Yamamoto Kei, Yamamoto Kazuyoshi, Maeda Sakae, Uemura Mamoru, Miyake Masakazu, Hama Naoki, Nishikawa Kazuhiro, Miyamoto Atsushi, Omiya Hideyasu, Miyazaki Michihiko, Ikeda Masataka, Hirao Motohiro, Takami Koji, Nakamori Shoji, Sekimoto Mitsugu
Dept. of Surgery, National Hospital Organization Osaka National Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1942-1944.
A 68-year-old man presented with type 3 advanced gastric cancer(Circ, tub2>por, HER2 score 3)in the antrum, with skip lesions in the duodenum. The tumor was cT4aN2M1(DUO)CY0, cStage IV . An XP plus trastuzumab regimen(1,000mg/m2 capecitabine[Xeloda®]twice a day on days 1-14, 80mg/m2 CDDP on day 1, 8 mg/m2 trastuzumab on day 1[second course- 6mg/m2])was administered every 3 weeks and repeated for 6 courses without severe adverse events. After 6 courses, the primary tumor and metastatic lymph nodes shrank by 31.7%(a PR according to the RECISTcriteria ), and open distal gastrectomy, D3 lymphadenectomy, and Roux-en-Y reconstruction(ante colic)were performed as conversion surgery(R0). During the administration of adjuvant chemotherapy with S-1, para-aortic, mediastinum, left supraclavicular fossa, and cervical lymph node recurrence developed. Four courses of weekly PTX plus trastuzumab as first-line chemotherapy and 11 courses of biweekly CPT-11 plus CDDP as second-line chemotherapy were administered. Because of prolonged adverse events such as Grade 3 diarrhea, the patient refused continuation of chemotherapy. The patient died 24 months after the start of preoperative chemotherapy.
