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ABSTRACT: PURPOSE: The purpose of this study was to investigate whether intravenous (i.v.) administration allowed docetaxel to penetrate ascites in gastric cancer patients with peritoneal dissemination. PATIENTS AND METHODS: Twelve patients with disseminated gastric carcinoma were enrolled in the study. All patients received docetaxel-containing drug regimens: i.v. administration of 40 mg/m(2) docetaxel in 6 patients, and 60 mg/m(2) in the remainder. Docetaxel concentrations in the plasma and ascites were measured. RESULTS: Docetaxel was detected in the ascites of 4 patients in the 40 mg/m(2) group and 5 patients in the 60 mg/m(2) group. The highest concentration of docetaxel in plasma was detected at immediately after administration (median: 1,660 ng/mL, 501-2,560 ng/mL), after which it gradually decreased. The highest concentration of docetaxel in ascites was observed at ~7 h after administration and varied among cases (median: 18 ng/mL, 11-52 ng/mL). CONCLUSION: Intravenous administration allows to penetrate ascites in gastric cancer patients with peritoneal dissemination.
Cancer Chemotherapy and Pharmacology 01/2013; · 2.83 Impact Factor
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ABSTRACT: OBJECTIVES:: The purpose of this study was to determine the survival benefit of bursectomy by retrospectively comparing the prognosis in patients undergoing D2 lymphadenectomy and gastrectomy (D2 gastrectomy) with bursectomy for gastric cancer with that in patients undergoing D2 gastrectomy alone. METHODS:: A total of 254 consecutive stage IA to IIIC gastric cancer patients undergoing curative intent surgery between 2004 and 2009 were enrolled. The patients were divided into 2 groups: a bursectomy group, which included patients undergoing curative D2 gastrectomy with bursectomy by one surgeon, and a nonbursectomy group, which included those undergoing curative D2 gastrectomy alone by other surgeons. RESULTS:: No statistically significant difference was observed in the number of metastatic nodes or penetration of the serosa between the 2 groups. The overall incidence of surgery-related complications was 24.0% in the bursectomy group (29 of 121 patients) and 25.6% in the nonbursectomy group (34 of 133 patients). The 5-year overall survival rate was 85.8% in the bursectomy group and 80.8% in the nonbursectomy group (hazard ratio 0.82; 95% confidence interval, 0.37-1.74; P=0.60). CONCLUSIONS:: The results of this retrospective study indicate no survival benefit for bursectomy plus D2 gastrectomy over D2 gastrectomy alone.
American journal of clinical oncology 08/2012; · 2.21 Impact Factor
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ABSTRACT: Complete remission from advanced-stage synchronous double primary (SDP) esophageal and gastric adenocarcinoma by chemotherapy alone is rare. We report a case of advanced-stage SDP esophageal and gastric adenocarcinoma in which a complete response to treatment was obtained with S-1 and cis-diamminedichloroplatinum (CDDP).
The patient was a 74-year-old man referred to our hospital complaining of dysphagia. Gastrointestinal endoscopy was performed and advanced-stage SDP esophageal and gastric adenocarcinoma diagnosed. Computed tomography revealed multiple regional lymph node metastases in the mediastinum. Neoadjuvant chemotherapy with S-1 and CDDP for advanced esophageal and gastric cancer was planned. An endoscopy following two courses of chemotherapy revealed that the esophageal cancer had been replaced with a normal mucosal lesion and the gastric tumor with a scar lesion; the results of biopsies of both were negative for cancer. Computed tomography revealed that the multiple lymph node metastases had disappeared. We diagnosed a complete response to S-1 and CDDP in advanced-stage SDP esophageal and gastric cancer. The patient is still alive with no signs of recurrence 22 months after the disappearance of the original tumor and metastatic lesions without surgical treatment.
These results suggest that complete remission from advanced-stage esophageal and gastric cancer can be obtained with chemotherapy with S-1 plus CDDP.
