A 85-year-old female with two lesions in left upper lobe (S1+2: 4.7 cm and S3: 1.5 cm) was diagnosed with pulmonary adenocarcinoma. Preoperatively, a mutation analysis of epidermal growth factor receptor (EGFR) gene resulted in negative one. A computed tomographic scan pointed out a contralateral small nodule (right S8: 1 cm) with bilateral multicentric ground glass opacities. Even though a very-elderly but a healthy IV-staged advanced lung cancer, she desired for receiving a multimodality therapy. Left upper lobectomy with mediastinal nodal dissection was preceded. Eventually, the postoperative pathology disclosed lung cancer with multiple pulmonary metastasis in the contralateral lobe (T3N2M1a, stage IV). An another detection method of EGFR gene mutation revealed a positive result of the resected specimen. A first-line adjuvant oral administration of erlotinib treatment had diminished the unresected multicentric lesions, which stable status have been maintained for more than 12 months. The first-line erlotinib therapy showed a dramatic response for the elderly patient with EGFR gene mutation-positive. A reliability and accuracy of the detection method should be important to select an appropriate treatment. In clinical practice of the selected population of advanced lung cancer with EGFR mutation-positive, combination therapy of aggressive surgical resection and erlotinib therapy might take advantage of extending the progression-free survival, in case of her no enough time in the rest life because of her very-elderly age.
Background; Combined chemotherapy with S-1 and docetaxel was implemented in patient with advanced or recurrent gastric cancer associated with peritoneal dissemination and malignant ascites. Methods; S-1 was administered orally at 80 mg/m2 for 14 consecutive days and docetaxel was administered at 40 mg/m2 on day 1, followed by a 1-week rest, as one course, and the treatment was repeated until progression or severe toxicity. Results; Three out of the five patients showed response to the treatment. The three patients with response had diffuse-type tumor according to the Lauren's classification. The median number of treatment courses was 4. The median survival time was 315 days, the median time to treatment failure was 225 days, and the 1-year survival rate was 20%. Conclusions; These results suggest that combined therapy with S-1 and docetaxel is a promising treatment for advanced or recurrent gastric cancer with malignant ascites and peritoneal dissemination.
A smoker, 55-year-old male with a small nodule in left S5 on computed tomographic (CT) scanning of chest was diagnosed with pulmonary adenocarcinoma (cT1N0M0, c-stage IA). However, the CT scanning revealed that several small nodules on pleural surface might suspect a pleural dissemination, that is, IV-staged advanced lung cancer. The patient desired for receiving an aggressive multimodality containing of surgery, immunotherapy, and gefitinib treatment. After thoracotomy, the small pleural nodules were intraoperatively diagnosed with pleural dissemination by pathological examination. However, there was no malignant pleural effusion and intraoperative cytological examination of intrathoracic lavage resulted in a negative finding. Because of clinical N2-negative disease without malignant pleural effusion, left upper lobectomy with mediastinal lymph nodes dissection was preceded. The postoperative pathological examination disclosed pulmonary adnocarcinoma with mixed subtypes (pT1N2M1a, p-stage IV) and with micropapillary pattern. A detection test of epidermal growth factor receptor (EGFR) gene mutation revealed a positive result (L858R). As a systemic therapy, a combination chemotherapy of gemcitabine and carboplatin was performed in 2 cycles for the remained pleural dissemination. The patient received combination therapy of gefitinib and interleukin-2 lymphokine-activated killer cell immunotherapy in 6 cycles. A CT scanning of chest displayed disappearances of the remained pleural dissemination. There had been uneventful for 25 months. On the third postoperative year, a stereotactic radiotherapy surgery was performed for small three brain metastases. He had been healthy and received the gefitinib treatment for 45 months without any regrowing of the irradiated cerebral metastases and the treated pleural dissemination. The combination therapy of gefitinib and immunotherapy in the postoperative early phase would take advantage of extending the patient's progression-free survival, and also in case of the selected population of the advanced lung cancer harboring a EGFR mutation-positive.
