Compared with conventional EMR, this new method may have significant benefits, particularly regarding one-piece resection of lesions between 11 and 20 mm in size, and may also have a lower recurrence rate.

No abstract

No abstract

We report a patient with liver metastasis from gastric cancer who has achieved a 5-year survival after systemic chemotherapy. The patient was diagnosed with advanced gastric cancer and received a total gastrectomy in August 1991, followed by adjuvant chemotherapy. Liver and lymph node metastases were detected in April 1994, and systemic chemotherapy with a combination of etoposide, doxorubicin, and cisplatin was initiated. Although the liver metastasis completely disappeared, lymph node metastasis at the falciform ligament of the liver and around the portal fissure remained after six courses of this therapy. A second type of chemotherapy, a combination of 5-fluorouracil and methotrexate, was then administered, 12 times, from December 1994 to May 1995, during which time no disease progression was observed. After surgery for the metastatic lymph nodes in August 1995, no progression was observed until December 1998, when a tumor thrombus was detected in the portal vein. Combination chemotherapy of irinotecan and cisplatin was initiated in January 1999. Although tumor regression was achieved after two courses of this, the disease continued to progress after five courses. In July 1999, a fourth type of chemotherapy, using 1 M tegafur-0.4 M gimestat-1 M otastat potassium (S-1), was initiated, and size reduction of the tumor thrombus was achieved; this therapy has continued to the time of submission of this report.

A 60-year-old female patient with gastric cancer and lymph node and liver metastases was treated with a combination of tegafur and uracil (UFT) (375 mg/m2/day) and mitomycin C (MMC) (5 mg/m2 once weekly). On day 15, when diarrhea appeared, chemotherapy was stopped immediately. On day 21, the WBC decreased to 900/microl and high fever developed. Despite treatment with granulocyte colony-stimulating factor and antibiotics, leukopenia persisted and the patient went into septic shock on day 26. On day 34, WBC increased to 5,400/microl and she recovered, with reduction in the size of the lymph node and liver metastases. Pharmacokinetic examination after intravenous injection of low-dose MMC (0.5 mg/m2) showed a markedly high peak plasma concentration (PPC), a large area under the time-versus-concentration curve (AUC) and reduced clearance. Similarly, oral administration of UFT (tegafur 300 mg/body) produced a relatively higher PPC and a larger AUC of 5-fluorouracil (FU). The activity of dihydropyrimidine dehydrogenase, the rate-limiting enzyme in the metabolism of FU, in peripheral mononuclear cells was within the normal range (0.265 nmol/min/mg). MMC is believed to have played a large part in inducing the severe toxicity observed in this patient. Physicians should be aware of the possibility of severe toxicity during treatment with UFT and MMC, although details of its incidence and mechanism are unclear.