World Journal of Surgical Oncology 07/2012; 10:133. · 1.12 Impact Factor
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ABSTRACT: A 77-year-old man with early synchronous double primary gastric and esophageal cancer showed complete response (CR) to chemoradiotherapy (CRT) with fluorouracil (5-FU) and cis-diamminedichloroplatinum (CDDP) and 60 Gy total dose of radiation. Gastrointestinal endoscopy had revealed type IIc squamous cell carcinoma in the lower oesophagus and type IIc adenocarcinoma in the mid-stomach region. Synchronous double primary early-stage esophageal and gastric cancer was diagnosed. The patient's age and chronic obstructive pulmonary disease (COPD) contraindicated radical esophageal surgery. Therefore, we decided to first administer CRT with 5-FU and CDDP for the esophageal cancer, and subsequently perform partial gastrectomy for the gastric cancer. After the CRT, neither of the tumors recurred. CR to CRT for the esophageal cancer and CR to chemotherapy for the gastric cancer were achieved. CONCLUSION: CRT with 5-FU and CDDP can produce CR in cases of early esophageal and gastric cancer.
Anticancer research 06/2011; 31(6):2339-42. · 1.73 Impact Factor
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ABSTRACT: We report a case of early-stage mucosal esophageal cancer, showing a complete response to S-1 and cis-diamminedichloplatinum (CDDP). The patient was a 67-year-old man with synchronous double primary early-stage mucosal esophageal and advanced gastric cancer. We planned neoadjuvant chemotherapy with S-1 and CDDP for the advanced gastric cancer and endoscopic mucosal resection for the early-stage esophageal cancer. After the first course of chemotherapy, the endoscopy revealed that the esophageal cancer had become a normal mucosal lesion, and the biopsy was negative for cancer. We diagnosed a complete response to S-1 and CDDP in early-stage esophageal cancer. After two courses of chemotherapy, distal gastrectomy was performed. The patient is still alive with no sign of recurrence at 16 months after the disappearance of the original tumor. These results suggest that chemotherapy with S-1 plus CDDP may be effective in early-stage esophageal cancer.
Anticancer research 03/2011; 31(3):1019-22. · 1.73 Impact Factor
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ABSTRACT: The patient was a 67-year-old male with Type 3 gastric cancer who underwent distal gastrectomy and D2 dissection in December 2004. It was diagnosed to be a cancer of se, n(1+), Stage IIIA. In October 2006, 22 months after the operations, abdominal CT showed multiple tumors with a maximum diameter of 35 mm in both hepatic lobes. The tumors were diagnosed as multiple hepatic metastases of the gastric cancer. After 5 courses of concomitant S-1+CPT-11 therapy, abdominal CT in February 2007 showed complete elimination of the multiple tumors in both hepatic lobes, and it was considered that a complete response (CR) had been obtained. After initiation of the treatment, 32 courses of S-1+CPT-11 therapy were performed, and at present, 24 months after the therapy, the patient has survived with no redevelopment of the cancer. All of the treatments were performed in an outpatient setting, and no side effects have been confirmed other than grade 1 gastric and skin symptoms. We experienced a case in which CR was achieved by S-1+CPT-11 therapy in a patient with hepatic metastasis of a gastric cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 01/2010; 37(1):157-9.
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ABSTRACT: The patient was a 51-year-old male diagnosed with gastric cancer in July 1999 by endoscopic examination, revealing multiple liver metastasis with abdominal computed tomography (CT). The serum levels of alpha-fetoprotein (AFP)were determined to be 91 ng/mL, and tumors were histopathologically identified as AFP-producing gastric cancer by immunohistological staining. We started combination chemotherapy with 5-fluorouracil (5-FU), Leucovorin (LV), etoposide (VP-16) and cis-diaminedichloroplatinum (CDDP) (designated as FLEP)in August 1999. The serum AFP value was normalized after two courses, and the liver metastases disappeared. The primary gastric tumor became a ulcer, and disappearance of the cancer was confirmed histologically. We continued adjuvant chemotherapy with S-1 as an outpatient. In April 2000, there was no sign of the liver metastases, but endoscopic examination showed IIc-like lesion in the stomach. We performed 2 courses of FLEP, but the tumor did not disappear. He underwent total gastrectomy with D2 dissection in June 2001. The pathological diagnosis was por 1, ss, ly2, v1, n(1+). He was still alive with no sign of recurrence 84 months after surgery. We experienced this AFP-producing gastric cancer in which CR was possible by FLEP. There was no recurrence after total gastrectomy for local recurrence.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(11):1885-8.
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ABSTRACT: The characteristics of jejunal ectopic pancreas in dynamic gadolinium-enhanced magnetic resonance imaging are described in a 40-year-old man with bowel obstruction. The pre-contrast signal intensity and post-contrast enhancement pattern of ectopic pancreas are the same as those of the pancreas.
Abdominal Imaging 01/2009; 35(1):85-7. · 1.73 Impact Factor
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Japanese Journal of Clinical Oncology 04/2008; 38(3):233. · 1.78 Impact Factor
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ABSTRACT: The effect of gastrectomy on pharmacokinetics after S-1 administration was investigated.
A dose of 40 mg/m(2) of S-1 was administered orally twice daily for 7 days (80 mg/m(2)/day) preoperatively in ten patients with resectable gastric cancer, and the same dose of S-1 was administered for 28 consecutive days after gastrectomy. Plasma concentrations of tegafur, gimeracil, and oteracil potassium, all the components of S-1, and 5-FU were measured on pre- and postoperative days. Concentrations of 5-FU in tumor and normal tissues were also determined.
At day 4 from the initial preoperative administration of S-1, the AUC of 5-FU was 1,055 +/- 304 ng h/ml. At day 18, day 28, and day 42 after gastrectomy, it was 1,012 +/- 331, 1,070 +/- 403, and 946 +/- 226 ng h/ml, respectively. No significant differences for plasma 5-FU were observed between pre- and postoperative days. In the resected tumor tissues, concentrations of 5-FU were 242 +/- 83 ng/g around 4.5 h and 91.7 +/- 37.0 ng/g around 20 h after the final administration, respectively.
Gastrectomy does not affect on pharmacokinetics of 5-FU derived from S-1 regardless of partial or total gastrectomy, indicating that S-1 can be a useful drug in postoperative adjuvant chemotherapy for gastric cancer.
Cancer Chemotherapy and Pharmacology 11/2007; 60(5):693-701. · 2.83 Impact Factor
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ABSTRACT: We administered a combination chemotherapy of S-1 plus cisplatin (CDDP) therapy to a patient with recurrenced cancer of esophagus in lymph node. S-1 (80 mg/m(2)/day), taken out of the capsule, was administered via the catheter for tube feeding on day 1 to day 21 and CDDP at 60 mg/m(2)/day by intravenous drip infusion on day 8 for 3 weeks followed by a drug-free 2 week period as the first course. After 2 courses, CT findings showed a complete regression of the lymph node for complete response (CR). He has been alive for 10 months without recurrence. Combined use of S-1 and CDDP is effective as chemotherapy for recurrenced esophageal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 10/2007; 34(9):1459-61.
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ABSTRACT: We performed in vivo chemosensitivity tests on human gastric carcinoma. To evaluate the efficacy of some combined chemotherapy for human gastric carcinoma maintained in the subcutaneous space in nude mice, we designed the following six experimental groups: 1) 5-FU group, 2) CDDP group, 3) CPT-11 group, 4) combined therapy group of 5-FU and CDDP, 5) combined therapy group of 5-FU and CPT-11, and 6) combined therapy group of CPT-11 and CDDP. An in vivo nude mice assay was performed. Histopathological changes of the tumors in nude mice, treated with anti-cancer agents,were also evaluated and compared to the results of the nude mice assay. Based on histopathological grading,the true positive rate of the nude mice assay was 0%, the true negative rate was 83.3%, and the accuracy rate was 83.3%. CPT-11 appeared to be highly efficacious when given in combination with CDDP in human gastric cancer cell lines. These results suggest that combination chemotherapy with CPT-11 and CDDP is clinically effective for gastric cancer patients.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2007; 34(6):881-4.
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ABSTRACT: There are many controversies regarding the treatment for primary gastric non-Hodgkin's lymphoma (PGL). We hypothesized that preoperative chemotherapy and extensive surgery would improve patient survival in the treatment of early stage patients with PGL.
Between 1997 and 2001, we prospectively evaluated 10 patients with stage IE and IIE PGL. The histological diagnoses were established by endoscopic biopsies in all cases. All patients received preoperative chemotherapy, i.e. CHOP or MACOP-B. Upon the completion of chemotherapy, the extensive surgery including total gastrectomy, splenectomy, cholecystectomy, and paraaortic lymphadenectomy were performed. The response rates of preoperative chemotherapy and overall survival were analyzed.
