1.
Gan To Kagaku Ryoho. 2020 Apr;47(4):725-727.
[Clinical Evaluation of the Efficacy and Adverse Effects of Nivolumab Treatment for Patients with Advanced Gastric Cancer].
[Article in Japanese]
Ohta A1, Komatsu S, Tsuji R, Tanaka S, Kumano T, Imura K, Shimomura K, Ikeda J, Taniguchi F, Doi T, Yamada S, Tomatsuri N, Yoshida N, Shioaki Y.
Abstract
BACKGROUND:
Nivolumab, a fully human IgG4 monoclonal antibody inhibitor of programmed death-1(PD-1), was approved for use in the treatment of patients with advanced gastric or gastroesophageal junction cancer who had been previously treated with B2 chemotherapy regimens in Japan.
METHODS:
We investigated the efficacy of nivolumab therapy in 15 consecutive patients with advanced gastric cancer between October 2017 and December 2018 in our facility.
RESULTS:
In our study, the 6-month overall survival rate was 67.7%, and the median survival time(MST)was 6.3 months. Immune-related adverse events(irAEs)occurred in the following patients: 2 patients, interstitial pneumonia(13%); 1 patient, myocarditis (6.7%); 1 patient, hypothyroidism(6.7%); and 1 patient, liver dysfunction(6.7%). Of the patients with an absolute lym- phocyte count(ALC)of C2,000/mL at baseline, 33%(4/12)experienced irAEs, while of those with an ALC of >2,000/mL, 67% had irAEs. The 6-month overall survival rate was better in patients with an ALC >1,600/mL(100%, 4/4)than in those with an ALC of C1,600/mL(35%, 4/11). The 6-month overall survival rate of the patients with a neutrophil-to-lymphocyte ratio(NLR)of <4 was 63%, which was better than the 33% rate in those with an NLR of B4.
CONCLUSIONS:
Nivolumab therapy was a safe and feasible treatment option. The cutoff values of ALC of 2,000/mL for irAEs and of ALC of 1,600/mL and NLR of 4 for prognosis might be effective surrogate markers in nivolumab treatment.
2.
Gan To Kagaku Ryoho. 2020 Apr;47(4):722-724.
[A Case of Esophageal Neuroendocrine Carcinoma(NEC)Treated with Collective Treatment].
[Article in Japanese]
Kitagawa S1, Watanabe Y, Katada Y, Iwamoto R, Kinoshita S, Ueno M, Mineta S, Okamoto Y, Kubota H, Higashida M, Okada T, Tsuruta A, Fujiwara Y, Yamaguchi Y, Ueno T.
Abstract
A 68-year-old man presented to our hospital. An upper gastrointestinal tract endoscopy performed elsewhere revealed an elevated lesion with a circumferential esophageal cancer(identified as small cell carcinoma). Perthe treatment forsmall cell cancer and the standard treatment for esophageal neuroendocrine carcinoma, 7 courses of CBDCA(5mg/m2)plus ETP (100mg/m2)were administered. The lesion shrank and the lymph node swelling disappeared and the patient was deemed to be in partial remission. Nine months later, however, the primary tumor increased in size. A transthoracic subtotal esophagectomy( laparoscope-assisted), 2 area dissection, and gastric tube reconstruction(post-sternal)were performed at 2 years and 10 months afterdiagnosis.
3.
Gan To Kagaku Ryoho. 2020 Apr;47(4):718-721.
[A Case of Intestinal Obstruction Caused by Peritoneal Metastatic Recurrence One Year after Radical Operation for Pancreatic Cancer].
[Article in Japanese]
Ota H1, Yokoyama S, Honda S, Ito K, Miyazaki H, Ueda H, Takiguchi N, Nakai S, Matsuno H, Takeoka T, Konishi K, Okada K, Fukunaga M, Kobayashi K.
Abstract
In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, Stage ⅡA). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.
4.
Gan To Kagaku Ryoho. 2020 Apr;47(4):715-717.
[A Case of Pancreatoduodenectomy for Pancreatic Head Cancer with Invasion to the Hepatic Artery from the Pancreatic Arcade].
[Article in Japanese]
Sato T1, Sakai H, Goto Y, Kanno H, Midorikawa R, Kojima S, Fukutomi S, Nomura Y, Kawahara R, Ishikawa H, Hisaka T, Yasunaga M, Okuda K.
Abstract
This case pertained a 53-year-old man who underwent nab-PTX plus GEM therapy for BR-A pancreatic head cancer. He achieved a partial response and underwent pancreatoduodenectomy. Dynamic CT showed blockage of the original common hepatic artery branching from the celiac artery. Hepatic blood flow was maintained by a pancreatic arcade branching from the superior mesenteric artery which ran along the ventral side of the pancreatic head. The cancer had invaded the same location; therefore, the hepatic artery and portal vein were both resected and reconstructed. The patient had no complications, such as postoperative pancreatic fistula, and was discharged 45 days postoperatively. Currently(5 months postoperatively), postoperative S-1-based adjuvant chemotherapy is being administered, and the patient had a recurrence-free survival.
5.
Gan To Kagaku Ryoho. 2020 Apr;47(4):712-714.
[A Case Report of R0 Resection after Chemotherapy for Locally Advanced Pancreatic Head Cancer with Ureter Invasion].
[Article in Japanese]
Eto R1, Kataoka M, Yanagisawa S, Nishimura M, Kobayashi S, Okaniwa A, Watanabe Y, Senda T, Hayama A, Oka Y, Machida T, Saeda Y, Tsuchiya S, Kaiho T.
Abstract
A 60-year-old woman was referred to our hospital due to pancreatic head cancer with right ureter invasion. We considered that it was difficult to achieve R0 resection for the patient by operation because of a wide range of retroperitoneal invasions involving the right ureter. She was treated with chemotherapy(gemcitabine plus nab-paclitaxel: GnP). GnP therapy was administered 3-weeks on/1-week off for 1 course. After 3 courses, we performed pancreaticoduodenectomy, right nephrectomy and partial transverse colectomy. We achieved R0 resection and considered the GnP therapy to be effective.
6.
Gan To Kagaku Ryoho. 2020 Apr;47(4):709-711.
[A Case of Malignant Lymphoma Undergoing HAI Treatment for Multiple Liver Metastases of Carcinoid That Appeared about Nine Years after Resection of Rectal Carcinoid with Liver Metastases].
[Article in Japanese]
Abstract
The present case pertained to a 70-year-old woman. The fecal occult blood test was positive. Colonoscopyrevealed rectal cancer. She underwent the first operation of low anterior resection. Pathological diagnosis was carcinoid, se, ly2, v0, n1. Approximately2 months later, multiple liver metastases were found. Because of strong enhancement at angiography, transarterial chemoembolization(TACE)was selected. After 3 rounds of TACE, we operated the residual liver metastasis approximately1 year and 7 months after the first operation. However, approximately8 years and 9 months after the first operation, multiple liver metastases were found again. Hepatic arterial infusion(HAI)was chosen because tumors showed weak en- hancement on CT. First, we tried high-dose HAI(5-FU 1 g/dayat 1-3 and 5-7, amount: 6 g/week), and liver metastases was almost in CR. However, extrahepatic metastasis was found on PET-CT. Because of rapid growth, we operated the growing lymph node. Pathological diagnosis was diffuse large-cell type B-cell malignant lymphoma. Thus, we extended the interval of HAI(weekly, biweekly, and monthly)and simultaneously4 courses of R-THP-COP(R: rituximab, THP: pirarubicin, C: cyclophosphamide, O: vincristine, P: prednisolone)therapyfor malignant lymphoma was administered. She is now an outpatient. Liver metastases continue to be in CR at approximately1 year and the IL-2R value is almost within normal range.
7.
Gan To Kagaku Ryoho. 2020 Apr;47(4):706-708.
[Adenocarcinoma in the Lung Detected Due to the Development of Perforative Peritonitis Caused by Small Intestinal Metastasis-A Case Report].
[Article in Japanese]
Abstract
Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine. The patient was diagnosed with acute peritonitis caused by perforation of the small intestine, and an emergency operation was performed. Laparotomy revealed perforation in the jejunum without any palpable tumor in the abdomen. Partial resection of the jejunum revealed an ulcerating lesion at the perforation site. Histological examination indicated small intestinal metastasis secondary to lung adenocarcinoma. Positron emission tomography performed after discharge showed a small reticular opacity with intense accumulation of FDG in the left lung. The patient was diagnosed with perforation of the small intestine metastasis secondary to lung adenocarcinoma. The postoperative course was uneventful; the patient received chemotherapy, and is alive 6months after the operation.
8.
Gan To Kagaku Ryoho. 2020 Apr;47(4):703-705.
[A Case of Sigmoid Colon Neuroendocrine Cell Carcinoma Discovered by Defecation Disorder].
[Article in Japanese]
Abstract
A 65-year-old man presented to our hospital with a chief complaint of abdominal pain during defecation. Abdominal contrast-enhanced CT showed circumferential wall thickening with contrast effects in the sigmoid colon, and multiple metastases in the liver. Colonoscopy revealed a type 2 colon tumor that was obstructing the passage. A diagnosis of sigmoid colon cancer and multiple liver metastases was made based on laparoscopic sigmoidectomy plus D3 dissection. Pathologically, the resected specimen was diagnosed as colorectal neuroendocrine cell carcinoma(NEC)that was positive for synaptophysin and CD56. Postoperatively, 8 courses of FOLFOX plus bevacizumab(BV)therapy were administered, but CT showed remarkable increase in liver metastasis, and he died 5 months after the operation. Colorectal NEC is a very rare disease, for which no chemotherapy has been shown to be effective. Since we encounterd a case of sigmoid colon NEC with multiple liver metastases that followed a rapid course, we have presented it along with a literature review.
9.
Gan To Kagaku Ryoho. 2020 Apr;47(4):700-702.
[An Analysis of Surgery for Colorectal Cancer Lung Metastasis].
[Article in Japanese]
Chino S1, Naito M, Maruyama M, Tokito T, Chuman M, Nakamura K, Kondo Y, Nishi Y, Takahashi Y, Watanabe M.
Abstract
OBJECTIVES:
Resection of lung metastasis in colorectal cancer leads to a good prognosis; therefore, surgical treatment for resectable metastases is recommended by the Japanese Society for Cancer of the Colon and Rectum Guidelines for the treatment of colorectal cancer. In this study, we investigated the factors that affect the prognosis of resection of such lung cancers.
RESULTS:
Outcomes of 23 cases of lung resection performed from 2000 to 2019 were investigated. The 5-year overall survival rate after lung resection was 55.5%, and the 5-year relapse-free survival rate after liver resection was 27.0%. Univariate analysis identified sex(p=0.024), tumor size(p=0.0129)and complications(p=0.0129)as prognostic factors, while multivariate analysis revealed sex(p=0.0278, relative risk=5.38)to be a prognostic factor.
CONCLUSION:
In this study, sex was identified as a poor prognostic factor. Further evidence from cases is needed to ascertain the effects of other factors.
10.
Gan To Kagaku Ryoho. 2020 Apr;47(4):697-699.
[Total Remnant Pancreatectomy for Remnant Pancreatic Carcinoma after Pancreaticoduodenectomy-A Report of Two Cases].
[Article in Japanese]
Abstract
We report 2 cases of total remnant pancreatectomy for remnant pancreatic carcinoma after pancreaticoduodenectomy (PD). Case 1 pertained to a 51-year-old man who underwent PD for pancreatic carcinoma(pT3N0, R0). Twenty-seven months later, he developed a remnant pancreatic cancer. Total remnant pancreatectomy was performed, but he died due to liver and lung metastases 27 months after the second surgery. Case 2 pertained to a 58-year-old women who underwent PD for papilla of Vater cancer(pT1N0, R0). Eight-four months later, she developed remnant pancreatic cancer, for which total remnant pancreatectomy was performed. She died due to liver metastasis 8 months after the second surgery. Pathological findings revealed recurrent carcinoma in both cases and carcinoma in situ with extensive intraductal growth to the branch in case 2. Both cases had no complications after total remnant pancreatectomy and achieved good quality of life(QOL). Longterm follow up after pancreatectomy is necessary for early diagnosis of remnant pancreatic carcinoma.
11.
Gan To Kagaku Ryoho. 2020 Apr;47(4):694-696.
[Two Cases of Laparoscopic Partial Resection of Stomach Using a Trans-Gastric Wall Approach for Submucosal Tumors].
[Article in Japanese]
Abstract
We performed laparoscopic partial resection of the stomach with a trans-gastric wall approach for submucosal tumors. Case 1: A 67-year-old woman was referred to our hospital because of tarry stool. Upper gastrointestinal endoscopy revealed a well demarcated, round, 45mm intraluminal-type submucosal tumor with delle on the anterior wall of the gastric upper body. Case 2: An 86-year-old woman was referred to our hospital because of anemia. Upper gastrointestinal endoscopy revealed a well demarcated, round, 25mm intraluminal-type submucosal tumor on the posterior wall of the gastric upper body. Laparoscopic partial resection of the stomach with a trans-gastric wall approach was performed. The operation times were 58 minutes and 73 minutes, respectively, and blood loss was low in both cases. This operative procedure is safe and easy and allows for resection resected with a direct view for surgeons without endoscopists.
12.
Gan To Kagaku Ryoho. 2020 Apr;47(4):691-693.
