Weekly administration of paclitaxel attenuated rectal stenosis caused by multiple peritoneal recurrence 8 years after the resection of gastric carcinoma

Abstract

toneal dissemination is the type of recurrence that most frequently occurs in gastric carcinoma, and it is extremely difficult to deal with [1]. Longterm survival of patients with peritoneal dissemination is desperately awaited, as the mean survival at present is less than 6 months [1]. Although anticancer chemotherapy is the primary treatment available for the majority of patients with diffuse peritoneal metastasis, response to anticancer chemotherapy is extremely poor. In particular, for the majority of the patients with peritoneal recurrence, first-line anticancer chemotherapy has already been given when they were in an advanced stage before the time of operation, and following the operation, and recurrence then appears as a consequence of resistance to the first-line anticancer chemotherapy. Nonetheless, anticancer chemotherapy appears to provide a significant survival advantage over best supportive care [2]. However, no effective second-line chemotherapy has yet been available for gastric cancer patients who have not responded to or who have relapsed after an initial response to first-line chemotherapy. Therefore, an effective second-line anticancer chemotherapy regimen is expected for the treatment of recurrent peritoneal dissemination of gastric carcinomas.We report herein a patient with rectal stenosis caused by the peritoneal dissemination of recurrent gastric carcinoma resected 8 years previously. Repeated weekly administration of paclitaxel has been effective for more than 13 months. The patient is considered to be in a state of tumor dormancy of recurrent gastric carcinoma. Case reportA 66-year-old Japanese woman was admitted to our hospital with complaints of abdominal pain, loose stools, and frequent bowel movements. The patient had undergone total gastrectomy associated with D3 lymph node dissection and Roux-en-Y reconstruction AbstractWe report a patient with rectal stenosis caused by peritoneal recurrence 8 years after a curative resection of advanced stage gastric carcinoma; the recurrence was effectively treated with the weekly administration of paclitaxel. The patient was a 66-year-old Japanese woman who was admitted to our hospital complaining of abdominal pain and frequent bowel movements. She had undergone total gastrectomy, due to advanced-stage gastric carcinoma with extensive lymph node metastasis, 8 years before, and had taken an oral anticancer agent, fluoropyrimidine, for 4 years after the operation. Colonofiberscopy performed on admission revealed circumferential rectal stenosis located 10 cm from the anal verge. Barium enema study demonstrated extensive poor expansion of the upper and lower rectum and irregularity of the descending colon. Abdominal computed tomography (CT) scanning revealed wall thickening in the rectum and descending colon. These findings were compatible with rectal stenosis caused by the peritoneal recurrence of gastric carcinoma. Weekly administration of paclitaxel was started. The abdominal symptoms soon disappeared when the second cycle of paclitaxel was compl...

Phase I/II Study of a Combination of S-1 and Weekly Paclitaxel in Patients with Advanced or Recurrent Gastric Cancer

“…Moreover, progression of the peritoneal disease generally leads to bowel obstruction, ascites and renal dysfunction. In the treatment of patients with advanced gastric cancer and poor general condition, the paclitaxel-based regimen, which has fewer severe adverse reactions but high efficacy, would be acceptable [45]. …”

Unresectable gastric cancer with multiple liver metastases effectively treated with combined paclitaxel and doxifluridine chemotherapy

“…Yamamoto et al 8 reported that weekly paclitaxel alone for peritoneal dissemination lowered ascitic fluid, while Sakurai et al 9 reported that weekly paclitaxel alone improved rectal stenosis caused by intraperitoneal metastasis. Arai et al 3 reported retrospectively on 45 patients who had undergone pretreatment and who were then treated with weekly paclitaxel alone for unresectable or recurrent gastric carcinoma.…”

Neoadjuvant chemotherapy with S-1 and surgical resection for a mucinous gastric cancer with peritoneal dissemination

“…We await the results of RCTs. It is true that new anticancer agents [26] for gastric cancer are available. However, the oral intake of chemotherapeutic agents is desirable for the outpatient setting so that the quality of daily living is not restricted for an extended period of time prior to surgery.…”