All patients were still alive with no signs of recurrence with a median follow-up of 86 months (range, 40 to 102 months) after surgery. In all patients, microscopic examinations did not reveal residual lymphoma cells in the resected stomach or lymph nodes. Chemotherapy-related preoperative complications such as perforation or intestinal bleeding did not occur in any of the cases. Postoperative complications developed in 30% (3/10) of patients and consisted of 2 pancreatic fistulas, 3 intra-abdominal abscesses, and 1 anastomotic leak.
Primary chemotherapy alone without surgery may produce complete remission in Stage IE-IIE PGL.
Hepato-gastroenterology 07/2007; 54(76):1285-8. · 0.66 Impact Factor
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ABSTRACT: This retrospective study evaluated the effects of neoadjuvant chemotherapy in advanced gastric cancer.
Between 2002 and 2005, we treated 14 patients with advanced gastric cancer (involvement of more than five nodes or tumor invasion into pancreas) and 25 patients with Stage III gastric cancer. The group of 14 patients with advanced gastric cancer received combination chemotherapy with S-1 and cis-diamminedichloroplatinum (CDDP) as a neoadjuvant chemotherapy (NAC). This regimen was repeated every 5 weeks for a total of 2-5 cycles. The 25 patients with Stage III gastric cancer was carried surgery alone (SA). All patients underwent extensive surgery, including gastrectomy, and D2 lymphadenectomy. The rate of response and overall survival in the two groups were compared.
All patients of NAC group completed the planned regimens of chemotherapy and surgery. Patients of the NAC group had a response rate of 78.6% (95% confidence interval 57.1-100.0%). The most common adverse effect was leukocytopenia (42.9%). However, only four patients (28.6%) had upper Grade 2 leukocytopenia, and all recovered promptly. Postoperative complications were not significant differentiated between NAC and SA group of patients (7.2 vs. 4.0%). Patients in the NAC group had a significantly better survival than those in the SA group (P = 0.03). The median survival has not been reached after 26.9 months of median follow-up for patients in the NAC group. 1-, 2-, and 3-year survival rates were 92.3, 92.3, and 61.5%, respectively. NAC was identified as an independent prognostic factor in all patients (P = 0.018).
Neoadjuvant chemotherapy with TS-1 + CDDP improves the survival in patients with advanced gastric cancer.
Journal of Cancer Research and Clinical Oncology 01/2007; 132(12):781-5. · 2.56 Impact Factor
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ABSTRACT: The FLEP regimen (5-FU, LV, ETP, and CDDP) has been recommended as a combination chemotherapy to control advanced and recurrent gastric cancer. We performed a phase II study of this regimen in 49 patients with advanced gastric cancer.
The treatment regimen consisted of: 5-FU at 370 mg/m(2) (days 1-5, i.v. 24 h); LV at a dose of 30 mg (days 1-5, i.v. bolus); and ETP and CDDP each at 70 mg/m(2) (days 7 and 21, i.a. 2 h), which was repeated every five weeks.
The overall response rate was 40.8% (20/49 patients) and the median survival time was 12.6 months (range 1.1-41.8). The adverse events were Grade 3/4 leukocytopenia (16.3%), Grade 3/4 thrombocytopenia (8.2%), Grade 3 nausea and/or vomiting (4.1%), and Grade 3 stomatitis (2.0%).
Based on the encouraging response rate and prognosis, we recommend applying the FLEP regimen to patients with primary advanced gastric cancer.
