[A case of advanced gastric cancer with distant lymph node metastases in cervical, supraclavicular and superior mediastinum successfully treated with S-1/Cisplatin (CDDP)/Lentinan combination chemotherapy].

The patient was a 76-year-old Japanese woman suffering from a left cervical tumor. An endoscopic examination revealed type 3 gastric cancer in the middle body of the stomach. 18FDG-PET-CT demonstrated distant multiple lymph node metastases in cervical, supraclavicular and superior mediastinum. Histopathological study showed poorly-differentiated adenocarcinoma in both stomach and supraclavicular lymph node. Serum CA19-9 was 794 U/mL. Since a curative operation was deemed impossible, S-1(100 mg/body) was administered orally for 21 consecutive days with a 14-day interval as one course combined with intravenous Lentinan (2 mg/body) once a week. Cisplatin (CDDP 60 mg/m2) was infused on day 8. The serum CA19-9 level decreased to 176 U/mL after a course of the regimen, to 39 U/mL after the second course, and to the normal level after the 3rd course finally. However, gastric endoscopic biopsy still showed a remnant malignant lesion. After 5 courses of the chemotherapy, both the primary lesion and the distant lymph node swelling disappeared on gastroscopy and PET-CT, respectively, which was a so-called complete response(CR). After that, only S-1 was administered for 3 weeks followed by a drug-free week as a course. The patient has now been in good health without a recurrence for 4 months after recognition of CR.