[A patient with recurrent gallbladder cancer responding to chemotherapy with CDDP/CPT-11 and gemcitabine]

A 79-year-old female patient was referred to our hospital for treatment of a recurrent gallbladder cancer. Before admission, she had undergone expanded cholecystectomy and had been treated successfully with 5-FU for 3 years to suppress the tumor growth in intraperitoneal lymph nodes. The recurrence of the tumor in lymph nodes near the pancreas head was demonstrated by computer tomography. We tried a course of a combination chemotherapy consisting of CPT-11 and CDDP (40 mg CPT-11/body/day on day 1 and 10 mg CDDP/body/day on day 2-5) to reduce the size of the nodes. Then, we repeated a total of 8 courses of the therapy at 4-week intervals. The status of the nodes was not changed for a year. Then, the lymph node started to enlarge again and obstructive jaundice appeared. So, we substituted gemcitabine (1 g/body/day) for the combination chemotherapy with expandable metallic stent implantation to drain the bile. As a result, metastatic lymph nodes were reduced in size and the dilatation of the interhepatic bile duct disappeared. Thereafter, the patient was given an additional 20 courses of gemcitabine therapy at 2-week intervals as an outpatient. No change was observed in the size of the metastatic lymph nodes for a year. However, the patient died of liver metastasis 8 years after operation and 6 years after she started chemotherapy for the recurrence. She maintained a good quality of life during that time. The present case suggests that combination of chemotherapy protocols is effective for clinical management of gallbladder cancer recurrence, which is generally considered to be difficult to manage with chemotherapy.