[A Case of Biliary Neuroendocrine Tumor with Neo Adjuvant Chemotherapy].
[Article in Japanese]
Abstract
A 65-year-old man was diagnosed with biliary carcinoma. Abdominal CT showed a tumor at the inferior bile duct. Tumor cells with small cell carcinoma were confirmed with biopsy of ERCP. Although the tumor seemed to be resectable, ERCP caused pancreatitis. We decided to perform surgery after the pancreatitis had healed to initiate neoadjuvant chemotherapy. According to the guideline of pancreatic NET(G3), we adopted the regimen of CDDP plus VP-16. After 2 courses, CT revealed that there were no changes in tumor size and that the pancreatitis was healing. We then performed pancreatoduodenectomy. Histological examination of the specimen demonstrated small cell NEC of the bile duct. Five months after the operation, multiple liver metastases manifested, leading to liver failure and death. NEC of the bile duct is known to be a highly malignant tumor with a poor prognosis. Further evaluation is needed to elucidate optimal therapy for biliary NEC.
13.
Gan To Kagaku Ryoho. 2020 Apr;47(4):688-690.
[A Successful Case of Locally Advanced Pancreatic Cancer Undergoing Curative Total Pancreatectomy after Chemotherapy].
[Article in Japanese]
Abstract
A 68-year-old man with jaundice was diagnosed with pancreatic cancer. The tumor seemed to invade the portal vein, the common hepatic artery, and the splenic artery plexus. The initial diagnosis was unresectable pancreatic cancer. The patient was treated with gemcitabine plus nab-paclitaxel therapy. The tumor reduced in size, and invasion of the main vessels was alleviated after 3 courses. Therefore, we performed total pancreatectomywith total gastrectomy. Histopathological findings showed pancreatic adenocarcinoma, T4(PV)N2M0, fStage Ⅳb, R0. There are reports of curative resection for unresectable pancreatic cancer after chemotherapy. However, the majorityof these reports were about pancreatoduodenectomyor distal pancreatectomy. We present a rare case of curative total pancreatectomy after chemotherapy.
14.
Gan To Kagaku Ryoho. 2020 Apr;47(4):685-687.
[A Case of Anaplastic Carcinoma with Osteoclastlike Giant Cells of the Pancreas Concomitant with Lung Recurrence of Solitary Fibrous Tumor].
[Article in Japanese]
Zhou D1, Kagawa S, Sato Y, Yoshitomi H, Furukawa K, Takayashiki T, Kuboki S, Takano S, Suzuki D, Sakai N, Nojima H, Mishima T, Nakadai E, Ohtsuka M.
Abstract
A 32-year-old woman presented with epigastric pain and an abdominal mass. Abdominal CT showed a 130mm pancreatic tail mass with an enhanced rim, central necrosis, and small calcification. A 6mm lung tumor was also found via chest CT. Her medical history included surgical resection of cerebral solitary fibrous tumor when she was 24 years old. When she was 31 years old, it had recurred but was cured by gamma knife radiosurgery. We performed distal pancreatectomy and splenectomy with lymph node dissection. According to pathological and immunohistochemical findings, it was diagnosed as an anaplastic carcinoma with osteoclast-like giant cells. She underwent surgical resection of the lung tumor 2 months after pancreatic resection and was diagnosed with metastasis from the solitary fibrous tumor. Fourteen months since undergoing pancreatectomy, the patient experienced no recurrence from both diseases. We report a rare resected case of anaplastic carcinoma of pancreas concomitant with recurrent solitary fibrous tumor.
15.
Gan To Kagaku Ryoho. 2020 Apr;47(4):682-684.
[A Case of HER2-Positive Gastric Cancer with Multiple Liver Metastases Treated with Curative Conversion Therapy after Chemotherapy].
[Article in Japanese]
Kato Y1, Natsuki S, Iimori N, Okuno T, Kametani N, Noda E, Yamamoto A, Yamada N, Nishimura S, Taenaka N, Matsunaga Y, Fujita S.
Abstract
A 66-year-old man underwent chemotherapy with S-1 plus cisplatin plus trastuzumab to treat advanced gastric cancer that was diagnosed as cStage Ⅳ adenocarcinoma(T3N1M1[P0, CYX, H1]). After 8 courses, liver metastases were absent on contrast-enhanced MRI. The patient underwent a laparoscopic distal gastrectomy with D2 lymphadenectomy. The gross appearance of the surgically resected specimen showed a shrunk gastric tumor measuring 1 mm. The postoperative course was uneventful, and the patient has been well, receiving maintenance chemotherapy of S-1 plus trastuzumab without evidence of recurrence for 15 months following the operation. Conversion surgery following chemotherapy might be an effective treatment for patients with advanced gastric cancer; however, further studies are needed to establish this treatment strategy.
16.
Gan To Kagaku Ryoho. 2020 Apr;47(4):679-681.
[Analysis of Early Palliative Care for Patients with Gastric Cancer].
[Article in Japanese]
Kawada J1, Hata T, Tanizaki K, Kawakami H, Shiraishi H, Kondo A, Arakawa S, Okano M, Kim Y, Okuyama M, Tsujinaka T, Imamoto H.
Abstract
BACKGROUND:
Palliative care delivered to cancer patients late in the course of disease are inadequate to improve advance care planning and quality of life; thus, early palliative care is recommended. We retrospectively analyzed early palliative care delivered to patients with gastric cancer.
METHOD:
Forty-nine gastric cancer patients who underwent surgery and had received interdisciplinary care from the first visit(early palliative care)were assessed for physical and psychosocial symptoms.
RESULTS:
All patients were followed up continuously by a nurse certified in palliative care support to provide quality patient-centered care from the beginning(advance care planning). Four patients had experienced relapse, and 3 older patients had decided not to receive chemotherapy following their advance care planning. However, all 4 patients were admitted to a palliative care unit without barriers.
CONCLUSION:
Early palliative care might lead patients to have advance care planning, and a better quality of life.
17.
Gan To Kagaku Ryoho. 2020 Apr;47(4):676-678.
[Long-Term Survival in a Case of Colon Cancer with Peritoneal Dissemination and Ovarian Metastasis after Multimodality Therapy].
[Article in Japanese]
Tanida T1, Noura S, Ogino T, Nagase H, Noguchi K, Hirota M, Oshima K, Tomimaru Y, Kawase T, Imamura H, Akagi K, Iwazawa T, Dono K.
