PMC3843915_01
CT image before the start of gemcitabine therapy. CT revealed a tumor located at the cervix of the gallbladder (arrowheads) also involving the common and right hepatic arteries, and enlargement of the No. 12 lymph node.
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F1
Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen showed the mass to be located at the cervix of the gallbladder and to involve the common and right hepatic arteries, with enlargement of the No. 12 lymph node (fig. 1).
a CT image obtained after 13 cycles of gemcitabine treatment. The tumor showed a 35% reduction in diameter, judged as a partial response according to the RECIST criteria, version 1.0. b CT image obtained after 20 cycles of gemcitabine therapy. The tumor has disappeared altogether on the CT images, and CR was confirmed.
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F2
After 13 cycles of treatment, a marked decrease of the tumor size on CT was noted (fig. 2a), and the treatment response was rated as partial response according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, version 1.0. After 15 cycles of treatment, the tumor disappeared altogether, and CR was confirmed by CT after 20 cycles of gemcitabine monotherapy (fig. 2b).
MRI at the time of the tumor relapse. MRI showed relapse of the tumor at the hilar porta hepatis. The lymph node metastasis invaded the celiac artery and common hepatic artery.
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F3
MRI showed relapse of the tumor at the porta hepatis (fig. 3).
Serial changes of the serum levels of carbohydrate antigen 19-9 and CEA during the treatment course. CA19-9 = Carbohydrate antigen 19-9; G = gemcitabine.
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F4
S-1 therapy and has remained alive for 79 months after the commencement of the first gemcitabine therapy. Serial changes of the serum levels of carbohydrate antigen 19-9 and CEA during the entire treatment are shown in fig. 4.