Abstract
BackgroundComplete remission from advanced-stage synchronous double primary (SDP) esophageal and gastric adenocarcinoma by chemotherapy alone is rare. We report a case of advanced-stage SDP esophageal and gastric adenocarcinoma in which a complete response to treatment was obtained with S-1 and cis-diamminedichloroplatinum (CDDP).Case presentationThe patient was a 74-year-old man referred to our hospital complaining of dysphagia. Gastrointestinal endoscopy was performed and advanced-stage SDP esophageal and gastric adenocarcinoma diagnosed. Computed tomography revealed multiple regional lymph node metastases in the mediastinum. Neoadjuvant chemotherapy with S-1 and CDDP for advanced esophageal and gastric cancer was planned. An endoscopy following two courses of chemotherapy revealed that the esophageal cancer had been replaced with a normal mucosal lesion and the gastric tumor with a scar lesion; the results of biopsies of both were negative for cancer. Computed tomography revealed that the multiple lymph node metastases had disappeared. We diagnosed a complete response to S-1 and CDDP in advanced-stage SDP esophageal and gastric cancer. The patient is still alive with no signs of recurrence 22 months after the disappearance of the original tumor and metastatic lesions without surgical treatment.ConclusionThese results suggest that complete remission from advanced-stage esophageal and gastric cancer can be obtained with chemotherapy with S-1 plus CDDP.
Highlights
Complete remission from advanced-stage synchronous double primary (SDP) esophageal and gastric adenocarcinoma by chemotherapy alone is rare
These results suggest that complete remission from advanced-stage esophageal and gastric cancer can be obtained with chemotherapy with S-1 plus CDDP
An endoscopy performed after two courses of chemotherapy revealed that the esophageal cancer had been replaced with normal mucosa and the gastric cancer with a scar lesion (Figures 1b, 2b); the results of the biopsies of both were negative for cancer lesions
Summary
The standard treatment for advanced-stage esophageal cancer is esophagectomy. Despite advances in surgical technique, the prognosis of advanced-stage esophageal cancer is still poor [1]. S-1 has recently produced good clinical responses and survival benefits in Japanese patients with gastric and colorectal adenocarcinoma, and hypopharyngeal and laryngeal squamous cell carcinoma In this case, S-1 was administered orally at a dose of 80 mg/m2 per day for 21 consecutive days followed by a 14-day drug-free interval. We diagnosed complete response of advancedstage SDP esophageal and gastric adenocarcinoma to S-1 and CDDP as a neoadjuvant chemotherapy, obviating the Figure 2 Upper-gastrointestinal endoscopy before and after treatment of upper gastric tumor. After 4 courses of the S-1 and CDDP chemotherapy regimen, the patient remains on outpatient 8 cycles adjuvant chemotherapy with S-1 only at a dose of 80 mg/m2 per day for 28 consecutive days followed by a 14-day drug-free interval without surgical treatment. As of September 2011, the patient is alive with no signs of recurrence at 22 months after the disappearance of the original tumors
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