We report herein on two cases in which critical bone marrow suppression was caused in the first course of TS-1 treatment.
A 79-year-old man with hypopharyngeal cancer of the right piriform fossa (cT2N0M0) underwent an operation with larynx-preserving partial pharyngectomy at our institution.
Two months later, a neoplastic lesion was observed in the posterior wall from the oropharynx to the hypopharynx. It was diagnosed by biopsy as a squamous cell carcinoma, and was considered as a local recurrence. The salvage operation was planned. Oral administration of TS-1 (70 mg/m²/day) was started for the purpose of induction chemotherapy under hospitalization. However, serious bone marrow suppression happened on the 13th day. The patient developed multiple organ failure, and died two days later. On the basis of result of the autopsy, the sepsis following agranulocytosis was considered to be the cause of death.
A 70-year-old-man with hypopharyngeal cancer of the right piriform sinus (cT4aN2bM0) underwent operation with a total laryngopharyngectomy. Multiple pulmonary metastasis and right cervical lymph node recurrence occurred 8 months postoperatively. Oral administration of TS-1 (74 mg/m²/day) was started. After a 2-week course of the TS-1, we had planned a break for one week.
However, a feeling of general malaise developed and the patient suddenly visited the hospital on the 5th day of the wash out period. A blood test revealed remarkable bone marrow suppression, and multiple organ failure occurred with sepsis. The patient was admitted of intensive care units for multidisciplinary treatments.
These two cases suggest that, even if a normally-accepted dose of TS-1 is given, severe bone marrow suppression may occur. Therefore strict and thorough observation is believed necessary in any such cases involving TS-1 treatment.