months in operable patients and 12 months in non-operable patients. The surgical with chemo-endocrine therapy promises to control well to local recurrence or axillary lymph node metastasis for the patients we selected.

We report two patients having recurrent breast cancer with brain metastases that was controlled well with a gamma knife radio-surgery. The patient is a 50-year-old woman. She underwent radical mastectomy for right breast cancer in September 1993. She suffered from multiple liver metastases in June 2000, so CEF therapy contained hepatic arterial infusion chemotherapy, and extended right lobectomy of the liver were performed in December 2001. Afterward, pleurodesis was carried out to the carcinomatous pleurisy. Then she underwent simple total hysterectomy and bilateral oophorectomy for torsion of the metastatic ovarian tumor. MRI study revealed brain metastases with a diameter of 1 cm in her right midbrain in April 2005, so a gamma knife radio-surgery was performed. After the radio-surgery, a weekly paclitaxel therapy followed by peroral chemotherapy with capecitabine was started, and she took the regimen continuously. Another patient is a 56-year-old woman. She underwent skin sparing mastectomy with axillary lymph node dissection for right breast cancer in November 2002. Metastases to the base of her skull were found in October 2004, so a gamma knife radio-surgery was carried out. After the radio-surgery, a weekly paclitaxel therapy with anastrozole was started. In both of the two patients, the metastatic brain tumors have not shown growth so far and are under good control as of March 2006.

A 73-year-old man underwent partial hepatic resection (55) for metachronous metastatic liver tumor from cecal cancer in November 2005. A reservoir port for hepatic arterial infusion (HAI) adjuvant chemotherapy was placed in the right femoral artery and the HAI chemotherapy was carried out. In January 2006, he had swellings of the right lower leg and inguinal region and was admitted to our hospital for a hematoma in the site of the reservoir port and deep venous thrombosis. The swelling of the right lower leg went down with a bed rest in a couple of days. However, the hematoma of the reservoir port site was increased. The hematoma was removed and sutured to stop bleeding and then compression homeostasis was applied for a week. An enhanced pelvic CT scan showed a pseudoaneurysm in the femoral artery and an impending rupture was suspected. He was immediately referred to a vascular surgeon and underwent emergency surgery. Intraoperative angiography showed a pseudoaneurysm, 2.5 cm in diameter, in the femoral artery. An approximate 1 cm tear around the catheter insertion site was found and a primary suture was performed. A rapid diagnosis and treatment are required when a pseudoaneurysm is suspected during HAI chemotherapy.

The importance of chemotherapy in the treatment of gastric cancer has increased after the appearance of more effective new agents such as TS-1. Therefore, the development of second line chemotherapy following TS-1 administration is needed urgently. Recently, we treated three cases of advanced and recurrent gastric cancers, using paclitaxel after TS-1 treatment. We herein describe these cases and discuss the therapeutic effect of paclitaxel and drug-related side effects in these patients.