Noda Hiroshi, Kakeji Yoshihiro, Kusumoto Tetsuya, Irie Koji, Yonemura Tomohiro, Hayashida Yutaka, Saito Takao
Department of Surgery, Saga Prefectural Hospital, Koseikan, Saga, Japan.
Hepatogastroenterology. 2002 Mar-Apr;49(44):379-82.
We herein report a case in which preoperative chemotherapy with cisplatin and 5-fluorouracil was found to effectively treat far advanced gastric cancer invading the pancreas forming a huge mass with regional and distant lymph node metastases. As a result of this treatment regimen, a potentially curative resection was performed which led to a substantially increased survival. The patient was treated with 10 mg of cisplatin and 1000 mg of 5-fluouracil each day preoperatively. After the continuous administration of these drugs for 28 days, the findings of extensive pancreas invasion and lymph node metastases dramatically disappeared. The tumor could be curatively resected by a total gastrectomy with lymph nodes dissection, combined with a distal pancreatectomy and splenectomy. A histological study of a resected specimen showed some cancer cell infiltration remaining within the muscularis propria with fibrous change. There was no evidence of either pancreas invasion or lymph node metastasis. As a result, postoperative adjuvant chemotherapy was performed, 14 months later lymph nodes recurrence was detected and the patient died 20 months after surgery. Our findings suggest that preoperative chemotherapy may thus be effective for the treatment of gastric cancer by both reducing the tumor burden and prolonging survival.
我们在此报告一例病例，其中发现术前使用顺铂和5-氟尿嘧啶进行化疗可有效治疗侵犯胰腺并形成巨大肿块且伴有区域和远处淋巴结转移的晚期胃癌。由于这种治疗方案，实施了可能治愈性的切除术，从而显著提高了生存率。患者术前每天接受10毫克顺铂和1000毫克5-氟尿嘧啶治疗。连续给药28天后，广泛胰腺侵犯和淋巴结转移的表现显著消失。通过全胃切除加淋巴结清扫，联合远端胰腺切除和脾切除，肿瘤得以根治性切除。对切除标本的组织学研究显示，固有肌层内仍有一些癌细胞浸润并伴有纤维改变。没有胰腺侵犯或淋巴结转移的证据。因此，进行了术后辅助化疗，14个月后检测到淋巴结复发，患者术后20个月死亡。我们的研究结果表明，术前化疗通过减轻肿瘤负担和延长生存期，可能对胃癌治疗有效。
