Keishi Sugimoto

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

BackgroundThis pilot study was carried out to evaluate the efficacy of chemotherapy for patients with peritoneal dissemination from gastric cancer or positive lavage cytology diagnosed by staging laparoscopy.MethodsSixteen patients were enrolled. Paclitaxel was administered at 120 mg/m2 on day 1 and S-1 was administered orally at 80 mg/m2 for 14 consecutive days, followed by a 1-week rest, as one course. After five courses of this therapy, the primary gastric tumors were evaluated and second-look laparoscopy was performed for patients showing partial response or stable disease with clinical benefit.ResultsPartial response or stable disease with clinical benefit was confirmed in seven and five patients, respectively, and these patients underwent second-look laparoscopy. No viable cancer cells were detected on cytopathological investigation during second-look laparoscopy in 9 patients who underwent surgical treatment. The intent-to-treat response rate for gastric tumor was 44% and the rate of disappearance of peritoneal metastasis was 38% (6 cases) at surgery. The median survival time was 555 days. Leucopenia of grade 3 and neutropenia of grade 3 were recognized in two and three patients, respectively.ConclusionThis chemotherapy regimen may be an acceptable option for patients with peritoneal dissemination. We plan to study this regimen further in gastric cancer patients with peritoneal dissemination.

Intraperitoneal administration of paclitaxel and oral S-1 for a patient with peritoneal dissemination and hydronephrosis due to advanced gastric cancer

We report a patient with type 3 gastric cancer with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. He was diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m2 was administered intraperitoneally on days 1 and 8, and S-1 at 100 mg/body was administered orally for 14 days, followed by 7 days’ rest, as one course. After five courses, primary tumor reduction was confirmed and no cancer cells were detected on pathocytological investigation at second-look laparoscopy. The patient underwent total gastrectomy with lymph node dissection. He died from liver metastasis 29 months after the initial treatment, but he had not suffered from peritoneal metastases and had kept a good quality of life (QOL) since that treatment. This chemotherapy can be applied as one of the promising candidates for the treatment of patients with peritoneal metastasis of gastric cancer.

Pilot study of intraperitoneal administration of paclitaxel and oral S-1 for patients with peritoneal metastasis due to advanced gastric cancer

BackgroundThere is no standard treatment for peritoneal dissemination from gastric cancer. A novel combination chemotherapy has been introduced for patients with advanced gastric cancer with peritoneal metastasis.MethodsThis pilot study was performed on four patients to confirm safety and efficacy. They were diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy, or with metastasis to the transverse colon. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m2 or 60 mg/body was administered intraperitoneally on days 1 and 8 and S-1, at 80–120 mg/body, was administered orally for 14 days followed by 7 days’ rest, as one course. After five courses of this therapy, the primary gastric tumors were evaluated by conventional examinations, and second-look laparoscopy was performed to assess the efficacy of the treatment against the peritoneal metastases.ResultsAfter five courses, primary tumor reductions were confirmed, and no cancer cells were detected on pathocytological investigation during second-look laparoscopy in any of the patients. Three patients underwent total gastrectomy with lymph node dissection and one underwent left upper abdominal evisceration. Final histological staging showed two stage 3 and two stage 4 patients. The intraperitoneal administration of paclitaxel and the oral administration of S-1 were well tolerated. Three patients died, at 8, 15, and 29 months, respectively, after the initial treatment, and one has been alive for 54 months without recurrence.ConclusionThis chemotherapy can be used in the treatment of patients with peritoneal metastasis of gastric cancer.

A case of esophageal cancer with chronic renal failure undergoing hemodialysis treatment showing long-term complete response with docetaxel chemotherapy and salvage endoscopic treatment

Chemotherapy for hemodialysis patients is not yet well codified, and the selection of individual patients remains difficult. We report the case of a 71-year-old hemodialyzed man who was successfully treated with docetaxel for squamous cell carcinoma of the esophagus. He had received radiotherapy for squamous cell carcinoma of the esophagus 6 years earlier. Metachronous esophageal cancer had developed at the upper third of the esophagus. He was treated tri-weekly with docetaxel at a dose of 60 mg/body in combination with hemodialysis three times a week. He achieved complete response after five cycles of chemotherapy. A small elevated lesion was diagnosed at the anal edge of the scar 26 months after initial treatment, and endoscopic mucosal resection and ablation was performed. Chemotherapy with docetaxel was continued up to 50 months without significant toxicity. The patient died of infection resulting from diabetic gangrene at 60 months after the initial chemotherapy, but no signs of recurrence have been observed until then. Docetaxel may be an effective anticancer agent for patients undergoing hemodialysis.