Journal of Cancer Research and Clinical Oncology 10/2002; 128(9):493-6. · 2.56 Impact Factor
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ABSTRACT: BACKGROUND: This clinicopathological study evaluated the utility of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 as predictors of locoregional recurrence and long-term disease-free survival in patients with gastric cancer.METHODS: During the period January 1989 to December 1994, 485 patients with primary gastric cancer were evaluated. Gastrectomies were performed in 434 patients. Prognostic factors were analyzed by the Kaplan-Meier method and multivariate analysis, using Cox regression.RESULTS: Elevated serum CEA and CA19-9 levels were observed in 92 of the 485 patients (19.0%), and in 95 of the 435 patients (21.8%), respectively, and both markers were elevated in 29 of these 435 patients (6.7%). Elevated serum CEA and CA19-9 levels correlated well with lymph node metastasis, lymphatic invasion, vessel invasion, stage grouping, depth of invasion, and curability. Patients with elevated serum CEA levels were at significantly higher risk of having all recurrence factors than were those with normal serum CEA levels. Patients with elevated serum CA19-9 levels were at significantly higher risk of having peritoneal metastases and distant metastases than were those with normal serum CA19-9 levels. A significant difference in the cumulative survival curves of patients was demonstrated between those with elevated and those with normal serum CEA or CA19-9 levels, even for patients at the same disease stage (stage III). Patients with elevated levels of both markers had a significantly worse prognosis than patients in whom the levels of both markers were normal. In patients who underwent gastrectomy, elevated serum CEA levels either preoperatively or within 3 weeks after gastrectomy were associated with significantly worse prognosis than were normal levels. When the cutoff level of serum CEA was increased to 10 ng/ml, serum CEA, age, lymph node metastasis, and surgical stage grouping were selected as independent prognostic factors by multivariate analysis of 14 prognostic factors, using Cox regression.CONCLUSION: Serum CEA and CA19-9 levels provide additional prognostic information in patients with primary gastric cancer. In particular, an elevated serum CEA level provides additional prognostic information and is a useful indicator of curability in patients who undergo gastrectomy. Serum CEA level is an independent prognostic factor in patients with primary gastric cancer.
Gastric Cancer 01/2001; 3(4):177-186. · 2.42 Impact Factor
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ABSTRACT: BACKGROUND: During a 10-year period (1986-1995), 59 of 538 patients with early gastric cancer (11.0%) had the superficial spreading type of gastric cancer. We attempted to elucidate the clinicopathological features and investigated the influence of those features on surgical procedures and patient prognoses.METHODS: These 59 superficial spreading lesions were analyzed with respect to macroscopic type, lymph node (LN) metastasis, recurrent pattern, and method of surgical operation. In addition, the lesions were compared with those of 393 other patients with small-sized cancer.RESULTS: In both groups, the IIc type macroscopic lesion occurred most frequently, and the depressed subtype occurred more frequently than the elevated subtype. There was no significant histologic difference between the groups. The incidence of LN metastasis was 8.7% in early gastric cancer, 7.1% in small-sized cancer, and 20.3% in superficial spreading cancer. The incidence of lymphovascular invasion was 24.4% in small-sized cancer and 50.8% in superficial spreading cancer. The incidences of LN metastasis and lymphovascular invasion were greater in superficial spreading cancer than in small-sized cancer. Despite extensive preoperative examination, determination of the tumor margin was impossible in 26 of the 59 patients with superficial spreading cancer. The incidence of recurrence was 2.0% in small-sized cancer and 5.1% in superficial spreading cancer.CONCLUSIONS: A wide resection with extensive lymph node dissection (D2 or more) seems to be an appropriate treatment for the superficial spreading type of early gastric cancer.
Gastric Cancer 09/1999; 2(2):129-135. · 2.42 Impact Factor
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ABSTRACT: This retrospective study evaluated the efficacy of and compliance with combined irinotecan hydrochloride (CPT-11) and S-1 chemotherapy in patients with liver metastases of gastric cancer.
A total of 28 gastric cancer patients with liver metastases received first-line chemotherapy. The response rate, overall survival, and toxicity were evaluated. Fourteen patients were treated with CPT-11+S-1 and they were compared with 14 patients who received cis-diamminedichloroplatinum (CDDP)+S-1.
The CPT+S-1 group showed a higher response rate than the CDDP+S-1 group (57.1% [95% CI 31.2-83.1%] vs. 42.9% [95% CI 16.9-68.8%]; p < 0.44). The median survival time of the CPT-11+S-1 group was significantly longer than the CDDP+S-1 group (16.1 months [95% CI 10.5-21.2] vs. 7.3 months [95% CI 2.2-14.7]; hazard ratio for death, 0.35 [95% CI 0.14-0.83]; p < 0.02). By multivariate analysis for the treatment with CPT-11+S-1 was identified as an independent prognostic factor. The most common adverse effect of CPT-11+S-1 therapy was leukopenia (57.1%), which was Grade 3 in 3 patients (21.4%). However, all patients recovered rapidly and there were no significant differences of toxicity between the two regimens.
CPT-11+S-1 therapy will achieve significantly longer survival than CDDP+S-1 without severe toxicity in gastric cancer patients with liver metastases.
Hepato-gastroenterology 56(96):1755-9. · 0.66 Impact Factor
