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1 127 S-1 + oxaliplatin Neoadjuvant Chemotherapy by S-1 + oxaliplatin for an Elderly Gastric Cancer Patient with Extensive Lymph Node Metastasis -A Case Report-. Hiroki Takeshita, Akinori Noguchi, Hiroyuki Tada, Seiji Umehara, Hiromichi Ishii and Naoki Tani Department of Surgery, Matsushita Memorial Hospital, Osaka, Japan neoadjuvant chemotherapy : NAC controversial S- + oxaliplatin ct N M Stage A No a,, a mm S- + oxaliplatin NAC Grade NAC DypT ypn M Stage B Grade S- + oxaliplatin NAC Abstract Safety and effectiveness of neoadjuvant chemotherapy for locally advanced gastric cancer with extensive lymph node metastasis has been demonstrated in recent years. However, indication for neoadjuvant chemotherapy in elderly patients with gastric cancer is still controversial. We report an elderly case of gastric cancer with extensive lymph node metastasis, that can be received curative gastrectomy after neoadjuvant chemotherapy by S- + oxaliplatin regimen. -

2 Case A year-old woman was diagnosed with ct N M StageIIIA advanced gastric cancer with extensive metastatic lymph nodes # a, and a that make it difficult to perform curative gastrectomy. We treated her with neoadjuvant chemotherapy consisting of courses of S- + oxaliplatin regimen. The neoadjubvant chemotherapy was terminated by Grade aminotransferase increased on day in course ; however there was no other adverse event. After the neoadjuvant chemotherapy, primary cancer and metastatic lymph nodes were reduced remarkably. A curative distal gastrectomy with D could be performed and the histological classification was ypt, ypn/, Grade. She is alive with no evidence of recurrence during the months after the operation. Conclusion Neoadjuvant chemotherapy by S- + oxaliplatin regimen is feasible for elderly patients with locally advanced gastric cancer with extensive lymph node metastasis. Key Words: Elderly, Gastric cancer, Neoadjuvant chemotherapy. StageT T N JCOG JCOG controversial S- + oxaliplatin SOX PS X Y Hb. U ct N M Stage A cm. kg BMI.. m Hb. g/dl Alb. g/dl CEA. ng/ml CA - U/mL mm Group tub >tub Fig. A CT.. mm T SS No a.. mm No No a.. mm.. mm No b -int.. mm

3 Fig. A NAC B NAC A mm B Fig. A M Type ct cn No a H P M Stage A No No a / L/ L Hb. g/dl HCT.. / L GOT U/L GPT U/L T-Bil. mg/dl BUN mg/dl CRE. mg/dl egfr. ml/min/. EF VC. FEV.. NAC SOX SOXG-SOX S- day - mg/body oxaliplatin day mg/body mg/m CT SOX Grade day Grade GOT/GPT = /U/L SOX SOX GOT/GPT = / U/L Alb Hb=. g/dl Alb. g/dl CEA. ng/ml CA - U/mL NAC

4 Fig. CT A NAC B NAC a.. mm b No a.. mm.. mm c No.. mm.. mm d No a.. mm.. mm No a NAC e No b -int.. mm BUN mg/dl CRE. mg/dl egfr. ml/min/. EF Fig. B CT NAC. mm NAC. mm No a.. mm Fig. B No No a.. mm.. mm SOX X Y + mm mm No CY H PCT No b -int Kocher No a -b int M D No a -b int Roux-en Y No a NAC Noa

5 Fig. A mm mm No B mm CD No a Grade min g Fig. A mm yct a Fig. B No a No ycn Adenocarcinoma tub >tub M Gre ytype mm ypt int INFb ypn Total / ppm pdm prm Grade ypt ypn M Stage BNo a No No a No No a Grade Fig C D S- S- day -mg/body Stage

6 ACTS-GC D Stage T T N S- /. /. S-. /. CLASSIC capecitabine oxaliplatin CapeOX ACTS-GC Stage overall survival : OS Stage A.Stage B. Stage T T N S- CapeOX JCOG: Japan Clinical Oncology Group / JCOG No a /bbulky N No a av cm. cm S- + SP D para-aortic lymph node dissection : PAND.. /. /. Grade S- + JCOG SP JCOG S- SOX S- + paclitaxel controversial G-SOX SOX SP SP B Bando SOX SP progression-free survival : PFS OS SOX S- SOX NAC JCOGS- NAC SOX day Grade

7 NAC JCOG D PAND PAND JCOG PAND PAND Yoshida Stage No a /b Potentially resectable metastasis Category No b -int.. mm PAND PAND SOX SOX /. Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M. Neoadjuvant chemotherapy with S- and cisplatin followed by D gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg ; : -. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K. Adjuvant chemotherapy for gastric cancer with S-, an oral fluoropyrimidine. N Engl J Med ; : -. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, Nakajima T, Ohashi Y. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S- versus surgery alone in stage II or III gastric cancer. J Clin Oncol ; : -. Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, Lee KW, Kim YH, Noh SI, Cho JY, Mok YJ, Kim YH, Ji J, Yeh TS, Button P, Sirzén F, Noh SH. Adjuvant capecitabine and oxaliplatin for gastric cancer after D gastrectomy CLASSIC : a phase openlabel, randomised controlled trial. Lancet ; : -. Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim SW, Kim HH, Choi JH, Kim HK, Yu W, Lee JI, Shin DB, Ji J, Chen JS, Lim Y, Ha S, Bang YJ. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D gastrectomy CLASSIC : -year follow-up of an openlabel, randomised phase trial. Lancet Oncol ; : -. Ito S, Sano T, Mizusawa J, Takahari D, Katayama H, Katai H, Kawashima Y, Kinoshita T, Terashima M,

8 Nashimoto A, Nakamori M, Onaya H, Sasako M. A phase II study of preoperative chemotherapy with docetaxel, cisplatin, and S- followed by gastrectomy with D plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis: JCOG. Gastric Cancer ; : -. S- Complete Response ; : -. SOX ; : -. S- + ; : -. Bando H, Yamada Y, Tanabe S, Nishikawa K, Gotoh M, Sugimoto N, Nishina T, Amagai K, Chin K, Niwa Y, Tsuji A, Imamura H, Tsuda M, Yasui H, Fujii H, Yamaguchi K, Yasui H, Hironaka S, Shimada K, Miwa H, Hamada C, Hyodo I. Efficacy and safety of S- and oxaliplatin combination therapy in elderly patients with advanced gastric cancer. Gastric Cancer ; : -. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K. D lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med ; : -. Yoshida K, Yamaguchi K, Okumura N, Tanahashi T, Kodera Y. Is conversion therapy possible in stage IV gastric cancer: the proposal of new biological categories of classification. Gastric Cancer ; : -.

速報 海外で行われた CLASSIC 試験 国内で行われた J-CLASSIC-PII 試験および胃癌術後補助化学療法におけるオキサリプラチン併用療法に関する日本胃癌学会ガイドライン委員会のコメント 試験名 :CLASSIC 試験文献 : Adjuvant capecitabine and oxal

速報 海外で行われた CLASSIC 試験 国内で行われた J-CLASSIC-PII 試験および胃癌術後補助化学療法におけるオキサリプラチン併用療法に関する日本胃癌学会ガイドライン委員会のコメント 試験名 :CLASSIC 試験文献 : Adjuvant capecitabine and oxal 速報 海外で行われた CLASSIC 試験 国内で行われた J-CLASSIC-PII 試験および胃癌術後補助化学療法におけるオキサリプラチン併用療法に関する日本胃癌学会ガイドライン委員会のコメント 試験名 :CLASSIC 試験文献 : Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):

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