[A case of long-term survival of a patient with intrahepatic bile duct cancer and early nodal recurrence who responded to S-1 therapy].
A 71-year-old man was referred to our hospital for further evaluation of hepatic dysfunction. A diagnostic workup revealed an intrahepatic bile duct cancer, and a right hepatic lobectomy was performed. Postoperative adjuvant chemotherapy with gemcitabine (1,000 mg/m², given for 3 weeks, followed by a 1 week rest) was begun. Because grade 3 anorexia developed, the dose of gemcitabine was decreased to 800 mg/m² from the third cycle of chemotherapy. Computed tomography showed nodal recurrence 6 months after surgery. One year after surgery, computed tomography revealed an extensive periaortic nodal recurrence, as well as recurrence in the remnant liver. Treatment was switched to S-1 (100 mg/ day, given for 3 weeks, followed by a 1 week rest). Grade 3 thrombocytopenia was developed during the tenth cycle of therapy. The treatment schedule was therefore changed to 3 weeks of therapy, followed by a 2 week rest. From the 36th cycle, the dose of S-1 was lowered to 80 mg/day (given for 2 weeks, followed by a 2 week rest). Nodal recurrence was resolved in 2 years after the start of treatment with S-1, and recurrence in the remnant liver nearly resolved in 4 years after starting the treatment, indicating a partial response. The carcinoembryonic antigen level fell to the normal range and the CA19-9 level remains at about 100 U/mL. Although the patient had grade 2 thrombocytopenia, he is now receiving the 43rd cycle of S-1 and remains alive for 5 years and 1 month after surgery. We believe that the continuation of chemotherapy while monitoring the patient's general condition led to an improved outcome.
Dept. of Surgery, Odawara City Hospital.
Hironobu
H
Makino
Hisashi
H
Kametaka
Takashi
T
Koyama
Kazuhiro
K
Seike
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D004338:Drug Combinations; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D010094:Oxonic Acid / Q000627:therapeutic use*; D012008:Recurrence; D005641:Tegafur / Q000627:therapeutic use*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid