Abstract
A 57-year-old man with anorexia, right lumbar and hip pain, and weight loss was admitted and diagnosed with type 4 gastric cancer with multiple bone metastasis. Bone scintigraphy disclosed multiple areas of abnor-mal radioisotope (RI) uptake in the pelvis, lumbar vertebra, and ribs. Plain bone X-ray examination showed multiple osteolytic shadows in the pelvis. Total gastrectomy with D1 lymph node dissection was done. Histo-logical examination of resected specimens showed poorly differentiated adenocarcinoma, intermediate type, se, INFβ, ly1, v2, n1, H0, P0, cy0, M1 (oss). We speculated that all cancer lesions except bone metastases had been resected. Pain was relieved and disappeared after early postoperative systemic chemotherapy with 5- FU and mitomycin C (MMC). Combined systemic chemotherapy with 5-FU, adriamycin, and MMC (modified FAM), and radiotherapy (Linac, 3Gy×12) for the pelvis resulted in the disappearance of abnormal RI uptake in bone scintigraphy and change of the metastatic lesions to osteosclerotic shadows on plain X-ray film. The patient continued to undergo immunochemotherapy with oral UFT and intravenous lentinan as an outpatient, and remained in good general condition with neither symptoms nor findings on X-ray or bone scintigraphy ex- amination. He died of heart failure 9 years and 8 months postoperatively. Multidisciplinary therapy including gastrectomy and postoperative combined chemoradiotherapy, thus, resulted in long-term survival
