Abstract
BackgroundStage IV advanced gastric cancer with para-aortic lymph node metastasis (PALM) is considered unresectable. Systemic chemotherapy is the treatment of choice for such tumors, while conversion surgery may be a treatment option in the case chemotherapy is effective but R0 resection is possible. We report a case of stage IV gastric cancer with PALM that showed pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) using S-1, oxaliplatin, and trastuzumab (SOX+HER).Case presentationA 69-year-old woman who was diagnosed with type 4 stage IV gastric cancer with PALM underwent five courses of NAC with the SOX+HER regimen. The primary tumor and the PALM shrank after treatment, suggesting that the NAC induced a partial response. We performed a total gastrectomy plus distal pancreaticosplenectomy with para-aortic lymph node dissection. Histological analysis revealed no remnant cancer cells in the primary tumor or the lymph nodes, confirming a pCR. The postoperative course was uneventful, and the patient was discharged on day 14 after the operation. S-1 was started as adjuvant chemotherapy, and the patient remains alive without recurrence 2 months after surgery.ConclusionThis case shows the possibility of conversion surgery after SOX+HER therapy for stage IV advanced gastric cancer with PALM.
Highlights
BackgroundGastric cancer is the fifth most common cancer and the third leading cause of mortality among all cancers worldwide [1]
Stage IV advanced gastric cancer with para-aortic lymph node metastasis (PALM) is considered unresectable
This case shows the possibility of conversion surgery after SOX+HER therapy for stage IV advanced gastric cancer with PALM
Summary
Gastric cancer is the fifth most common cancer and the third leading cause of mortality among all cancers worldwide [1]. Stage IV gastric cancer with paraaortic lymph node metastasis (PALM) is considered an unresectable metastatic disease, and its prognosis remains poor after isolated surgical treatment [2]. Abdominal computed tomography (CT) revealed a thickened gastric wall and swollen lymph nodes along with the lesser curvature (Fig. 1b), celiac artery, splenic artery, and PAN An abdominal CT scan revealed a smaller primary lesion, regional lymph node (Fig. 3b), and PAN (Fig. 3c). The histological findings of the surgically resected specimen revealed atrophy and fibrosis of the gastric mucosa in the lesion area accompanied by inflammatory cell infiltration, and there was no clear infiltration of cancer cells at any site (Fig. 4c). No remnant cancer cells in the lymph nodes, including PAN, were detected (Fig. 4d). At 2 months after surgery, she remains alive without recurrence
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