Chronotherapy with TS-1 for Multiple Liver Metastases from Ampullary Carcinoma: Report of a Case

Naoyuki Yokoyama, Yoshio Shirai, Katsuki Muneoka*, Toshifumi Wakai and Katsuyoshi Hatakeyama

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
Department of Surgery, Niitsu Medical Center Hospital*

Liver metastases from ampullary carcinoma are resistant to chemotherapy. In the Japanese-language literature, we found only one case of ampullary carcinoma liver metastases, for which hepatic arterial infusion of combined 5-fluorouracil (5-FU) and low-dose cisplatin achieved a complete response. We herein report a case of patient with ampullary carcinoma metastases to the liver, for which systemic chemotherapy using TS-1 was effective. A 74-years-old woman presented with unresectable multiple liver metastases occurring 1 year after a pylorus-preserving pancreaticoduodenectomy for ampullary carcinoma. She received oral administration of TS-1 (50 mg at 3 p.m. and 100 mg at 10 p.m.) every other day. 5-FU Serum concentrations were higher at night time and the peak concentration of 5-FU (539 ng/ml) was obtained at 3 a.m., suggesting the chronomodulating nature of this regimen. No adverse effects were noted. A partial response was achieved with only one hepatic tumor remaining in the liver. Five months after the initiation of the TS-1 treatment, she was readmitted with massive hematemesis and died of uncontrollable bleeding. Autopsy revealed that the hemorrhage came from hemobilia due to breakdown of a hepatic artery running within the remnant tumor. The experience of this case suggests that TS-1 administration with chronomodulation may be effective for ampullary carcinoma metastases to the liver. Arterial bleeding may be a lethal complication of chemotherapy, provided that the tumor responded well to the treatment.

Key words
ampullary carcinoma, chronomodulation, 5-fluorouracil

Reprint requests
Naoyuki Yokoyama Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
1-757 Asahimachi-dori, Niigata, 951-8510 JAPAN

Accepted
October 19, 2005

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