Abstract
BackgroundDespite recent progress in systemic chemotherapy, the prognosis of patients with peritoneal metastases from gastric cancer is still poor. Efficacious intraperitoneal and systemic combination chemotherapy regimens to treat patients with peritoneal metastases have recently been developed.Case presentationA 74-year-old man with gastric cancer T4b (transverse mesocolon) N3 M1 (peritoneum) received combination chemotherapy with intraperitoneal administration of paclitaxel, intravenous oxaliplatin, and oral S-1. Eight courses of combined chemotherapy had remarkable anti-tumor effects on the primary lesion, lymph node metastases, and peritoneal metastases. Total gastrectomy with regional lymph node dissection was performed. Pathological examination revealed no viable tumor cells in the resected specimens. After gastrectomy, the patient received 25 courses of the same chemotherapy without oxaliplatin and has no evidence of recurrence 24 months later.DiscussionTherapeutic approaches including systemic chemotherapy, extended resection, and heated intraperitoneal chemotherapy have been used to treat patients with peritoneal metastases. Repeat therapy with intraperitoneal paclitaxel has been used recently. Intraperitoneal administration of paclitaxel results in prolonged retention in the peritoneal cavity with effects against peritoneal metastases. Repeated administration of paclitaxel does not cause adhesions in the peritoneal cavity. When combination chemotherapy is effective, salvage gastrectomy is a promising option with minimal morbidity and mortality.ConclusionCombined chemotherapy with intraperitoneal paclitaxel and systemic chemotherapy followed by gastrectomy is a promising strategy for patients with advanced gastric cancer and peritoneal metastases.
Highlights
Despite recent progress in systemic chemotherapy, the prognosis of patients with peritoneal metastases from gastric cancer is still poor
Combined chemotherapy with intraperitoneal paclitaxel and systemic chemotherapy followed by gastrectomy is a promising strategy for patients with advanced gastric cancer and peritoneal metastases
We have reported that surgery after a response to combination chemotherapy is a promising option for patients with Peritoneal metastases (PM) or positive peritoneal cytology from gastric cancer [4, 5]
Summary
PM from gastric cancer are difficult to treat, and the prognosis of patients with PM is still poor. Survival was not affected by the presence or absence of port complications [13] Considering these facts, repeated intraperitoneal chemotherapy is safe and can be tolerated with long-term sequential administrations, resulting in strong suppression against PM over a long period of time. The median survival reached 26.5~30.5 months with minimal morbidity and no mortality [4, 5] This patient had the equivalent of P2 peritoneal metastases and received eight courses of combined chemotherapy. We have performed 15 salvage gastrectomies after combined chemotherapy at Jichi Medical University Hospital since 2016, but this was the only patient that achieved a pathologic complete response In this case, it is reasonable to consider that surgery may not be necessary if a complete response is achieved, but we believe that tumor cells will survive even after this treatment in most case. We believe it is necessary to perform cytoreductive surgery and adjuvant combined chemotherapy
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