We experienced a pancreatic cancer patient whose muscle cramp arose by using S-1 was improved by the administration of a Kampo formulation Goshajinkigan (GJG).
Eighty-year-old female was diagnosed as having unresectable pancreatic cancer and then chemotherapy with S-1 and gemcitabine was initiated. After 4th course, gemcitabine had been discontinued by the toxicity, and then single administration for two weeks of a dose of 80 mg of S-1 was continued every three weeks. She often experienced muscle cramp at low legs, and she visited the emergency room with complaint of gait disturbance due to worse of muscle cramps. Her biochemical study showed almost normal electrolytes levels. Then a Kampo formulation Shakuyaku-kanzo-to (SKT), which was thought to be rapid-acting for these symptoms, was administered because of her sustained marked symptoms. No effect of SKT on these symptoms was observed; therefore, GJG was selected by Kampo medicine physician in combination with her complaints and body status. The administration of GJG was started 2.5 g once a day and then dose escalation was scheduled because it might induce gastrointestinal disorders. Since dose was escalated 5 g twice a day 2 weeks after initiation, incidence of muscle cramp was reduced three times a week. After 7 weeks, symptoms were disappeared. At this moment, she can continue the chemotherapy with S-1 under control of adverse event by the administration of 5 g of GJG twice a day.
Background: The objective of this retrospective study was to clarify prognostic factors in pancreatic cancer patients treated with curative resection followed by adjuvant chemotherapy with S-1. Methods: Both overall survival (OS) and recurrence-free survival (RFS) were examined in 76 pancreatic cancer patients who underwent curative surgery and received adjuvant chemotherapy with S-1 after surgery between 2007 and 2014. Results: When the length of OS was evaluated according to the log-rank test, significant differences were observed in the pathological tumor size. In addition, univariate and multivariate Cox’s proportional hazards analyses demonstrated that the pathological tumor size was the only significant independent prognostic factor for both OS and RFS. The 5-year OS was 0% in the pathological tumor size ≥ 60 mm group and 30.4% in the pathological tumor size < 60 mm group (p=0.010). Moreover, similar results were observed for recurrence-free survival (p=0.008). Conclusions: The pathological tumor size is the most important prognostic factor for OS and RFS in patients with pancreatic cancer treated with curative resection followed by adjuvant chemotherapy with S-1. The present results suggest that adjuvant chemotherapy with S-1 is not sufficient, especially in patients with relevant risk factors.
Background: The benefit of resecting recurrent tumor after curative esophagectomy for esophageal cancer remains unclear, especially when it requires resection of multiple visceral organs. Case presentation: A 56-year-old male patient with previous history of surgical treatment for esophageal achalasia 21 years before was referred to our hospital for treatment of lower thoracic esophageal cancer. He underwent a thoracoscopic esophagectomy and laparoscopic gastric mobilization with curative intent. Nine months after the operation, abdominal computed tomography revealed an intraperitoneal abscess formed along the distal part of the splenic artery. Percutaneous drainage of the abscess and cytological examination diagnosed the tumor as recurrent squamous cell carcinoma from the esophageal cancer. For symptom alleviation and potential cure, the recurrent nodule together with the pancreatic tail, spleen, and left adrenal grand were resected. The pathological examination confirmed recurrent esophageal cancer at the splenic hilar. Three years later, the patient remains disease free. Conclusion: We experienced a case with metastatic recurrence of lower thoracic esophageal cancer to the hilar of the spleen. When tumor recurrence of esophageal cancer is solitary, an aggressive surgical treatment with multiple-organ resection potentially results in long-term disease-free survival in selected patients.
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