a Division of Graduate, The second clinical medical school and the second affiliated hospital of Zhengzhou University , Zhengzhou , China.
c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China.
Cancer Biol Ther. 2018;19(10):875-878. doi: 10.1080/15384047.2018.1456600. Epub 2018 Apr 30.
Advanced gastric cancer with a pathological complete response to neoadjuvant chemotherapy and surgery followed by early brain metastasis is rare. A 52-y-old male patient who was diagnosed with advanced gastric cancer (cT4N2M0, stage ШB). Radiological examinations after three cycles of preoperative chemotherapy with a modified FOLFOX6 (mFOLFOX6) regimen showed a partial response (PR) had been achieved. The patient underwent curative surgery consisting of proximal gastrectomy, and D2 lymph node dissection. The lack of abnormal gastric cancer cells in the primary lesion or lymph nodes confirmed a pathological complete response (pCR). Postoperative chemotherapy with oral S-1 was administrated. However, during the second cycles of postoperative chemotherapy, the patient experienced headaches, projectile vomiting and convulsion. Upon further examination, a tumor representing metastasis to the brain was recognized by cranial enhanced magnetic resonance imaging (MRI) examination and cytopathology of cerebrospinal fluid. In addition to documenting the case report, we reviewed the literature associated to features of metastatic brain malignancies that form from gastric cancer. In short, advanced gastric cancer patents achieved pCR after preoperative chemotherapy typically have good prognosis; however, great attention should be paid on detecting metastatic events.
新辅助化疗和手术治疗后病理完全缓解，继而早期发生脑转移的进展期胃癌罕见。一名 52 岁男性患者，诊断为进展期胃癌（cT4N2M0，ШB 期）。接受改良 FOLFOX6（mFOLFOX6）方案三周期术前化疗后影像学检查显示部分缓解（PR）。行根治性手术，近端胃切除术和 D2 淋巴结清扫术。原发灶和淋巴结均未见异常胃癌细胞，证实病理完全缓解（pCR）。术后给予 S-1 口服化疗。然而，在第二周期术后化疗时，患者出现头痛、喷射性呕吐和抽搐。进一步检查发现，头颅增强磁共振成像（MRI）检查和脑脊液细胞学证实有脑转移瘤。除了记录病例报告外，我们还回顾了与胃癌形成的转移性脑恶性肿瘤特征相关的文献。简而言之，新辅助化疗后达到 pCR 的进展期胃癌患者通常预后良好，但应高度关注转移事件的发生。