Background: While surgery remains the sole mainstay of any curative treatment for gastric cancer, the relapse rate is high and survival remains low even after surgical resection with curative intent. Methods: Based on biochemical modulation theory, this trial was assigned for gastric cancer patients as post operative adjuvant setting with at least 4 cycles of either UFT (UF group) or 5-FU plus low dose cisplatin (CF) and UFT (CD group). The planned 4 cycles of CF treatment was received by 95% of patients in the CD group. One year of UFT was received by 93 (99%) and 91 (97%) of the patients in the groups administered UFT and cisplatin/5FU+UFT, respectively. Results: The result suggests better 5 year survival rate in the combination treatment group, with a reduction in risk of 13%. 5 year DFS was also showed benefit of combination therapy over UFT alone, with a reduction in risk of 15%. Conclusion: These findings from our phase III randomized trial suggest that low dose cisplatin+5-FU followed by UFT may hold promise as a treatment for curatively resected locally advanced gastric cancer patients.
In 1999, a 60-year-old female diagnosed with tracheobronchial adenoid cystic carcinoma, was rejected due to the high risk reconstruction surgery of the carina. Our interventional radiological doctor implanted metallic stents for bilateral bronchial stenosis (right: Ultraflex, left: Spiral Z stent) to prevent endobronchial edematous asphyxia during radiation therapy. Radiotherapy showed that the tumor had decreased in size. The migrated right metallic stent was removed but the left one remained because it could not be removed. She had been unevenful for 3 years after the metallic stent implantation. In the 4th year, bronchoscopic balloon dilatation therapy had been performed for the produced dyspnea due to the exuberant granulation once every year for 4 years. The left lung had been destroyed by resuscitate pneumonia, thus we performed a pneumonectomy as salvage surgery using a cardiopulmonary bypass. The postpneumonectomy syndrome, dysphagia and dyspnea had confused her. Bronchoscopic balloon dilatation therapy had been continued for the right single airway stenosis every three months for 2 years. Eventually, she died of respiratory failure due to the recurrence of the disease after 12 years of treatment. We should require use of a silicone stent for the low grade malignancy of tracheobronchial airway stenosis. Eventual open thoracotomic removal should be done for management of the long-term complications of nonremovable metallic stents.
Inadequate knowledge about health, illiteracy, cultural and religious issues, poverty, chronic infection, and malnutrition are continuously adding additional threat on the huge burden of cancers in Bangladesh. The aim of this study was to determine the trends and distributions of cancers in Bangladesh. Retrospective analysis was done on the cancer patients registered in the National Institute of Cancer Research and Hospital (NICRH) in Dhaka, Bangladesh during January, 2008 to December, 2010. Of total 27,281 cancer patients, 56.2% were male and majority were from 45-54 years age group. There was an increasing trend of cancers during the study period (P <0.05). According to International Classification of Diseases for Oncology (ICD-O, 3rd edition), most frequent cancers were respiratory system and intrathoracic organs (23.1%) followed by digestive organs (18.5%), female genital organs (11.9%), breast (11.7%), and lip, oral cavity and pharynx (11.6%). Overall, lung cancer was the leading cancer followed by breast, cervical, lymph node and lymphatics, and esophageal cancer. Lung cancer was the leading cancer among male followed by lymph node and lymphatics, and esophagus. However, top of the list was occupied by the breast cancer among females followed by cervical cancer, and lung cancer. In conclusion, an increasing trend of cancer was observed in Bangladesh. Lung and breast cancer was the leading cancer in male and female, respectively; and most frequent cancer was observed among illiterate and middle aged population. We recommend exerting proper emphasis on anti-tobacco campaign and breast self-examination for the females in addition to increasing overall awareness against cancers in Bangladesh.
Background: The Polish breast cancer screening program was initiated as part of National Cancer Control Program in July 2005 by establishing a network of accredited regional centers and the central coordination point. The changes in reproduction behaviors and lifestyle in Poland have contributed to rapid increase of breast cancer incidence and mortality. The aim of this article is to describe the results of the program after 7 years from its implementation and to advocate for its continuance. Methods: Data on incidence and mortality due to breast cancer among women aged 50-69 were extracted from the National Cancer Registry. Annual reports of the National Cancer Control Program and other data provided by the Ministry of Health in Poland were analyzed. Results: Between January 1999 and December 2009 there were 142,307 new cases of breast cancer and 54,927 deaths because of it reported in Polish females. Poland is a country with relatively low and dynamically increasing incidence of breast cancer compared to Western European countries. The coverage of the nationwide screening program was around 40%. Conclusion: The late introduction of the screening program with a high recall rate resulted in dynamic increase of incidence. This leads to stabilization of the breast cancer mortality since more cases could be detected at early stage and treated more effectively. The Polish National Cancer Control Program which includes the breast cancer screening met the interim measures recommended in the European Guidelines and should be continued in the future with higher coverage on the target population.