Japanese Journal of Cancer and Chemotherapy最新文献

An 80-year-old woman with a history of lobectomy for small cell lung carcinoma(SCLC)presented with melena 2 years after surgery. Contrast-enhanced abdominal CT and enteroscopy revealed a bleeding tumor at the proximal jejunum. Partial small bowel resection was performed for hemostasis and diagnosis. Histopathology confirmed jejunal metastasis from SCLC. Due to advanced age and ongoing hemodialysis, no adjuvant therapy was administered. She remains recurrence-free 7 months postoperatively. Small intestinal metastasis from SCLC is rare, but long-term survival after resection has been reported. We report this rare surgical case of jejunal metastasis from SCLC with gastrointestinal bleeding.

An 89-year-old woman was referred to our department for surgery of subobstructed transverse colon cancer. She was operated on by Pfannenstiel incision and intracorporeal anastomosis after 3 days of preoperative fasting and mechanical bowel preparation with Tokakujokito. The postoperative course was good, and the patient was discharged on the seventh postoperative day. It has been reported that intracorporeal anastomosis leads to faster recovery of peristalsis after surgery and shorter postoperative hospital stay. In addition, the Pfannenstiel incision is associated with less complaints of wound pain, and the patient is weaned off the bed more quickly, so the combination with intracorporeal anastomosis is expected to result in an even faster postoperative recovery. Intracorporeal anastomosis for advanced cancer with stenosis is currently under discussion, but there is no significant difference in postoperative abscess formation or recurrence of seeding compared to extracorporeal anastomosis in normal cases, and it may be considered if the mechanical bowel preparation is well performed. We believe that mechanical bowel preparation with Tokakujokito may lead to better evacuation of stools in advanced cancer with stenosis, and thus expand the indications for intracorporeal anastomosis. We report this case and the innovations we have made in mechanical bowel preparation with Tokakujokito in our department.

A 69-year-old man underwent chemotherapy for bladder recurrence after right ureteral cancer surgery, and blood tests showed CA19-9 levels of 7,700 U/mL. Abdominal plain CT scans showed wall thickening at the fundus of the gallbladder. MRCP, endoscopic ultrasound(EUS), and contrast CT scans were performed, and the patient was diagnosed with adenomyomatosis of the gallbladder and underwent laparoscopic cholecystectomy with full-thickness dissection. Postoperative pathological examinations showed adenocarcinoma cells in the Rokitansky-Aschoff sinus(RAS), and the patient was diagnosed with gallbladder cancer(pT2, N0, M0, INF b, ly0, v0, n0, CM0, EM0, Stage Ⅱ). The postoperative course was uneventful, and the patient was discharged 2 days after surgery. A second stage operation was planned, but FDG-PET/CT scans performed 5 weeks after surgery showed ascites and abnormal accumulation suggestive of peritoneal dissemination. The patient subsequently died 4 months after surgery due to progression of the primary disease.

We report a case of tubular breast carcinoma discovered during an ultrasound examination during an opportunistic breast cancer screening. The patient was a 71-year-old woman. An ultrasound examination during an optional health check revealed a mass lesion in her left breast and she visited our department. Mammography revealed no abnormal findings. Ultrasonography revealed a hypoechoic mass measuring 5 mm in diameter in the AC area of the left breast. Core needle biopsy revealed tubular carcinoma. Systemic examination revealed no obvious distant metastasis. A circular lumpectomy and sentinel lymph node biopsy was performed. Histopathological findings showed tubular breast carcinoma, tumor diameter 7 mm, negative resection margins, and no lymph node metastasis. Ki-67 6.2%, ER positive, PgR positive, HER2 negative. After postoperative radiation therapy, the patient is being followed up with an aromatase inhibitor. One year after surgery, there has been no obvious metastasis or recurrence. Tubular carcinoma is pathologically characterized by a high amount of fibrous stroma surrounding the lumen, and ultrasound findings often show a hypoechoic mass with unclear boundaries and attenuation of posterior echoes. In this case, ultrasound examination was also useful in estimating the histological type.

