title: [A case of effective multidisciplinary treatment for advanced gallbladder carcinoma with distant lymph node metastases].
abstract: A 59-year-old woman with upper abdominal pain was diagnosed as having an advanced-stage gallbladder carcinoma with significant metastases in the para-aortic lymph nodes to the more distant right external iliac nodes by imaging studies. These findings suggested that the tumor was unresectable, and therefore, palliative cholecystectomy with lymph node biopsy was performed. Furthermore, we initiated chemoradiotherapy with linac radiotherapy( 50 Gy) and weekly gemcitabine (GEM 300 mg/body) for 6 weeks. Partial response (PR) was achieved after chemoradiotherapy. Subsequently, we initiated chemotherapy with GEM alone (1,000 mg/m2) on days 1, 8, and 15, every 28 days for 15 courses. Following disease progression, we initiated chemotherapy with S-1 alone( 80 mg/m2/day) on days 1-14, every 21 days for 9 courses, as second-line treatment. Two years later, following re-progression of the disease, we performed best supportive care with retrograde ureteral stenting for hydronephrosis and retrograde biliary stenting for obstructive jaundice. The patient survived for 35 months after palliative surgery. Moreover, she remained well and performed normal activities for 34 months. This experience indicates that, in patients with unresectable gallbladder carcinoma, multidisciplinary treatment could extend survival and improve the quality of life.
authors.affiliation: Dept. of Surgery, Kimitsu Chuo Hospital.
authors.forename: Kazuyasu
authors.initials: K
authors.lastname: Shinmura
authors.forename: Takashi
authors.initials: T
authors.lastname: Kaiho
authors.forename: Shinji
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Ryo
authors.initials: R
authors.lastname: Okamoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Nishimura
authors.forename: Soichi
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Okaniwa
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsuchiya
authors.forename: Wakako
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010094:Oxonic Acid / Q000627:therapeutic use; D011788:Quality of Life; D005641:Tegafur / Q000627:therapeutic use; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine