Peixoto Renata D'Alpino, de Sousa Tercia Tarciane, Silva Pedro Alexandre Ismael Amaral, de Meirelles Luciana Rodrigues, Teixeira Carlos Henrique Andrade
Centro Oncológico Antônio Ermírio de Moraes, São Paulo, Brazil.
Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Case Rep Oncol. 2018 May 17;11(2):305-310. doi: 10.1159/000488978. eCollection 2018 May-Aug.
Peritoneal carcinomatosis is usually a terminal disease with short median survival in patients with gastric cancer. Systemic FOLFOX is one of the most used regimens in the first-line treatment of metastatic gastric cancer. However, there is scarce evidence that cytoreductive surgery (CRS) and intraperitoneal heated chemotherapy (HIPEC) improves oncological outcomes of patients with advanced gastric cancer.
Herein we present a case of a young woman with advanced gastric cancer with omental and peritoneal metastases who achieved an excellent response after 6 months of FOLFOX followed by CRS and HIPEC.
A 53-year-old woman was diagnosed with advanced gastric carcinoma, with extensive omental caking and several peritoneal implants measuring 2 cm at the largest diameter. The patient received mFOLFOX6 for 6 months with excellent clinical and radiographic response. She was then submitted to a D2 total gastrectomy followed by CRS and HIPEC with mitomycin. The final pathology report showed a focal adenocarcinoma in the stomach measuring 0.4 mm with no residual tumor in the peritoneum (ypT1ypN0). The patient has been well and disease free for more than 4 years.
While still controversial, CRS followed by HIPEC may be a curative therapeutic option for highly selected patients.
腹膜癌病通常是一种终末期疾病，胃癌患者的中位生存期较短。全身应用FOLFOX是转移性胃癌一线治疗中最常用的方案之一。然而，几乎没有证据表明减瘤手术（CRS）和腹腔内热化疗（HIPEC）能改善晚期胃癌患者的肿瘤学结局。
在此，我们报告一例年轻女性晚期胃癌患者，伴有大网膜和腹膜转移，在接受6个月的FOLFOX治疗后行CRS和HIPEC，取得了良好疗效。
一名53岁女性被诊断为晚期胃癌，伴有广泛的大网膜结块和多处腹膜转移灶，最大直径为2 cm。患者接受mFOLFOX6治疗6个月，临床和影像学反应良好。随后她接受了D2全胃切除术，接着行CRS和丝裂霉素腹腔内热化疗。最终病理报告显示胃内有一个0.4 mm的局灶性腺癌，腹膜无残留肿瘤（ypT1ypN0）。该患者已健康无病生存4年多。
虽然仍存在争议，但CRS联合HIPEC可能是经过严格筛选的患者的一种治愈性治疗选择。