We report here a successfully treated case in a high-risk patient with esophageal squamous cell carcinoma followed by immune-related adverse events(irAEs)of interstitial pneumonia after previous immune checkpoint inhibitor(ICI)therapy for advanced lung cancer. A 70-year-old man had achieved the long-term complete response to pembrolizumab maintenance after carboplatin and pemetrexed chemotherapy. However, he developed irAE-associated interstitial pneumonia requiring prolonged corticosteroid therapy. After diagnosis of esophageal cancer(cT3rN0M0, cStage Ⅱ), neoadjuvant docetaxel, nedaplatin, and 5-fluorouracil(UDON)chemotherapy resulted in tumor shrinkage, but interstitial pneumonia worsened, necessitating the reintroduction of corticosteroids. Following a 75-day taper, the patient underwent robot- assisted mediastinal esophagectomy with recurrent laryngeal nerve integrity monitoring(NIM system). Postoperative course was uneventful, and the patient was discharged on postoperative day 14. Then, 3 months of night home enteral nutrition of 1,200 kcal/day prevented weight loss and no recurrence has been observed for over 1 year. The mediastinoscopic approach reduces thoracic invasiveness and pulmonary complications, particularly beneficial in pulmonary high-risk patients. Robotic assistance enabled precise dissection, and NIM use facilitated nerve preservation leading to aspiration pneumonia. This case demonstrates that combining minimally invasive robot-assisted mediastinal esophagectomy with NIM system, UDON chemotherapy, and nutritional support enable favorable outcomes in high-risk esophageal cancer patients with ICI-related irAEs.

Solid papillary carcinoma(SPC)is a newly recognized disease entity that was incorporated into the WHO classification in 2012. It is rare and less than 1% of all breast cancers, that is the reason of no stand treatment protocol. Here, we report a case of SPC encountered at our institution. The patient was a 47-year-old woman who presented with a progressively enlarging mass in the right breast. The tumor was detected as a solid mass with well-defined margins, approximately 5 cm in maximum diameter on imaging examination. Although neoadjuvant chemotherapy was considered due to the large tumor size, no definitive evidence of invasion was found on preoperative evaluation, and upfront surgery was selected. She underwent right total mastectomy and sentinel lymph node biopsy. Histopathological examination revealed solid cellular proliferation with fibrovascular cores, large nest formation, partial comedo necrosis, and a 2 mm focus of invasion, leading to a diagnosis of SPC with invasion. Immunohistochemical staining of the invasive component showed ER-positive, PgR-positive, HER2 score 2+(DISH non-amplified), Ki-67 index 6%, and synaptophysin-positive, suggesting a Luminal-type SPC with invasion. Postoperatively, the patient was started on tamoxifen, and she remains recurrence-free to date. This case underscoring the importance of careful pre-treatment assessment of malignancy.

A comprehensive treatment(COMPT)composed of macroscopic complete removal of peritoneal metastasis(PM)and perioperative chemotherapy has been performed to cure patients with PM. The present article shows the theoretical basis to cure patients with low grade mucinous carcinoma peritonei(LGMCP)from appendiceal mucinous neoplasm(AMN)by COMPT. When the micrometastasis(MM)does not exist outside the surgical field, complete cytoreductive surgery/complete cytoreduction(CRS, CCR-0)alone can cure the patients(Scenario A). If the MM burden left after CCR-0 resection(Scenario C)or neoadjuvant chemotherapy(NAC)+CCR-0(Scenario D)is less than the threshold level that could be completely eliminated by IOHIPEC, patients will be cured by CRS+IOHIPEC. Scenario F shows the status where MM can be completely eliminated by NAC, resulting in cure by NAC+CRS without IOHIPEC. In trying to cure patients with PM, our aim is to induce patients to follow Scenarios A, C, D or F. Between 2009 and 2023, 509 patients with LGMCP from AMN received CCR-0. Of these patients, 142 patients were treated with neoadjuvant laparoscopic(NLHIPEC)and CRS, neoadjuvant intraperitoneal chemotherapy(NIPC), and 101 patients were treated with neoadjuvant systemic chemotherapy(NSC)NIPC was performed 5 cycles, before CRS. Five-year, and 10-year overall survival rates of these patients after CCR-0 resection were 88.7%, and 77.6%, respectively. Recurrence was found in 158 patients, and peritoneal, pleural, and lung recurrence were found in 143, 6 and 3 patients. Treatment options related to the cure were inspected. To define cure, patients who survived without recurrence longer than 5 years were cured(n=202), and 43.2%(19/44)of patients were cured after CCR-0 alone(Scenario A). Patients treated with CRS+IOHIPEC were cured in 54.3%(132/243), and those treated by NIPC+CCR-0 were cured in 53.5%(38/71). Cured rates after treatment by NIPC and NSC were 53.5%(38/71), and 38.5%(35/91)(p=0.056, χ2 =3.65). Cure rate after non NIPC+CCR-0+IOHIPEC(68/117; 58.1%), and NIPC+CCR-0+IOHIPEC(34/54; 63.0%) were significantly higher than those after CRS alone(19/44; 43.2%). The PCI scores of patients treated with IOHIPEC and non IOHIPEC were 15.1±10.4 and 13.7±9.7(NS). In contrast, PCI scores for patients treated with NIPC and with NSC were 10.7±8.2 and 16.8±10.6(p<0.0001). Grade 3, 4 and 5 postoperative complications after CRS were encountered in 43 (9.2%), 43(9.2%)and 5(0.9%)patients, respectively. Conclusions: CCR-0 with IOHIPEC and NIPC may improve the cure rate of patients with LGMCP. According to our theory, this improvement is due to the elimination of MM by IOHIPEC and reduction of MM burden within threshold levels, that can be completely eliminated by IOHIPEC. We await more effective options for the elimination of MM.