Abstract
A 70-year-old woman underwent treatment for cecal cancer(pT4bN1M0, Stage Ⅲb)in 2010. Four years and 2 months after the first surgery, she underwent ileum resection for stenosis due to perineal dissemination(P3). Two years after this recurrence, during which time she had completed 26 courses of FOLFIRI plus bevacizumab(Bmab), 9 courses of capecitabine plus oxaliplatin(CapeOX)plus Bmab, and 3 courses of Cape, no peritoneal dissemination was detected by computed tomography( CT). Thereafter, an additional 19 courses of Cape plus Bmab were introduced, but CEA continued to increase. Right ovarian metastasis was suspected based on CT and FDG-PET/CT examination. Four years and 1 month after the initial recurrence of perineal dissemination, the patient underwent bilateral ovarian resection, during which the lack of peritoneal dissemination was confirmed. Pathologically, right ovarian metastasis was diagnosed. The patient is still alive 4 years and 6 months after the first operation.
18.
Gan To Kagaku Ryoho. 2020 Apr;47(4):673-675.
[A Case of Epithelial Cyst Occurring in Intrapancreatic Accessory Spleen].
[Article in Japanese]
Sakamoto T1, Takeda Y, Ohmura Y, Katsura Y, Imada A, Takase K, Toya K, Yukawa Y, Kawai K, Murakami K, Kagawa Y, Masuzawa T, Takeno A, Hata T, Murata K.
Abstract
Although accessory spleens are often found in clinical practice, it is rare to identify cystic disease in an intrapancreatic accessory spleen. Here, we report a case of an epithelial cyst that occurred in the intrapancreatic accessory spleen. The patient was a 54-year-old male. Liver dysfunction was identified by the primary care doctor, and abdominal CT showed a tumorous lesion in the pancreatic tail. The patient was then referred to our hospital. Contrast-enhanced CT revealed a multilocular cystic lesion in the pancreatic tail. In endoscopic ultrasound, there was no obvious solid tumor in the cyst. A cystic disease such as serous cystic neoplasm(SCN)or mucinous cystic neoplasm(MCN)was suspected, and we performed a laparoscopic distal pancreatectomy. Postoperative pathological examination revealed an accessory spleen in the tail of the pancreas. The identified epithelial cyst was present in this accessory spleen. An epithelial cyst that occurs in the intrasplenic accessory spleen is a rare disease, but it is necessary to keep in mind as a possible differential diagnosis.
19.
Gan To Kagaku Ryoho. 2020 Apr;47(4):670-672.
[Laparoscopic Resection of a Huge Gastric Gastrointestinal Stromal Tumor after Neoadjuvant Chemotherapy-A Case Report].
[Article in Japanese]
Kawabata K1, Takahashi T, Nakajima K, Tanaka K, Miyazaki Y, Makino T, Kurokawa Y, Yamasaki M, Mori M, Doki Y.
Abstract
An 83-year-old woman was hospitalized with abdominal discomfort. Abdominal computed tomography(CT)revealed a hugetumor (size, 15 cm)in thegastric body. Based on thefindings of endoscopic ultrasonography-guided fine-needle aspiration, she was diagnosed with gastrointestinal stromal tumor(GIST). Invasion of thesurrounding viscera and distant metastasis were not observed; however, owing to the tumor size(>10 cm), we initiated neoadjuvant chemotherapy with imatinib. CT performed a month after chemotherapy revealed tumor shrinkage, and CT repeated 6 months after the second CT revealed tumor shrinkage to 8 cm. The patient showed a partial response to chemotherapy. She was deemed suitable to undergo laparoscopic radical resection and subsequently underwent laparoscopic partial gastric resection. Histopathological examination of the resected specimen(measuring 10 cm)revealed hyaline degeneration in most tumor cells and positive ckit expression in only some proportion of tumor cells. Based on histopathological evaluation, the tumor was diagnosed as Grade 2b. The patient showed an uneventful postoperative course. After discharge, she received imatinib as adjuvant chemotherapy and is progressing well without recurrence. Taken together, we reported the case of a huge gastric GIST in a patient who showed significant tumor shrinkage following preoperative neoadjuvant chemotherapy and successfully underwent laparoscopic radical resection.
20.
Gan To Kagaku Ryoho. 2020 Apr;47(4):667-669.
[A Case of Advanced Rectal Cancer with the Metastatic Abdominal Aortic Bifurcation Lymph Node Performed by Laparoscopic Surgery after Chemotherapy].
[Article in Japanese]
Abstract
A 63-year-old underwent examination for constipation and was found to have an unresectable advanced rectal cancer. Metastatic abdominal aortic bifurcation lymph node and lung metastasis were suspected upon CT(cT3N3M1a[PUL1], cStage Ⅳa), and chemotherapy was administered(CapeOX plus Bmab). After 4 courses of chemotherapy, the size of the primary tumor and the lymph nodes decreased(PR). We performed laparoscopic rectum resection and abdominal aortic bifurcation lymph node. The pathological diagnosis indicated partial response(residual cancer cells)(Grade 1a). After 4 courses of chemotherapy(CapeOX), we performed pulmonary partial resection for metastatic lung cancer. This case suggests that laparoscopic resection of rectum after chemotherapy with CapeOX plus Bmab for locally advanced rectal cancer is a potential- ly effective procedure.
21.
Gan To Kagaku Ryoho. 2020 Apr;47(4):664-666.
[A Case Report of Lymph Node Metastasis of Hepatocellular Carcinoma Resected by Laparoscopic Surgery].
[Article in Japanese]
Tsuboi K1, Matsuo Y, Omi K, Ueda G, Hayashi Y, Imafuji H, Saito K, Morimoto M, Ogawa R, Takahashi H, Takiguchi S.
Abstract
The case presented is a 72-year-old male with no history of hepatitis B or C. Dynamic CT revealed a 2 cm mass in the liver (S8), with arterial phase hyperenhancement and delayed phase washout. The patient underwent an open S8 subsegmentectomy. The mass was pathologically diagnosed as well-to-moderately differentiated hepatocellular carcinoma(T2N0M0, Stage Ⅱ). At 2 years 10 months postoperatively, MRI showed a 4 cm mass in contact with the pancreatic head, inferior vena cava, and duodenum. The mass had moderate FDG uptake on PET scan, and early phase hyperenhancement and delayed phase washout on dynamic CT. We performed laparoscopic mass resection, suspecting lymph node metastasis of the hepatocellular carcinoma, which was confirmed by the pathological diagnosis. The patient has survived for 1 year without recurrence. Lymph node metastasis of hepatocellular carcinoma is rare. It is unclear whether surgical resection is feasible in such cases. Here, we report a case of lymph node metastasis of hepatocellular carcinoma resected by laparoscopic surgery.
22.
Gan To Kagaku Ryoho. 2020 Apr;47(4):661-663.
[A Resected Case of Hemorrhagic Hepatic Cyst Difficult to Differentiate from Mucinous Cystic Neoplasm of the Liver].
