Background An oral combined fluoropyrimidine anticancer drug, tegafur/gimeracil/oteracil potassium (S-1), has been used alone or in mixture for cancer of the colon. and curative resection was judged to end up being feasible. Conclusion Occasional situations where S-1/CPT-11 therapy was effective have already been lately reported. The patient’s tumor became resectable regardless of the discovery of cancer of the colon connected with bone metastasis at the original examination, offering expect cancer patients. Launch The typical chemotherapy for non-resectable advanced cancer of the colon is mixture chemotherapy with 5-fluorouracil/leucovorin (5-FU/LV) and irinotecan (CPT-11) or with 5-FU/LV and oxaliplatin (L-OHP) [1-4]. An oral mixed fluoropyrimidine anticancer medication, tegafur/gimeracil/oteracil potassium (S-1), has been used by itself or in mixture for cancer of the colon [5-7]. We encountered an individual with sigmoid cancer of the colon with multiple costal metastases, in whom S-1/CPT-11 mixture therapy was effective and curative resection became relevant. Case display The individual was a 42-year-old guy with dysuria and fecaluria from past due January 2004, who attended the Urology Section of our medical center. Cystoscopy and pelvic CT suggested a tumor of digestive tract origin invading the urinary bladder. The patient was referred to the Department of Digestive Surgery. At the initial examination, height, was 160 cm; body weight, 63.5 kg; and body surface area, 1.89/m2. Overall performance status was grade 0. A fist-size tumor was palpable in the lower abdominal region. There was no particular past medical history or familial medical history. At the initial examination, white blood cell count, was 7,600/l; reddish blood cell count, 509 103/l; hemoglobin, 16.4 g/dl; AST, 19 IU/l; ALT, 11 IU/l; creatinin clearance, 185.9 ml/min, C reactive protein, 2.19 mg/dl; CEA, 4.3 ng/ml; and CAl9-9, 7.3 U/ml. Bacterial culture of urine detected em Escherichia coli /em and em Klebsiella SAG inhibitor database pneumoniae /em . No malignant cells were identified on urine cytoanalysis. Pelvic computerized tomography (CT) revealed a mass lesion measuring 8 cm was present in the pelvis, with direct invasion of the posterior wall of the urinary bladder. Abdominal CT detected no space-occupying lesion in the liver or swelling of peritoneal lymph nodes. Colonoscopy revealed a 1/2-circumferential ulcerated tumor in the sigmoid colon, and a protuberant tumor was noted on the anal side of the main tumor. Histopathologically, both tumors were well-differentiated adenocarcinoma. 99mTc-HMDP bone scintigraphy revealed many lesions with accumulation in the left ribs, which were diagnosed as multiple costal metastases (Physique ?(Figure1A).1A). Chest imaging showed no abnormal GLP-1 (7-37) Acetate findings. Open in a separate window Figure 1 A) 99mTc-HMDP bone scintigraphy showing many lesions with accumulation in the left ribs, which were diagnosed as multiple costal metastases. B) After chemotherapy with S-1 and CPT-11, the costal metastases have resolved. Based on the above findings, the diagnosis of T4, M1, stage IV sigmoid colon cancer was made (TNM classification), and curative resection was considered impossible. Colostomy was performed on April 5, 2004, and chemotherapy with S-1 and CPT-11 was initiated on April 14. S-1 at 50 mg/m2 was administered orally from day 1 to day 14. CPT-11 at 40 mg/m2 was administered intravenously day 1 and 15. This treatment was followed by a 2 week rest, and was repeated every 4 weeks . Since drug-induced liver dysfunction (grade 3) and diarrhea (grade 2) developed after completion of the 2nd cycle, the S-1 dose was reduced to 40 mg/m2 after their improvement, and 6 cycles of administration were performed in total (total dose: SAG inhibitor database S-1: 7,560 mg as tegafur, CPT-11: 480 mg). This therapy resulted in resolution of the multiple costal metastases (Physique ?(Figure1B),1B), and a 50% reduction of the local lesion on CT. Down-staging to T3, M0, stage SAG inhibitor database IIA was achieved, SAG inhibitor database and curative resection was judged to be possible. A Sigmoidectomy, lymphadenectomy, and partial cystectomy were performed on January 22, 2005. On histopathological examination the ulcerated tumor with a obvious margin was a well-differentiated adenocarcinoma measuring 3 3 cm. Subserous retention of mucus was noted, but the tumor was typed as pT2, ly0, v0, pN0, indicating the possibility of curative resection..