Hironori Shigeoka, Haruhiko Imamoto, Takushi Yasuda, Hitoshi Shiozaki, Department of Surgery, Kinki University School of Medicine, Osaka 589-8511, Japan.
World J Gastrointest Oncol. 2010 Jun 15;2(6):282-6. doi: 10.4251/wjgo.v2.i6.282.
This report presents a case of highly advanced gastric cancer that achieved a histologically complete response (CR) to preoperative chemoradiotherapy with S-1 plus low-dose Cisplatin. A 60-year-old male patient underwent FDG positron emission tomography (PET) during a routine health examination. The patient was found to have swollen paraaortic lymph nodes. Shortly thereafter, he was diagnosed with gastric carcinoma with a type 2 tumor in the antrum with paraaortic lymph node metastases based on FDG-PET, endoscopic examination and abdominal computed tomography. After the completion of chemoradiation therapy (CRT), the tumor and the paraaortic lymph node metastases disappeared. The patient underwent surgery 5 wk after the completion of CRT, including a subtotal gastrectomy with Roux-en-Y reconstruction, D3 lymph node dissection and a left adrenalectomy. No cancer cells were detected in the resected specimen either in the primary lesion or lymph nodes, thus confirming a pathologically CR to CRT (CR grade 3). The patient has been stable and well without any evidence of recurrence for 48 mo after surgery. Such a preoperative CRT regimen might therefore be very effective for treatment of some advanced gastric cancers.
本报告介绍了一例高度进展期胃癌患者，其接受 S-1 联合低剂量顺铂术前放化疗后达到组织学完全缓解（CR）。一名 60 岁男性患者在常规体检时进行了 FDG 正电子发射断层扫描（PET）。患者发现有肿大的主动脉旁淋巴结。此后不久，根据 FDG-PET、内镜检查和腹部计算机断层扫描，他被诊断为胃腺癌，幽门前区有 2 型肿瘤，伴有主动脉旁淋巴结转移。放化疗（CRT）完成后，肿瘤和主动脉旁淋巴结转移消失。患者在 CRT 完成后 5 周接受了手术，包括胃大部切除术加 Roux-en-Y 重建、D3 淋巴结清扫术和左肾上腺切除术。切除标本中无论是原发灶还是淋巴结均未发现癌细胞，因此确认对 CRT 有病理 CR（CR 分级 3）。术后 48 个月，患者情况稳定，无复发迹象。因此，这种术前 CRT 方案可能对某些晚期胃癌的治疗非常有效。