[Article in Japanese]
Park SA1, Tomimaru Y, Noguchi K, Nagase H, Ogino T, Hirota M, Oshima K, Tanida T, Noura S, Kawase T, Imamura H, Akagi K, Iwazawa T, Dono K.
Abstract
CASE:
A 77-year-old woman was referred to our hospital for detailed examination of a cystic liver tumor. Contrast-enhanced CT and MRIshowed a cystic liver tumor with an enhanced mural nodule in S6 of the liver. Under a preoperative diagnosis of hemorrhagic hepatic cyst and mucinous cystic neoplasm(MCN)of the liver, extended posterior segmentectomy was performed. Histological examination of the tumor revealed no neoplastic cells, and the tumor was finally diagnosed as a hemorrhagic hepatic cyst of the liver.
CONCLUSION:
Similar to previous reports of hemorrhagic hepatic cysts, preoperative differential diagnosis from MCN of the liver was difficult in this case. Hemorrhagic hepatic cysts are rare and are sometimes confused with MCN of the liver, especially when an enhanced mural nodule is found in the cyst. The possibility of hemorrhagic hepatic cysts should be considered during diagnosis of liver cystic tumors.
23.
Gan To Kagaku Ryoho. 2020 Apr;47(4):658-660.
[A Case of Liver Metastasis of Distal Bile Duct Cancer].
[Article in Japanese]
Abstract
A 60-year-old female visited our hospital due to anorexia and jaundice in March 2016. She underwent pancreatoduodenectomy( PD)and was diagnosed with distal bile duct cancer. The histopathological diagnosis was distal bile duct cancer, tub2, pT3aN1M0, pStage ⅡB. Postoperatively, she received S-1 therapy as adjuvant chemotherapy. One year after surgery, abdomi- nal enhanced CT and EOB-MRI revealed a liver metastasis(S3; 20mm). After 4courses of gemcitabine(GEM)/cisplatin(CDDP) combination therapy, there was no new lesion; thus, we performed partial hepatectomy(S3)in July 2017. The histopathology findings revealed well differentiated adenocarcinoma that was similar to the primary lesion, and the tumor was confirmed as a recurrence of bile duct cancer. She remains alive without second recurrence for 2 years since the tumor resection(about 3 years since PD). Surgical intervention might be beneficial in selected patients with recurrent bile duct cancer.
24.
Gan To Kagaku Ryoho. 2020 Apr;47(4):655-657.
[Long-Term Survival in a Patient with Stage Ⅳ Gastric Cancer Successfully Treated with Multidisplinary Treatment].
[Article in Japanese]
Toya K1, Takeno A, Nose Y, Mori R, Kawai K, Sakamoto T, Naito A, Murakami K, Katsura Y, Ohmura Y, Kagawa Y, Masuzawa T, Takeda Y, Tamura S, Murata K.
Abstract
A man in his 60s who had epigastric pain was referred to our hospital and diagnosed with advanced type 3 gastric cancer with multiple liver metastases, cT4acN2cN1(H1), cStage Ⅳ(HER2 3+). He underwent chemotherapy using capecitabine, cisplatin(CDDP), and trastuzumab(T-mab)(XPT). After 7 courses of XPT and 23 courses of XT, liver metastases disappeared, and we decided to perform open distal gastrectomy, D2+ #18 lymphadenectomy, and Billroth Ⅰ reconstruction as a conversion surgery. Despite adjuvant chemotherapy with S-1 plus T-mab, multiple lymph nodes recurrence occurred 3 months after the surgery. He was found to be in complete remission as assessed by CT after 5 courses of second-line CPT-11 treatment, which was discontinued after 17 courses. The patient is alive without recurrence at 57 months after the initial treatment and 22 months after the last treatment.
25.
Gan To Kagaku Ryoho. 2020 Apr;47(4):652-654.
[Case of a 5mm Rectal Neuroendocrine Tumor(G1)with Lymph Node Metastasis].
[Article in Japanese]
Abstract
Screening colorectal endoscopy revealed a 5mm rectal neuroendocrine tumor(NET: G1)in a 72-year-old man. Endoscopic mucosal resection(EMR)was performed, and the histopathological examination demonstrated lymphatic and vessel invasion with a possible positive vertical margin. Therefore, we performed laparoscopic low anterior resection, lymphadenectomy, and ileostomy as additional surgical resections. No residual tumor was found in the specimen, but 3 metastatic lymph nodes were identified. The rate of lymph node metastasis in rectal NETs of diameter<10mm is low, and additional surgery can reduce the patient's quality of life affected due to impaired anorectal function. However, in the Japanese guidelines for NET, additional surgery is adopted in cases with high-risk factors for lymph node metastasis. Therefore, it is necessary to select between additional surgery and careful follow-upfor rectal NETs of diameter<10mm with high-risk factors because of possible lymph node metastasis.
26.
Gan To Kagaku Ryoho. 2020 Apr;47(4):649-651.
[A Case of Intussusception Caused by Ascending Colon Cancer in an Elderly Woman].
[Article in Japanese]
Nomura T1, Katsumata K, Kasahara K, Wada T, Kuwabara H, Shigoka M, Enomoto M, Ishizaki T, Nagakawa Y, Tsuchida A.
Abstract
In September 2015, a 90-year-old woman presented with abdominal pain and emesis as the chief complaints. Except for WBC counts of 10,420/mL, CRP levels of 5.69mg/dL, and ALP levels of 359 IU/L, no other abnormal values were noted, and CEA and CA19-9 tumor marker levels were normal at 3.9 ng/mL and 5.7 U/mL, respectively. Abdominal CT showed intussusception of the right colon and a solid tumor at the presenting portion. Surgery for suspected intussusception caused by colon cancer was performed. Surgical findings revealed a protruding lesion at the ascending colon that extended to the transverse colon, and the intussusception was intrusive up to the ascending colon at the end of the intestinal ileum. Thus, resection of the right half colon and dissection of lymph nodes were performed. Resected specimens revealed a type 1 tumor measuring 65×50×30mm in diameter at the ascending colon. Histopathologic findings revealed tub1>tub2, SS, ly0, v0, PM0, DM0, N0 (0/27)Stage Ⅱa tumor. The postoperative course was favorable, and the patient was discharged on postoperative day 12. We report about a rare case of intussusception caused by ascending colon cancer.
27.
Gan To Kagaku Ryoho. 2020 Apr;47(4):646-648.
[A Successful Management of Thrombocytopenia Due to Multiple Lung Metastasis of Intrahepatic Cholangiocarcinoma Using Laparoscopic Splenectomy-A Case Report].
[Article in Japanese]
Kim Y1, Hata T, Tanizaki K, Okano M, Kawada J, Okuyama M, Yamasaki M, Hama N, Manou M, Imamoto H, Tsujinaka T.
Abstract
We report a case of multiple lung metastasis of intrahepatic cholangiocarcinoma treated with chemotherapy, in which laparoscopic splenectomy was effective for thrombocytopenia. A 74-year-old woman was diagnosed with multiple lung metastasis of intrahepatic cholangiocarcinoma 6 years after partial liver resection(S3). She was undergoing treatment for post-transfusion hepatitis C infection since the age of 46 years and developed thrombocytopenia due to splenomegaly. The previous hospital determined that there was no indication for chemotherapy due to thrombocytopenia. Elective laparoscopic splenectomy resulted in an increase in the platelet count and facilitated the initiation of gemcitabine(GEM)and cisplatin (CDDP)combination chemotherapy. The patient has maintained a good treatment course without interruption due to thrombocytopenia during chemotherapy. In advanced cancer patients with thrombocytopenia complication due to splenomegaly, laparoscopic splenectomy may offer an effective auxiliary means for the safe implementation of chemotherapy.
28.
Gan To Kagaku Ryoho. 2020 Apr;47(4):643-645.
[A Case of Ileus Due to Colon Cancer with Non-Occlusive Mesenteric Ischemia].
[Article in Japanese]
Abstract
Abdominal computed tomography(CT)revealed ileus due to sigmoid colon cancer in a 68-year-old man with abdominal pain, and endoscopic decompression using a transanal ileus tube was attempted. The blood test on the following day showed a marked increase in CRP 46.13mg/dL. Abdominal contrast CT was performed, and mesenteric ischemia was confirmed. Emergency surgery was performed on the same day. The ileum, and ascending, transverse, and descending colon appeared mottled and necrotic and were excised. A specialized diet started on the 5th postoperative day, and parenteral nutrition was used for a long period of time, due to the possibility of short bowel syndrome. The ileostomy and colostomy was closed 57 days after the operation. The patient finished parenteral nutrition on the 88th postoperative day without obvious nutritional absorption disorder and was discharged on the 94th postoperative day as oral intake only. We reported a case of ileus due to colon cancer with non-occlusive mesenteric ischemia(NOMI).
29.
Gan To Kagaku Ryoho. 2020 Apr;47(4):640-642.
[A Case of Colon Cancer with Tumor Embolism in the Superior Mesenteric Vein Disappearing after Chemotherapy].
[Article in Japanese]
Abstract
A woman in her 50s received a detailed examination for her abdominal pain. CT indicated intestinal wall thickening of the ascending colon, lymphadenopathy, and tumor embolism in the superior mesenteric vein. Colonoscopy revealed type 2 tumor in the hepatic flexure of the colon, and she was diagnosed as having moderately differentiated adenocarcinoma by biopsy specimen. She received 12 courses of FOLFOXIRI plus BV therapy after ileostomy. As the tumor embolism disappeared and the primary lesion shrank after chemotherapy, right hemicolectomy and lymph node dissection were performed. Six months after surgery, she has had no recurrent disease. This case suggests that FOLFOXIRI plus BV therapy could be an effective treatment for right colon cancer with tumor embolism.
30.
Gan To Kagaku Ryoho. 2020 Apr;47(4):637-639.
[A Case of Medullary Carcinoma of the Colon with Poor Prognosis].
[Article in Japanese]
Tamai K1, Okamura S, Kitahara T, Minoji T, Takabatake H, Watanabe N, Yamamura N, Fukuchi N, Ebisui C, Yokouchi H, Kinuta M, Ohishi K.
Abstract
An 87-year-oldwoman was referredowing to lightheadedness. Severe anemia(Hb 3.9 g/dL)was detected, and colonoscopy revealeda circumferential elevatedlesion at the transverse colon(Group 5, por). The patient was diagnosed with colon cancer(cT4a, N0, M0, Stage Ⅱ), andright hemicolectomy was performed. Immunochemical analysis showedthat the lesion was MLH1- andPMS2- and confirmed a diagnosis of medullary carcinoma. Although the patient was discharged 48 days after surgery without any incident, she was readmitted because of lower leg edema. Liver metastasis and peritoneal dissemination were suspectedon performing computedtomography, andthe patient died3 5 days after readmission. Medullary carcinoma has molecular pathological features such as methylation of the promoter region andassociatedattenuation of MLH1 protein expression, as well as microsatellite instability. The prognosis for medullary carcinoma is relatively good comparedto that for poorly differentiatedad enocarcinoma, though the present case hada poor prognosis. Herein, we report a literature review.
31.
Gan To Kagaku Ryoho. 2020 Apr;47(4):634-636.
[A Case of Pancreatic Adenocarcinoma with Inferior Vena Cava Invasion].
[Article in Japanese]
Abstract
A 66-year-old Japanese woman was admitted to our hospital for jaundice. Abdominal computed tomography(CT) showed dilatation of the intra- and extra-hepatic bile duct, and a hypovascular lesion measuring 30mm in diameter in the head of the pancreas. This tumor was in contact with the(superior mesenteric vein: SMV)and(inferior vena cava: IVC), but there were no obvious signs of invasion. Upper gastrointestinal endoscopy showed obstruction of the duodenum. We chose to perform an upfront surgery, considering the patient's general condition being stable and the difficulties associated with endoscopic biliary drainage. During surgery, stiff attachment between the tumor and IVC was identified and wedge resection of the IVC wall was performed. SMV resection and end-to-end reconstruction were also carried out. Pathological studies of the surgical specimen revealed direct invasion by the pancreatic adenocarcinoma into the adventitia of the IVC. The postoperative course was uneventful, and the patient was discharged from the hospital on the 27th postoperative day; she underwent adjuvant chemotherapy(S-1 100mg/day)and is still alive without tumor recurrence, 21 months after surgery. Cases of resected pancreatic adenocarcinoma directly invading the IVC are rare. In this case, pancreaticoduodenectomy along with wedge resection of the IVC wall could safely be performed, and no complications were observed. There is a need for further accumulation of similar cases.
32.
Gan To Kagaku Ryoho. 2020 Apr;47(4):631-633.
[A Case of Esophagogastric Junction(EGJ)Cancer for Which Pathological Complete Response(pCR)Was Obtained by Multidisciplinary Treatment].
[Article in Japanese]
Sugita H1, Sakuramoto S, Aoyama J, Ito S, Oya S, Watanabe K, Fujiwara N, Miyawaki Y, Sato H, Mihara Y, Horita Y, Hamaguchi T, Okamoto K, Yamaguchi S, Koyama I.
Abstract
We report the case of a 68-year-old male with EGJ cancer, who was treated with palliative radiotherapy for persistent bleeding, and for whom, pCR was ultimately obtained by chemotherapy. Chemotherapy was planned to treat the EGJ cancer with intramural metastasis of the esophagus, but anemia due to persistent bleeding from the tumor was noted. Even with frequent blood transfusions, the anemia was difficult to control. Palliative radiotherapy was performed at 30 Gy/10 Fr for hemostasis, followed by chemotherapy. After approximately 9 months of chemotherapy, reduction of the primary tumor, a metastatic lymph node, and disappearance of the intramural metastasis of the esophagus were noted, and conversion surgery was performed. In the final histopathological examination, pCR was obtained. Radiotherapy for persistent bleeding from advanced gastric cancer is a minimally invasive treatment, and therefore could be an effective treatment to enable chemother- apy without any loss of compliance.
33.
Gan To Kagaku Ryoho. 2020 Apr;47(4):625-627.
[A Case of Duodenal Cancer with Advanced Lymph Node Metastasis Treated with mFOLFOX6 Preoperative Chemotherapy].
[Article in Japanese]
Abstract
A 60-year-old man underwent surgical distal gastrectomy 10 years prior to receiving treatment for stomach cancer. He visited our hospital with complaints of abdominal fullness and weight loss. Abdominal computed tomography(CT)revealed intestinal blockage starting at the duodenum near the Treitz ligament. During upper alimentary canal endoscopy, a type 2 tumor coveringthe entire circumference of the horizontal duodenum was found, and biopsy results indicated that the tumor was a well-differentiated adenocarcinoma. Although no distant metastasis was observed in the abdominal CT scan, multiple attached bulky lymph nodes were observed leadingto a suspicion of metastasis. Finally, the patient was diagnosed as having progressive duodenal cancer accompanied with advanced lymph node metastasis. A gastrojejunal bypass surgery with laparoscopy was performed. When the patient's overall condition improved, mFOLFOX6 chemotherapy was started, and 6 courses were completed. As the sizes of the primary tumor and bulky lymph nodes decreased, surgery to completely remove the cancer was performed. UFT/UZEL supplemental postoperative chemotherapy was administered for 6 months. The patient remained alive, with no remissions 3 years post-surgery.
34.
Gan To Kagaku Ryoho. 2020 Apr;47(4):621-624.
[Complete Response with Neoadjuvant Chemotherapy and Curative Resection in a Case of Locally Advanced Gastric Cancer That Was Strongly Positive for HER2 with Multiple Liver Metastases].
[Article in Japanese]
Abstract
As a part of community screening, a 64-year-old man underwent gastric fluoroscopy, which revealed abnormalities indicative of a type 3 tumor. Contrast-enhanced abdominal computed tomography showed advanced gastric cancer with multiple regional lymph nodes and liver metastases. Chemotherapy was initiated, and after completion of 2 courses of capecitabine (Cape)and oxaliplatin(OHP)therapy, a distalgastrectomy was performed. The response to chemotherapy was Grade 2, and the lymph node status was pN1(1/17). The patient was strongly positive for HER2; thus, 4 courses of Cape, OHP, and trastuzumab(T-mab)therapy were administered for the metastatic liver lesions, and the liver metastases shrank markedly. S5 subsegmentectomy and S7 partial resection were performed subsequently, and pathological analysis showed completely necrotic tissue. Remarkable progress has been made in chemotherapy for gastric cancer, and the use of T-mab in combination is extremely effective for gastric cancer that is strongly positive for HER2. In our patient, we resected the primary lesion and liver metastatic lesions after neoadjuvant chemotherapy. The metastatic lesion showed complete response(CR). Metastases and recurrences can even occur in patients with primary and/or metastatic lesions who show a CR. Furthermore, whether cancers that are strongly positive for HER2 are recurrent remains unknown. The patient is alive and recurrence-free after having undergone a hepatectomy.
35.
Gan To Kagaku Ryoho. 2020 Apr;47(4):615-619.
[Long-Term Survival for a Patient with StageⅣ Gastric Cancer with Multiple Liver Metastases for Ten Years Who Was Treated with Only S-1Chemotherapy].
[Article in Japanese]
Abstract
An 82-year-old woman presented with a dull feeling in her stomach and anemia. The gastroscopy and abdominal CT scan showed a progressive gastric tumor with multiple liver metastases, and a biopsy specimen revealed moderately differentiated tubular adenocarcinoma. A subtotal gastrectomy with D1 plus lymph node dissection was performed. The final diagnosis was as follows: H1, P0, CY0, M1, pT3, pN2, and fStageⅣ. We considered her age, and postoperative chemotherapy with of an oral anticancer drug, S-1, was initiated at a daily dose of 100 mg, with a 2-week administration and 1-week suspension schedule. The multiple liver metastases obviously reduced in size(PR)by 3 months, and the CT scan revealed complete response(CR)by 8 months after beginning S-1 administration. However, grade 2 anorexia and general malaise developed, so the S-1 administration was changed to a daily dose of 80 mg, with a 2-week administration and 2-week suspension schedule. However, an adverse event of nausea appeared again, and the patient needed a 2-month discontinuation. Therefore, S-1 administration was changed to alternate-day administration, at a daily dose of 100 mg. Subsequently, no side effects were observed, and we continued the S-1 administration for 4 years. She has maintained a complete response(CR) for 10 years, with no obvious cancer recurrence.
36.
Gan To Kagaku Ryoho. 2020 Apr;47(4):609-613.
[A Case of Significant Ejection Fraction Reduction and Heart Failure Induced by Osimertinib].
[Article in Japanese]
Abstract
BACKGROUND:
In recent years, osimertinib has been increasingly used as a therapeutic drug for epidermal growth factor receptor(EGFR)mutation-positive lung cancer, with heart failure rarely reported as an adverse event. We report here a case of a significantly decreased ejection fraction and heart failure that were induced by osimertinib. We consider the case important and include a discussion of relevant previous reports.
CASE:
The patient was a 73-year-old woman who had been on oral gefitinib as first-line treatment for EGFR mutation-positive(exon19 deletion)non-small cell lung cancer for approximately 1 year and 2 months. Thereafter, she tested positive for an EGFR resistance mutation(T790M); and accordingly, oral osimerti- nib was started at 80mg/day as second-line treatment. After continuing this treatment for 6 months with no particular adverse events, she visited our hospital and was found to have dyspnea on exertion and increased pleural effusion. Based on these findings, cancer relapse was suspected, and the patient was hospitalized for detailed examinations. She was diagnosed with heart failure based on the elevated BNP level that was found in a blood test and CT and echocardiography findings, and her ejection fraction deteriorated to 19% from a pretreatment level of 59%. The conditions improved after diuretic and b- blocker treatment. Given the absence of any possible cause of heart failure or reduced ejection fraction in her past history of illness and medication, we concluded that these conditions were induced by osimertinib.
CONCLUSION:
While heart failure induced by EGFR-TKIs has been rarely reported, osimertinib may cause cardiomyopathy due to human epidermal growth factor receptor type 2(HER2)inhibitory activity.
