Search

Multiple lymphomatous polyposis (MLP) is an uncommon type of gastrointestinal lymphoma characterized by the presence of multiple polyps along the gastrointestinal tract. Most of this entity is in fact considered the counterpart of gastrointestinal tract involvement for mantle cell lymphoma (MCL). To our knowledge, there have been no reports on [fluorine-18]-fluorodeoxy-glucose ((18)F-FDG)-positron emission tomography (PET)/computed tomography (CT) imaging for gastrointestinal MCL with MLP. We present the results of (18)F-FDG PET/CT imaging in a patient with gastrointestinal tract involvement of MCL showing continuous MLP from the stomach to the rectum and intestinal intussusception. FDG-PET/CT findings were false negative in typical MLP spreading widely over the gastrointestinal tract, but uptake was noted in large lesions with deep infiltration considered atypical as MLP. On FDG-PET/CT imaging, the Ki-67 proliferative index, which is a cell proliferation marker, showed neither correlation with the presence of uptake nor the maximum standardized uptake value.

A 71-year-old man receiving maintenance dialysis because of diabetic nephropathy presented with hematemesis at another hospital in January 2008. A gastrointestinal endoscopy demonstrated a II a-like lesion in the angle of the stomach, and he was admitted to our hospital. A diagnosis of gastric adenocarcinoma (cT2N2M0, Stage IIIA) was made. An operation could not be performed because of the high risk, so combination chemotherapy with 5-FU and l-LV was initiated. After 3 courses of treatment, the size of the primary tumor was markedly reduced. After 6 courses, the primary lesion had changed to a scar, and an endoscopic biopsy revealed no cancer cells. His performance status did not deteriorate, and no serious adverse events occurred during the course of treatment. Chemotherapy was continued because the overall response was SD. 5-FU/l-LV therapy should be considered as a safe and useful treatment for a hemodialysis patient with advanced gastric cancer.

Background: Phase I/II clinical trials of S-1 plus cisplatin for advanced gastric cancer have yielded good responses and the treatment was well tolerated. In this S-1 Plus cisplatin versus S-1 In RCT In the Treatment for Stomach cancer (SPIRITS) trial, we aimed to verify that overall survival was better in patients with advanced gastric cancer treated with S-1 plus cisplatin than with S-1 alone., Methods: In this phase III trial, chemotherapy-naive patients with advanced gastric cancer were enrolled between March 26, 2002, and Nov 30, 2004, at 38 centres in Japan, and randomly assigned to S-1 plus cisplatin or S-1 alone. In patients assigned to S-1 plus cisplatin, S-1 (40-60 mg depending on patient's body surface area) was given orally, twice daily for 3 consecutive weeks, and 60 mg/m(2) cisplatin was given intravenously on day 8, followed by a 2-week rest period, within a 5-week cycle. Those assigned to S-1 alone received the same dose of S-1 twice daily for 4 consecutive weeks, followed by a 2-week rest period, within a 6-week cycle. The primary endpoint was overall survival. Secondary endpoints were progression-free survival, proportions of responders, and safety. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00150670., Findings: 305 patients were enrolled; seven patients were ineligible or withdrew consent, therefore, 148 patients were assigned to S-1 plus cisplatin and 150 patients were assigned to S-1 alone. Median overall survival was significantly longer in patients assigned to S-1 plus cisplatin (13.0 months [IQR 7.6-21.9]) than in those assigned to S-1 alone (11.0 months [5.6-19.8]; hazard ratio for death, 0.77; 95% CI 0.61-0.98; p=0.04). Progression-free survival was significantly longer in patients assigned to S-1 plus cisplatin than in those assigned to S-1 alone (median progression-free survival 6.0 months [3.3-12.9] vs 4.0 months [2.1-6.8]; p<0.0001). Additionally, of 87 patients assigned S-1 plus cisplatin who had target tumours, one patient had a complete response and 46 patients had partial responses, ie, a total of 54% (range 43-65). Of 106 patients assigned S-1 alone who had target tumours, one patient had a complete response and 32 had partial responses, ie, a total of 31% (23-41). We recorded more grade 3 or 4 adverse events including leucopenia, neutropenia, anaemia, nausea, and anorexia, in the group assigned to S-1 plus cisplatin than in the group assigned to S-1 alone. There were no treatment-related deaths in either group., Interpretation: S-1 plus cisplatin holds promise of becoming a standard first-line treatment for patients with advanced gastric cancer.

