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.