37.
Gan To Kagaku Ryoho. 2020 Apr;47(4):605-608.
[Effects of Oral Magnesium and Antacid Administration on Serum Magnesium Levels and Renal Function in Patients Receiving Cisplatin].
[Article in Japanese]
Abstract
The efficacy of magnesium oxide(MgO)when taken daily as a laxative for hypomagnesemia and renal dysfunction due to cisplatin(CDDP)administration is not clear. It is known that the efficacy of MgO is suppressed when used in combination with antacids, such as proton pump inhibitors. Therefore, we conducted a retrospective analysis of the effects of MgO and antacid administration on serum Mg levels and renal function(estimated glomerular filtration rate: eGFR)in CDDP-treated patients. In the analysis of up to 6 cycles of CDDP administration, the serum Mg levels and eGFR of CDDP-treated patients (n=614)were significantly reduced(p<0.001 and p=0.002, respectively, ANOVA). Patients who used MgO had higher serum Mg levels than patients who did not use MgO(p<0.001, ANOVA). However, no effect of MgO administration was observed on eGFR(p=0.832, ANOVA). There was no effect of antacid combination on serum Mg levels and eGFR in patients receiving MgO. MgO use may have contributed to a reduction in hypomagnesemia. However, it was considered that the decrease in eGFR could not be suppressed as the improvement in hypomagnesemia was slight. Intravenous Mg supplementation is required when CDDP is administered. Furthermore, it is expected that oral Mg supplementation will improve Mg absorption.
38.
Gan To Kagaku Ryoho. 2020 Apr;47(4):598-603.
[Ⅲ. Diagnosis of Skin Malignancy with Dermoscope].
[Article in Japanese]
Togawa Y1.
39.
Gan To Kagaku Ryoho. 2020 Apr;47(4):594-597.
[Ⅱ. A Novel Strategy for Treating Advanced Melanoma].
[Article in Japanese]
40.
Gan To Kagaku Ryoho. 2020 Apr;47(4):588-593.
[Ⅰ. Molecular Mechanisms Underlying the Development and Progression of Malignant Melanoma].
[Article in Japanese]
41.
Gan To Kagaku Ryoho. 2020 Apr;47(4):587.
[Melanoma and Non-Melanoma Skin Cancers].
[Article in Japanese]
Saida T1.
42.
Gan To Kagaku Ryoho. 2020 Apr;47(4):582-586.
[Current Status of Perioperative Chemotherapy for Lung Cancer].
[Article in Japanese]
Abstract
Clinical trials have been conducted to evaluate the efficacy of perioperative chemotherapy. The results of trials on preoperative chemotherapy or chemoradiotherapy have not clearly shown an improved prognosis, although potential benefits have been noted in selected cases. As for adjuvant treatment, cisplatin-containing regimens have been shown to have prognostic benefit in cases of stage Ⅱ and ⅢA(N2)disease. In Japan, the adjuvant use of tegafur/uracil has been recommended for stage Ⅰ and Ⅱ adenocarcinoma with a tumor diameter of more than 2 cm. The efficacy of the perioperative use of molecular- targeted agents has been evaluated in some clinical trials, but the results to date have not shown any significant improvement in prognosis. Immune checkpoint inhibitors have also been assessed in some trials, and these may change the strategy for the perioperative management of lung cancer.
43.
Gan To Kagaku Ryoho. 2020 Apr;47(4):578-581.
[The Current and Future Status of Perioperative Therapy in Pancreatic Cancer].
[Article in Japanese]
Ueno M1.
Abstract
In metastatic pancreatic cancer, combined chemotherapy such as FOLFIRINOX and gemcitabine plus nab-paclitaxel became standard of care. Current standard of care in preoperative settingwas adjuvant S-1 for 6 months in Japan. Neoadjuvant gemcitabine plus S-1 became the new standard in 2019. In Western countries, gemcitabine plus capecitabine and modified FOLFIRINOX without bolus 5-FU and with reduction of irinotecan to 150mg/m2 became standard of care. We will implement in current and future status of preoperative therapy.
44.
Gan To Kagaku Ryoho. 2020 Apr;47(4):574-577.
[Perioperative Chemotherapies for Patients with Colorectal Liver Metastasis].
[Article in Japanese]
Abstract
Perioperative chemotherapies are expected to improve prognosis of patients with colorectal liver metastasis(CRLM). In patients with a resectable CRLM, the adjuvant chemotherapy with 5-FU/LV effectively prolongs DFS or RFS. In patients with unresectable CRLM, a neoadjuvant chemotherapy with high response rate and high liver resection rate, such as FOLFOX(or CAPOX, SOX)plus bevacizumab, FOLFOX/FOLFIRI plus cetuximab, or FOLFOXIRI plus bevacizumab, could be an optimal regimen for the conversion therapy.
45.
Gan To Kagaku Ryoho. 2020 Apr;47(4):569-573.
[Perioperative Chemotherapy for Gastric Cancer].
[Article in Japanese]
Abstract
Radical surgery is the mainstay for the treatment for advanced gastric cancer. However, the results are still not satisfactory. Various kind of perioperative chemotherapy has been evaluated to improve the therapeutic results. In Japan, adjuvant chemotherapy is regarded as a standard treatment. Japanese gastric cancer treatment guidelines have recommended the adjuvant chemotherapy with S-1 for 1 year in patients with pStageⅡor Ⅲgastric cancer. Meanwhile, the efficacy of S-1 plus docetaxel has been demonstrated in Stage Ⅲ gastric cancer, and it is recommended as a standard treatment for Stage Ⅲ gastric cancer in the guidelines. On the contrary, neoadjuvant chemotherapy(NAC)is regarded as a standard treatment for advanced gastric cancer in the West. The FLOT regimen is recommended for patients with good performance status. As the patient background and operative results are significantly different between the West and the East, extrapolation of the Western evidences seems to be difficult. We have to establish our own evidence of NAC.
46.
Gan To Kagaku Ryoho. 2020 Apr;47(4):563-568.
[Indications of Endoscopic Submucosal Dissection for Early Gastric Cancer].
[Article in Japanese]
Abstract
Endoscopic submucosal dissection(ESD)has been established as a standard treatment for early gastric cancer with low possibility of lymph node metastasis. Based on the results of the multicenter prospective study(JCOG0607), expanded indication for differentiated-type gastric cancer in Gastric Cancer Treatment Guidelines 2014 changed to absolute indication in Gastric Cancer Treatment Guidelines 2018. The other multicenter prospective study(JCOG1009/1010)will reveal the longterm outcomes of ESD for undifferentiated-type gastric cancer. With the advance of an aging society in Japan, the indication and curability of early gastric cancer for elderly patients should be discussed in the future.
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