Background: Deletion or shortening of chromosomal telomeres is associated with cellular aging and carcinogenesis. Telomeric sites are interstitially located in chromosomes. To clarify the frequency of telomerase abnormalities in cancer and their relationship with any characteristics of gastric carcinomas, telomeric aberrations in eleven cultured specimens of human gastric cancer were investigated by cytogenetic analysis., Materials and Methods: Chromosomal metaphase specimens, obtained by primary culture of cells from surgical specimens of eleven gastric cancer patients, were examined by fluorescent in situ hybridization (FISH) using all telomeric and chromosome 17 specific-telomeric DNA probes. The number of telomeric signals and interstitial telomeric signals (ITS) were counted. DNA ploidy was examined by flow cytometry., Results: The mean telomere signal per nucleus (MTS) observed in peripheral blood lymphocytes (PBLs) of normal volunteers (n=10) was 71.3+/-3.9%. The MTS in the carcinoma cells (46.9+/-2.6%) was significantly lower than in PBLs (p<0.01). Although ITS were not observed in PBLs, the mean rate of ITS was 41.2+/-22.0%, and the mean rate of ITS per chromosome was 2.1+/-2.1% in the cancer specimens. In DNA aneuploid carcinoma cells, the MTS was significantly lower, the mean rate of ITS tended to be higher (p=0.072), and the mean rate of ITS per chromosome was significantly higher (p<0.05), than in DNA diploid lymphocytes. Histologically, the mean rate of ITS per chromosome in carcinomas with venous infiltrations was significantly greater than in those without (p<0.05)., Conclusion: Deletion and interstitial translocation of telomeric loci of chromosomes were frequent alterations in gastric carcinoma cells and increased numbers of interstitial telomeric signals were associated with venous invasion.

The safety of chemotherapy combining TS-1 and pirarubicin (THP) for treatment of recurrent or locally advanced gastric cancer was evaluated. THP was administered by intravenous drip infusion at a dose of 14 mg/m2 every other week. TS-1 was administered orally at a dose of 40 mg/m2 twice a day for 2 weeks followed by 2 weeks of rest (level 1), for 3 weeks followed by 2 weeks of rest (level 2), and for 4 weeks followed by 2 weeks of rest (level 3). Three patients were treated with the level 1 schedule. One patient with peritoneal dissemination received 22 courses of the treatment, and benefited from a long-term NC. However the remaining 2 cases were diagnosed as PD after 4 courses and were withdrawn from further treatment. Two patients in this group suffered from grade 2 adverse events according to the NCI-CTC. Only 1 patient who had liver metastasis was treated at level 2. Fourteen courses were administered, and a PR was achieved while grade 2 adverse events were observed. One of 3 patients who were treated with level 3 had grade 3 adverse events. Consequently, 3 more cases were added to this dose level, and no additional grade 3 adverse events were observed, while grade 2 adverse events were seen in 4 cases. Urinary urgency had completely disappeared in 1 patient with peritoneal recurrence. Myelosuppression, which was the main observed adverse event, was well controlled and of brief duration. The response, including alleviation of clinical symptoms, was confirmed in 3 of 5 chemo-naive patients.

A 64-year-old man underwent gastrectomy and partial liver resection for gastric cancer and liver metastasis, and was administered intra-arterial infusion chemotherapy for metastases of the remnant liver. This treatment was very effective against the liver metastases, but 13 months after the operation obstructive jaundice occurred. An examination revealed obstruction of the bile duct and choledocholithiasis. The choledocholithiasis was treated using a percutaneous transhepatic cholangio-scope, and choledocho-duodenostomy was performed for the obstruction of the bile duct. Findings from the operation suggested that the obstruction was caused by the intra-arterial infusion chemotherapy. At present, 2 years after the first operation, the patient is alive without the regrowth of the liver metastasis.

We evaluated the effects of intra-arterial infusion chemotherapy for liver metastases and lymph node metastases of gastric cancer. Of 410 patients undergoing gastrectomy in our department from July 1993 to December 2000, 29 (7.1%) had liver metastases. Intra-arterial infusion chemotherapy was carried out for 15 patients with liver metastases and 10 patients with lymph node metastases. There were 11 patients with liver metastases evaluated as follows: PR 5, NC 2, PD 4. Two patients with lymph node metastases were PR. In a comparison between the intra-arterial and non-intra-arterial chemotherapy group, it was observed among the patients with synchronous liver metastases that the survival period of the intra-arterial group was significantly longer than that of the non-intra-arterial group (p = 0.0164 logrank test). On the supposition that the survival period is counted from the day of computed tomography metachronous liver metastases was detected, in all liver metastases patients, the survival period of the intra-arterial group was significantly longer (p = 0.0212 logrank test). These results showed that the intra-arterial infusion chemotherapy is a useful treatment for gastric cancer patients with liver metastases.

We used fresh materials and paraffin blocks of advanced gastric cancer to examine the relationship of DNA ploidy pattern from flow cytometry (FCM) to degree of malignancy and prognosis. No significant relationship was found between the frequency of DNA aneuploid (DA) and the clinicopathological factors (depth of invasion, degree of progression, histological type, lymph node metastasis, ly, v etc.). FCM examination using fresh materials revealed significant difference in prognosis between the non-DA and DA groups for non-curative stage III or IV cases (p < 0.05). On the other hand, in terms of the relationship between DNA ploidy patterns from paraffin blocks and prognosis for curative resection cases of ss-gastric cancer, prognosis was significantly better in the non-DA group than in the DA (p < 0.01). These results indicate that the clinicopathological prognostic factors for gastric cancer are connected in a complex way and that DNA ploidy patterns alone are not superior to the prognosis determining factors used in the past.

A 56-year-old man who had undergone curative gastrectomy for Borrmann 2 type gastric cancer 43 months before, had a cancer recurrence (liver metastasis and peritoneal dissemination). Intra-arterial hypertensive chemotherapy with MMC for liver metastasis and intra-arterial sequential MTX/5-FU chemotherapy for peritoneal dissemination were given. He died of lung cancer with brain metastasis 27 months after this therapy. But in autopsy the remarkable effects of chemotherapy were recognized in intra-abdominal recurrent sites, and in fact, microscopically no cancer cells were found in metastatic lesions. We thus concluded that intra-arterial noradrenaline-induced hypertensive MMC therapy for liver metastasis and intra-arterial sequential MTX/5-FU therapy for peritoneal dissemination were useful treatment.

To prevent dissemination to the peritoneum following surgery for gastric cancer, examinations were performed with mouse ascites cancer models and the objective of enhancing the combined effect of MMC, CDDP and 5-FU. Pharmaceutical dosage was set at approximately 30% of the increased life span (ILS) for Meth-A. The dosage was 0.2 mg/kg for MMC, 1 mg/kg for CDDP and 37.5 mg/kg for 5-FU. Results indicated that simultaneous combination of 0.2 mg/kg of MMC and 1 mg/kg of CDDP extended life significantly more than individual administration, and clinical application of this combination was considered to be possible. In contrast, simultaneous combination of 1 mg/kg of CDDP and 37.5 mg/kg of 5-FU had no clear life-extending effect compared to individual administration of each. Some biochemical modulation of the administration method was thus considered necessary.

