title: [A case of advanced gastric cancer with simultaneous multiple bone metastases and double occurrence of disseminated intravascular coagulation successfully controlled with combined chemotherapy].
abstract: A 41-year-old man was found to have advanced gastric cancer with simultaneous multiple bone metastases when pyloric stenosis was being diagnosed in our hospital. We performed gastrojejunostomy from the lower third of the stomach to the upper third of the duodenum to relieve the obstruction. However, at 8 days after surgery, disseminated intra-vascular coagulation (DIC) occurred. Therefore, the patient was administered combined chemotherapy with TS-1 plus low-dose cisplatin in addition to anti-DIC therapy. TS-1 (150 mg/day) and cisplatin (10 mg/body intravenously over the course of 30 minutes) were administered on days 1 to 5, 8 to 12, and 15 to 19 (weekday-on/weekend-off schedule). There was remarkable response to this chemotherapy, and the patient was shifted from inpatient to outpatient treatment. The treatment course was repeated for 4 cycles until remission was observed. Because of hematologic relapse due to DIC at 6 months after the first treatment, he was readmitted for administration of combined chemotherapy. Fortunately, DIC once again responded to the same chemotherapy regimen. In this pathologic condition, combined chemotherapy is unavoidable when DIC occurs with cancer. Accordingly, it is necessary that an effective combined chemotherapy with mild bone marrow suppression be chosen. A companion drug should be chosen in consideration of delayed homo-toxicity and of the possibility of relapse into DIC in the drug withdrawal period. In addition, it is indispensable that careful consideration be given to the most favorable dose and regimen.
authors.affiliation: Division of Surgery, Nerima Hikarigaoka Hospital, Third Dept. of Surgery, Nihon University School of Medicine.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Shigeoki
authors.initials: S
authors.lastname: Hayashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Masuda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Karube
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Ookame
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Aoki
authors.forename: Naotaka
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujii
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005743:Gastrectomy; D006801:Humans; D008297:Male; D010094:Oxonic Acid / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; D011725:Pyridines; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D002945:Cisplatin