2017 Volume 25 Issue 2 Pages 60-62
Background: Despite the recent improvement in chemotherapy for Stage IV gastric cancer (GC), cure of this condition remains challenging. In the present report, we would like to describe a case of Stage IV GC, in which the first-line treatment achieved complete response and R0 surgical resection was successfully performed.
Case Presentation: A 64-year-old female patient presented with a chief complaint of appetite loss. Gastrointestinal endoscopy revealed Type 2 tumor at the antrum of stomach. The biopsy specimen diagnosed the patients having HER2-positive moderately differentiated adenocarcinoma of stomach. Serum level of CA19-9 was elevated to more than 12000 u/ml (normal range < 37 U/ml). Enhanced abdominal computed tomography (CT) demonstrated enlarged para-aortic lymph nodes (LNs) as well as the regional LNs, and the patient was diagnosed as having Stage IV GC. The patient underwent four courses of first-line treatment with S-1+CDDP+Trastuzumab. Consequently, the LNs and the primary tumor became undetectable. The patient underwent distal gastrostomy with dissection of regional and para-aortic LNs. Pathologically, the tumor cells were identified sparsely in the fibrotic tissue of stomach, although the tumors in LNs were completely necrotic. So far, there is no sign of tumor recurrence for more than 6 months.
Conclusion: Conversion therapy for Stage IV GC is possible, and seems clinically beneficial in selected patients.