A 61-year-old female patient was diagnosed with stage ⅡB squamous cell carcinoma of the uterine cervix. She underwent chemoradiotherapy, which included whole pelvic irradiation(50 Gy), intracavitary irradiation(24 Gy), and 6 cycles of nedaplatin therapy at the gynecology department. After chemoradiotherapy, a biopsy of the uterine cervix was performed, and pathological examination showed evidence of remission. Six months later, a CT scan and MRI scan revealed a 23 mm mass in the S3 region of the liver, which was diagnosed as a solitary, metachronous liver metastasis. The patient was referred to our department for surgery and underwent laparoscopic hepatic lateral segmentectomy. Pathological findings confirmed that the metastasis was from squamous cell carcinoma of the uterine cervix. Postoperatively, the patient was followed up without chemotherapy. However, 3 months after surgery, a CT scan revealed multiple liver metastases and lymph node metastases. The patient is currently receiving chemotherapy at another hospital. While liver metastasis in cervical cancer is not uncommon, isolated, metachronous liver metastasis is rare. Including our case, there have been only 8 such reports in Japan, making this a rare case.

We report the short-term outcomes of 38 cases of colorectal cancer in patients aged 85 years or older treated at our institution from April 2023 to April 2025. The median age was 88 years, with 13 male and 25 female patients, all of whom had comorbidities. The primary location of the lesions was the right colon in 19 cases, the left colon in 6 cases, and the rectum in 13 cases. Open surgery was performed in 8 cases, laparoscopic surgery in 14 cases, and robotic surgery in 16 cases. There were no in-hospital deaths, and the median postoperative hospital stay was 11 days for open surgery and 7 days for laparoscopic and robotic surgery. The proportion of patients who were discharged to the same environment as before admission was 63% for open surgery, 79% for laparoscopic surgery, and 100% for robotic surgery. In cases of colorectal cancer surgery in patients aged 85 years or older, strict perioperative management and postoperative rehabilitation are essential to achieve early social reintegration. Minimally invasive surgery may contribute to shorter hospital stays, and particularly in the case of robotic surgery, it may offer a useful approach for facilitating discharge back to the pre-hospitalization environment.

Objective: In this study, we investigated the relationship between nutritional indicators and prognosis in cancer patients who underwent CV port placement at our institution.

Methods: Eighty-six cancer patients who underwent CV port placement for palliative or nutritional purposes between January 2016 and December 2020 were retrospectively analyzed. Items examined included age, gender, nutritional markers(BMI, serum ALB, CRP, PNI, NLR, mGPS), and prognosis.

Results: The median age was 72 years, and the gender ratio was 45 males and 41 females. Median BMI 19.4, serum ALB 3.1 g/dL, CRP 1.65 mg/dL, PNI 38.5, NLR 4.08, mGPS 0/1/2=14/20/52. Median survival was 71 days. In univariate analysis of prognostic factors, the long-term survival group(≥90 days)had lower CRP and NLR and fewer mGPS 2 cases than the short-term survival group(<90 days). On the other hand, BMI, serum ALB, and PNI were not significantly different between the 2 groups. Multivariate analysis identified only CRP<1.65 mg/dL as an independent predictor of 90-day survival.

Conclusion: CRP in cancer patients undergoing CV port placement for palliative and nutritional purposes might be a predictor of>90- day survival in cancer patients undergoing CV port placement for palliative and nutritional purposes.