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A 76-year-old woman with tarry stool was referred to our hospital for further examination. Contrast-enhanced computed tomography(CT)revealed a heterogeneous 15 cm tumor located in the left upper abdominal cavity. The tumor had a rich vascularity and was associated with intra-abdominal bleeding. Gastroscopy showed a large submucosal tumor in the gastric body. A biopsy was performed, and the patient was diagnosed with a c-kit-positive gastrointestinal stromal tumor(GIST)of the stomach. Imatinib mesylate(400mg/day)was administered for 6 months. Vascularity in the tumor was diminished and no new lesion had emerged, although there was no remarkable reduction in tumor size. The patient underwent partial gastrectomy and splenectomy with curative intent. She is currently alive 1 year and 4 months after surgery with no evidence of recurrence.

A 72-year-old man visited our hospital because of dysphagia and weight loss. He was diagnosed by endoscopy with advanced (stage IV) basaloid squamous carcinoma of the thoracic esophagus. CT and CT-guided tumor biopsy revealed two lung metastases in the right upper and lower lobes, with diameters of 8 and 5 mm, respectively. The primary lesion disappeared after concurrent chemoradiotherapy consisting of 5-FU, cisplatin, and 60-Gy irradiation, which was administered for palliation of obstructive and hemorrhagic symptoms. Subsequently, eight cycles of chemotherapy were administered, resulting in a reduction in size of the metastases. However, multiple cycles of chemotherapy caused prolonged toxicity, and the metastases slightly enlarged during chemotherapy-free periods. Since the number of metastases did not change, stereotactic body radiotherapy was performed, which resulted in disappearance of the lung metastases. Five years following initial diagnosis, the patient has been doing well, with no signs of disease recurrence.

In a group of 209 colorectal cancer patients with unresectable tumors, 10 patients underwent curative resection after combination chemotherapy at our hospital between 2006 and 2012. Of these 10 patients, 5 presented with peritoneal dissemination at the start of chemotherapy. With the exception of 1 patient with peritoneal recurrence, peritoneal dissemination and liver metastasis were observed in all patients at the time of diagnosis of colorectal cancer. Computed tomography (CT) and/ or positron emission tomography-CT examination revealed disappearance of peritoneal dissemination in response to chemotherapy, except in 1 patient with peritoneal recurrence. After combination chemotherapy, surgical resection of liver metastases and peritoneal dissemination was performed. Pathological and intraoperative findings indicated disappearance of peritoneal dissemination in 3 patients and P2 grade peritoneal dissemination in 1 patient. In the patient with peritoneal recurrence, 1 tumor was completely resected. Interestingly, none of the 3 patients that exhibited complete disappearance of peritoneal dissemination showed peritoneal recurrence, although 1 patient exhibited metastases in the lung and non-regional lymph nodes. In contrast, the patient with P2 grade peritoneal dissemination showed peritoneal recurrence and lung metastasis. All 5 patients survived (duration from diagnosis of colorectal cancer, 31-83 months). Herein, we report the use of combination chemotherapy to achieve the disappearance of peritoneal dissemination, changing unresectable colorectal cancer with peritoneal dissemination into resectable cancer.

A questionnaire survey on postoperative adjuvant chemotherapy for gastric cancer was conducted for 76 hospitals affiliated with the Hiroshima Oncology Group of Gastric Cancer in Hiroshima prefecture in January 2011. Responses were obtained from 29 hospitals, including 12 core cancer treatment hospitals, and the following results were obtained. The percentage of patients completing 1 year of oral S-1 was >70%, affecting approximately 75% of the entire hospital cohort. Dose reduction was conducted in approximately 30% of patients because of age, poor PS, and renal insufficiency. The standard S-1 regimen (4 weeks of S-1 treatment followed by 2 weeks of rest)was adopted in almost half of the patients, whereas the rest of the patients received another treatment schedule such as 2 weeks of treatment followed by 1 week of rest. Dose reduction and withdrawal of S-1 due to adverse events were conducted more frequently in hospitals with low completion rates of 1-year S- 1 treatment than those with a high completion rate. S-1 was most commonly discontinued because of subjective adverse events and patient request, although the discontinuation rate according to objective adverse events such as bone marrow depression was not very high. The fact that some hospitals had high completion rates suggested the importance of supplementary tools for patient IC.

The intravenous or subcutaneous route is a useful option for administering opioids when cancer patients with moderate to severe pain are unable to take oral medication. An injectable form of oxycodone is now available, and three patients with cancer-related pain were treated successfully with continuous intravenous or subcutaneous oxycodone. The first case showed transient switching from oral oxycodone to the parenteral form during the active treatment phase, resulting in satisfactory pain management. The second case suggested that oxycodone may have a more favorable analgesic profile in severe neuropathic cancer pain compared with fentanyl. Finally, the third case demonstrated that oxycodone injection is relatively safe for renal-impaired patients.

Aim: The Hiroshima Oncology Group of Gastric Cancer(HOG-GC)distributed a multiple-answer questionnaire to investigate the realities of chemotherapy for gastric cancer., Subjects and Method: Seventy-six hospitals in Hiroshima were surveyed. The Japanese classification was used for the staging criteria., Results: Forty-one hospitals, including 10 centers for cancer treatment, completed and returned the questionnaires. For stage II & III cases requiring adjuvant chemotherapy, S-1 was the most commonly used(84%)regimen. A standard starting dose was used in 79% of these cases, and S-1 was administered for one year continuously in 84% of the cases. For stage I B & II (T1), S-1 and UFT were used in 45%and 20%of the cases, respectively. In cases with non-resectable gastric cancer, S-1 plus CDDP and S-1 alone were used as a first-line therapy in 62% and 26% of the patients under 75 years age, respectively, and in 33% and 46% of the patients older than 75 years of age, respectively. In patients with ascites and peritoneal dissemination, S-1 plus CDDP, S-1, S-1 plus DTX, S-1 plus PTX, and PTX were used in 26%, 15%, 21%, 17%, and 17% of cases, respectively. Some of the patients with peritoneal dissemination underwent gastrectomy., Conclusion: S-1 was widely used for gastric cancer chemotherapy in Hiroshima Prefecture. Taxane-containing regimens or palliative gastrectomy were commonly used in cases with peritoneal dissemination.

A 66-year-old man was referred to our hospital because of a two-week history off ever and low back pain. There was a hard anal mass on rectal examination. Colonoscopy and computed tomography showed anal adenocarcinoma, multiple metastases to lymph nodes and bones. Blood test showed severe disseminated intravascular coagulation (DIC). Microscopic examination of the bone marrow aspirate revealed disseminated carcinomatosis of the bone marrow. Systemic chemotherapy (mFOLFOX6) was started, then remission of DIC and shrinkage of the tumor were observed. Although the patient had cerebral infarction during the first course of chemotherapy, he received nine courses of treatment. He died six months later because of cerebellar hemorrhage.