title: [S-1 monotherapy achieved twenty-month survival for peritoneal lavage cytology-positive gastric cancer patient undergoing noncurative resection].
abstract: We report a gastric cancer patient with positive peritoneal lavage cytology (CY1) who achieved 20-month progression free survival by S-1 monotherapy. An 82-year-old male patient who underwent distal gastrectomy with residual disease for type 4 scirrhous gastric cancer manifesting pyloric stenosis, direct invasion to the pancreas, and CY1. He received S-1 monotherapy postoperatively. His ECOG performance status (PS) was 0. The initial treatment schedule was 100mg/day, twice daily for 4 weeks with a 2-week rest, repeated every 6 weeks. Grade 2 thrombocytopenia at the end of the 5th course of treatment required discontinuation of one course of treatment, and subsequent treatment was continued with a dose reduction to 80mg/day. Afterwards, although treatment was temporarily postponed for 2 weeks, the dose modification enabled him to receive S-1 for 20 months, leading to a relative dose intensity of 81%. There was no evidence of disease progression. The most severe adverse events were transient grade 3 neutropenia as well as leukocytopenia, anemia, and thrombocytopenia, grade 2 each, without gastrointestinal toxicities. His PS was not deteriorated. Although survivalrates of CY1 gastric cancer patients are still poor, our case suggests that S-1 monotherapy is effective against CY1, even for patients aged over 80, if the relative dose intensity is maintained by comprehensive patient management and appropriate dose modification.
authors.affiliation: Gastrointestinal Unit, Settlement Clinic.
authors.forename: Shouji
authors.initials: S
authors.lastname: Shimoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Kiyokawa
authors.forename: Masato
authors.initials: M
authors.lastname: Nishida
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
mesh_terms: D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004338:Drug Combinations; D005743:Gastrectomy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010094:Oxonic Acid / Q000627:therapeutic use*; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005641:Tegafur / Q000627:therapeutic use*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid