PURPOSE: Although several clinical trials have proven the efficacy of adjuvant S-1 treatment in gastric cancers, it is still unclear which patients receive the most benefit. In this study, we prospectively recruited patients with locally advanced gastric cancer who had undergone curative resection followed by adjuvant S-1 administration to investigate which factors affect the outcomes. MATERIALS AND METHODS: Between July 2010 and October 2011, we enrolled 49 patients who underwent curative resection for stage II or III gastric cancer and who subsequently received adjuvant S-1 treatment for 1 year. RESULTS: Twenty-nine patients (59.2%) continued S-1 treatment for 1 year, and 12 patients (24.5%) experienced recurrent disease during the follow-up period. Patients with continuation of S-1 for 1 year had significantly increased rates of disease-free survival (P<0.001) and overall survival (P=0.001) relative to the patients who discontinued S-1 during year 1. Multivariate analysis indicated poor outcomes for patients with stage III disease and those who discontinued S-1 treatment. Excluding patients who discontinued S-1 due to cancer progression (n=7), adjuvant treatment with S-1 still demonstrated a significant difference in the disease-free survival rate between the patients who continued treatment and those who discontinued it (P=0.020). CONCLUSIONS: S-1 is tolerated as adjuvant treatment in gastric cancer patients. However, discontinuing S-1 treatment may be an unfavorable factor in the prevention of recurrence. S-1 adjuvant treatment should be continued for 1 year if possible through the proper management of toxicities.
Compliance ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis* ; Prospective Studies* ; Recurrence ; Stomach Neoplasms*

To examine diseases of the small intestines, the use of different methods including a small bowel series and push type enteroscopy have been employed, but these procedures are restrictive and have a low diagnostic accuracy rate. Recently, the use of double balloon enteroscopy has been introduced, and it is expected that this procedure will be of great value for research of diseases of the small intestine as it enables one to obtain a biopsy tissue sample and to perform diagnostic and therapeutic endoscopy while examining small intestine visually. We report as case of a patient that visited our institution complaining of abdominal pain, and the patient was diagnosed as suffereing from an intestinal obstruction due to a bezoar. The patient was treated by surgery after an investigation with the aid of a double balloon enteroscope.
Abdominal Pain ; Bezoars ; Biopsy ; Double-Balloon Enteroscopy ; Endoscopy ; Humans ; Intestinal Obstruction ; Intestine, Small

A gastrointestinal stromal tumor (GIST) is a rare disease but is the most common nonepithelial neoplasm in the gastrointestinal tract. GIST accounts for 0.1~3.0% of gastrointestinal malignancies, and 20~30% of GISTs are found in the small intestine. GIST with extraluminal growth is difficult to diagnose. We report a case of a jejunal GIST with obscure bleeding that was diagnosed using double balloon enteroscopy.
Double-Balloon Enteroscopy* ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Small ; Jejunum* ; Rare Diseases

Hepatocellular carcinomas are one of the most common malignancies in the world. However, no effective therapeutic modality has been proven to prolong the survival of patients in an inoperable stage. The purpose of this study was to determine the response rate and the toxicities of a combination of pirarubicin, UFT and leucovorin in patients with non-embolizable hepatocellular carcinomas, or who had progressed during their transcatheter arterial chemoembolization treatment. MATERIALS AND METHODS: Of 23 patients with a hepatocellular carcinoma, 11 had progressed during a transcatheter arterial chemoembolization, with the other 12 being transcatheter arterial chemoembolization-naive. All the patients were treated with pirarubicin (70 mg/m2 i.v., day 1), UFT (350 mg/m2 P.O., day 1~21), and leucovorin (25 mg/m2 P.O., day 1~21). RESULTS: Twenty patients were able to be evaluated, with a partial response being achieved in four, giving an overall response rate of 20% (95% confidence interval, 7~44%). The median overall survival time was 6 months, and the median survival time of the transcatheter arterial chemoembolization-naive patients was significantly longer than that of those treated by transcatheter arterial chemoembolization (p=0.012). The most significant dose-limiting toxicity was leucopenia and thrombocytopenia. CONCLUSION: The combination of pirarubicin, UFT and leucovorin therapies showed marginal antitumor activity and significant toxicity in patients with non-embolizable or failed transcatheter arterial chemoembolization hepatocellular carcinomas.
Carcinoma, Hepatocellular* ; Drug Therapy* ; Humans ; Leucovorin* ; Thrombocytopenia