Eighty-one cases of advanced gastric cancer, who had been treated by intra-arterial infusion chemotherapy, were examined for complications related to catheter indwelling. Subjects consisted of 46 cases of aortic cannulation (via femoral artery, 29; via subclavian artery, 17) and 35 cases of hepatic cannulation (via laparotomy, 29; via subclavian a, 6). As the result, complications were more frequent in the cases via femoral (24.1%) and via laparotomy (41.4%), whereas there was only one case in subclavian route. Six cases (67%) of dislocations developed within one month after cannulation and occlusions (8 cases) were often found in cases of one shot or non-injection. In conclusion, cannulation via subclavian artery is an excellent method.

Four patients with hepatic metastasis of gastric cancer (one synchronous, three metachronous), received intraarterial noradrenaline-induced hypertensive chemotherapy. The outlet of the indwelling catheter was placed in the proper hepatic artery in two patients, in the thoracic aorta in one patient and in both places in one patient. When the systolic blood pressure rose 50 percent above the level in the untreated state, mitomycin C via the catheter was administered for 10 minutes. Partial remission was found in 2 patients, NC in one patient and PD in another. One patient showing PR died of a relapse of hepatic metastasis 8 months after treatment. Another patient with PD died of multiple bone metastases after 12 months. The two other patients are alive 19 months after treatment. Intraarterial noradrenaline-induced hypertensive chemotherapy is one of the useful treatments of choice for hepatic metastasis of gastric cancer.

Early gastric cancer composed of signet ring cell carcinoma is usually present as a depressed lesion and rarely manifests as a protruding lesion. To our knowledge, only eight cases have been reported in the literature. We herein report such a rare lesion which developed in an asymptomatic 55-year-old man.

We used treatment with intra-arterial injection in cases of liver and peritoneal metastasis in progressive or recurrent gastric cancer patients. The investigation of the relationship between efficiency of therapy and survival period was evaluated. The effective rate of sequential treatment of peritoneal metastasis with MTX.5-FU in 34 cases was 35.3%, while that of liver metastasis with MMC combined with DSM in 12 cases was 50%. Although the effective rate among 16 cases treated with MMC.5-FU combined with Angiotensin II was 50%, no effect was recognized in the groups treated with AF and MF. In cases of peritoneal metastasis with MTX.5-FU, the prognosis PR cases was significantly better than that of NC.PD. For treatment of liver metastasis with MMC combined with DSM and MMC.5-FU combined with Angiotensin II, the PR prognosis was unsatisfactory and the survival period did not significantly improve compared with that of NC.PD. In future cases of liver metastasis, these results indicate the extreme difficulty in maintaining therapy and controlling the lesion after PR. We speculated that sequential treatment of peritoneal metastasis with MTX.5-FU was useful because it significantly extended the survival period in PR cases.

Sequential low-dose Methotrexate.5FU therapy was conducted on a total 52 cases of advanced or recurrent gastric carcinoma. Intra-aortic infusion therapy was performed in 31 cases and intravenous administrative therapy was employed in the remaining 21 cases. The two groups were compared in terms of the response rate and side effects. Thirty mg/m2 of Methotrexate (MTX) was given by bolus injection into the aorta or venous route, followed by 500 mg or 750 mg of 5FU by bolus injection 3 hours later. Twenty four hours after the injection of MTX, 30 mg of Leucovorin was given intravenously or orally. The major lesion of intra-aortic infusion group was primary site (stomach) in 10 cases, peritoneum and digestive tract in 9 cases, Douglas' pouch in 5 cases, liver in 3 cases, abdominal wall in 2 cases and retro-peritoneal lymph nodes in 2 cases. On the other hand, the major lesion of the intravenous administrative group was the primary site (stomach) in 5 cases, peritoneum and digestive tract in 6 cases, Virchow's lymph-node in one, hepatic hilus in one and lung in one. Response could be evaluated in 31 patients with intra-aortic therapy. Partial response was found in 9 cases and NC in 16. PD was found in 5 and so the rate of response was 29.0% (9/31). The major lesion of 9 responders was inoperable Borrmann's Type 4 gastric cancer in 2 cases, peritoneal recurrence with an abdominal mass in 4, recurrence in the abdominal wall in one, Douglas' pouch in one, and intestinal stenosis in one.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifty-five gastric cancer patients with liver metastasis received arterial infusion chemotherapy. In 14 patients who had lesions in the liver intra-hepatic artery infusion chemotherapy was performed, while in 41 patients who had lesions in the liver and other sites intra-aortic infusion chemotherapy was performed. Methods for inserting the catheter into the aorta or hepatic artery and treatment schedules were reported previously. Between 1975 to 1981, 33 gastric cancer patients with liver metastasis were treated with 5-FU only (4 cases). MMC.5-FU (18 cases) and ADM.5-FU (11 cases). No response was seen, but minor response was seen in two cases. Between 1982 to 1988, 22 gastric cancer patients with liver metastasis were treated using arterial MMC.5-FU therapy combined with angiotensin II (13 cases), arterial MMC therapy combined with degradable starch microsphere (6 cases) and sequential MTX.5-FU (3 cases). The response rate of MMC.5-FU therapy combined with angiotensin II was 5/13 (38%) including one complete response. The responders of MMC-combined DSM therapy were seen in 3 (50%) out of 6 patients. However, no response was seen in sequential MTX.5-FU therapy. In the present study, a 61-year-old patient treated with MMC.5-FU combined with angiotensin II therapy, survived for 49 months after treatment. In order to improve the prognosis of gastric cancer patients with liver metastasis, it is important to increase the delivery of anticancer drugs to the target tissues by using certain drugs like angiotensin II and DSM. In the future, further studies should be done to prolong the duration of remission by arterial chemotherapy.

Sialyl Lewis(x)-i (SLX) as a new tumor-associated antigen was assayed in sera of 133 gastric cancer and 62 colorectal cancer patients with preoperative state in order to elucidate the clinico-pathological features. The percent positives in sera of patients with gastric and colorectal cancer were 12.7% (17/133) and 16.1% (10/62), respectively, and there were few positive cases in the early stages. Therefore, it is suggested that the early diagnosis for gastric and colorectal cancer using SLX alone may be difficult. However, it is revealed that SLX has a high tumor-specificity in consideration of the clinico-pathological properties such as H, P, n, ly, v factors, depth of cancer invasion and operative radicality. These data suggested that SLX could be applicable as a useful tumor-marker which shows the metastasis or extension of carcinoma.

Clinicopathological factors such as depth of cancer invasion, size, gross type, frequency of metastases to regional lymph nodes, and distant prognosis were evaluated in last consecutive 339 cases with solitary early gastric cancer. The conservative surgery, that is, subtotal gastrectomy with complete dissection of lymph nodes of group 1 and selective celiac group and partial bursectomy, would be indicated for early gastric cancers located in antrum or corpus. But if the metastasis to the group 2 lymph nodes is suspected during the surgery, it is necessary to dissect lymph nodes en bloc more than group 2. The results, concerning the type of early gastric cancer without lymph node metastasis and the indication of endoscopic treatment, were as follows; 1. Intramucosal cancer of elevated type less than 2 cm in diameter. 2. Intramucosal cancer of depressed type less than 1cm in diameter, without peptic ulcer within the lesion, and a differentiated tubular adenocarcinoma histologically. 3. Intramucosal cancer of flat type less than 2 cm in diameter. But it is difficult to detect the depth of cancer invasion and lymph node metastasis preoperatively. We would emphasize that endoscopic treatment should be indicated in the case for which surgical treatment is not indicated.