Japanese Journal of Cancer and Chemotherapy最新文献

In the case of borderline resectable or unresectable locally advanced pancreatic cancer, the indication for surgical resection is considered after preoperative chemotherapy(radiation)and reevaluation of the patient's condition. During neoadjuvant chemotherapy, many patients show progressive hematocytopenia due to bone marrow suppression;hence, careful perioperative blood management has a significant impact on surgical resection procedures and outcomes regarding short-term or long-term prognoses. In this study, we report successful cases of transfusion-free surgery for initially borderline resectable and unresectable pancreatic cancer in 4 patients for whom transfusion was not an option, using the PBM treatment program.

A 60s man presented with leukemia for an underlying disease, which had CR to chemotherapy. By medical examination, an INSM1-positive small cell carcinoma was found next to the right lung hilar region. The patient was diagnosed with cT2aN1M0. Radiation therapy was performed with 45 Gy at the hilum of the lung and mediastinum, and 4 courses of chemotherapy(CDDP 80 mg/m2+VP-16 100 mg/m2)was performed. Whole brain radiation therapy was also performed at 25 Gy. As a result, the lung cancer had CR. However, a small nodule remained in the right upper lobe, which was diagnosed as non-small cell lung cancer using a bronchoscope. There were not metastasis with lymph node or distant station by examination with PET. Right upper lobectomy and lymph node dissection were performed. Pleomorphic carcinoma was diagnosed, and there was no remain of small cell carcinoma. These findings suggest that early detection of the second cancer is important for long-term survival after small cell lung cancer treatment. Improvement of prognosis through surgical resection should be considered.

An 86-year-old woman was referred from another hospital for gemcitabine monotherapy for locally advanced pancreatic head cancer. After 8 courses of gemcitabine monotherapy, follow CT showed partial response, and biliary metallic stent which had been placed 8 months ago displaced into the duodenum. An upper gastrointestinal endoscopy was performed and the stent was retrieved. There has been no subsequent elevation in hepatic and biliary enzymes, and she is currently under observation without re-stenting. There have been reports of displaced biliary stents causing gastrointestinal perforation and intestinal obstruction. For cases where chemotherapy is effective and the placement duration of the bile duct stent is prolonged, it is necessary to increase the frequency of abdominal X-rays to monitor the dislocation of the bile duct stent carefully.

A 50s male was diagnosed with multiple hepatocellular carcinomas(HCCs), tumor thrombus in the right atrium, and multiple lung metastases. Because the HCCs were unresectable, chemotherapy was planned. However, the patient developed obstructive jaundice 20 days after the first visit, before chemotherapy could be initiated. Immediate treatment was thought necessary to prevent HCC progression. Because the Child-Pugh score was A(6 points)on the first visit, lenvatinib was administered without drainage. The jaundice improved after 10 days of treatment, and computed tomography revealed shrinkage of the HCC and improvement in intrahepatic bile duct dilatation 14 days later. The lenvatinib treatment was continued thereafter, and jaundice did not recur. The patient died 9 months later. This report highlights the usefulness of lenvatinib without drainage in patients with obstructive jaundice due to HCC when urgent treatment is necessary and liver function is well-preserved.

For many years, drug therapy for endometrial cancer has centered on chemotherapy regimens such as adriamycin+cisplatin(AP)or paclitaxel+carboplatin(TC). In recent years, however, the introduction of immune checkpoint inhibitors(ICIs)has dramatically changed the treatment landscape. Multiple phase Ⅲ trials(eg, NRG-GY018, DUO-E)have demonstrated that adding ICIs to TC chemotherapy improves prognosis, and in 2024 combination therapies with pembrolizumab or durvalumab were approved in Japan for advanced or recurrent endometrial cancer. Additionally, development of antibody-drug conjugates(ADCs)is underway, and ADCs targeting HER2, TROP2, and other tumor-specific antigens are anticipated to become new therapeutic options.

A 76-year-old man underwent laparoscopic total gastrectomy for advanced proximal gastric cancer and was diagnosed as pT4aN2M0, pStage ⅢA. Three years postoperatively, abdominal CT revealed a 2-cm mass near the splenic hilum, and further evaluation led to a diagnosis of isolated lymph node recurrence of gastric cancer at the splenic hilum. A total of 11 courses of chemotherapy, including nivolumab combined with SOX regimen, were administered. The lesion remained localized with no new metastases, and surgical resection was planned. Robotic distal pancreatectomy was performed using the da VinciTM SP System. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Pathological examination confirmed metastatic adenocarcinoma. As of 4 months after surgery, the patient remains recurrence-free. We present this resected oligometastasis case with a review of the relevant literature.

A 66-year-old man was referred to our hospital for further evaluation and treatment of advanced gastric cancer, which was diagnosed after the patient presented with a history of a loss of appetite. The patient was diagnosed with advanced gastric cancer with pyloric stenosis and peritoneal dissemination(cT4aN+M1, P1, cStage ⅣB;Japanese Classification of Gastric Carcinoma, 15th edition). After undergoing gastrojejunostomy, the patient received 5 courses of SOX plus nivolumab. The tumor markedly regressed and the peritoneal dissemination disappeared. No peritoneal metastasis(P0)or positive cytology(CY0)was observed on staging laparoscopy, and conversion surgery was deemed feasible. The patient underwent distal gastrectomy with D2 dissection and partial resection of transverse colon to achieve R0 resection. Pathological findings revealed ypT3N2, P0, and CY0, corresponding to ypStage ⅢA. The histological therapeutic effect was graded as Grade 1b. Postoperative adjuvant chemotherapy with oral S-1 was administered for 6 months. The patient remained recurrence-free for 8 months after surgery. Recent research supports that R0 resection through conversion surgery can prolong survival, even in patients with advanced gastric cancer with peritoneal dissemination. Additionally, immune checkpoint inhibitor-based chemotherapy is recommended as first-line treatment for unresectable advanced gastric cancer, with increasing reports of favorable responses. This case is a valuable example in which SOX plus nivolumab therapy was effective, allowing curative resection via conversion surgery in a patient with peritoneal dissemination of advanced gastric cancer.

The patient was a 47-year-old woman who underwent partial colon resection and medial segmentectomy of the liver via laparotomy for descending colon cancer with a metastatic liver tumor. Postoperative chemotherapy was administered. Six months later, she developed pelvic recurrence and subsequently underwent bilateral adnexectomy, hysterectomy, and lymph node dissection, which confirmed colorectal metastasis. Two years and 6 months after the initial surgery, a gradually enlarging abdominal wall mass was detected. As the mass rapidly increased in size and became painful, an abdominal wall metastasis from colorectal cancer was suspected. Surgical intervention was deemed necessary to prevent deterioration in the patient's quality of life due to potential tumor ulceration. The tumor was resected under general anesthesia, including partial resection of the rectus abdominis muscle. Histopathological examination confirmed metastasis from colorectal cancer. Postoperatively, the patient's abdominal wall pain resolved. At the time of reporting, the patient had died of pulmonary metastasis, although there was no local recurrence at 1 year and 2 months postoperatively.

The efficacy of perioperative treatment with pembrolizumab for early-stage triple-negative breast cancer(TNBC)at high risk of recurrence was demonstrated in the KEYNOTE-522 trial, and it's indication was expanded in Japan as of September 2022. We report a case in which transient elevation of CEA was observed following treatment with the pembrolizumab. The patient was a 41-year-old woman who presented to a local clinic with a mass in the right breast. She was diagnosed with right breast cancer and referred to our department for further treatment. The clinical stage was T2N0M0, and the tumor was ER-negative, PgR-negative, and HER2-negative, confirming a diagnosis of TNBC. We initiated perioperative treatment in accordance with the KEYNOTE-522 regimen. She underwent a total mastectomy of the right breast with sentinel lymph node biopsy, achieving a pathological complete response. Postoperatively, she was scheduled to receive 9 courses of pembrolizumab. During postoperative therapy, an elevation in CEA was observed. Although recurrence was suspected, further evaluation revealed no evidence of recurrence. Instead, thymic enlargement was noted. As follow-up continued, CEA levels began to decline and the thymic enlargement showed a tendency to regress. These findings suggest a potential association between immune checkpoint inhibitor and thymic enlargement, as well as a possible link to the observed CEA elevation.

A 66-year-old woman was referred to our hospital with complaints of pain in the lower right abdomen and bloody stools for 2 days. The WBC counts of 9,100/μL, CRP levels of 5.0 mg/dL, Hb counts of 9.8 g/dL were without normal range, but no other abnormal values were noted. Abdominal CT showed intussusception of the right colon with a solid tumor. Lower gastrointestinal endoscopy revealed a type 1 tumor in the ascending colon. The scope was not passed through to the oral side, and repositioning by endoscopy was unsuccessful. Since abdominal pain had been continued, an emergency surgery 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, right hemicolectomy of the colon with D3 lymphadenectomy was performed. Resected specimens revealed a type 1 tumor measuring 60 mm in diameter at the ascending colon. Histopathologic findings revealed pT2, pN1a, cM0, pStage Ⅲa tumor. The postoperative course was favorable, and the patient was discharged on the postoperative day 13.