Yura Masahiro, Takahashi Tsunehiro, Fukuda Kazumasa, Nakamura Rieko, Wada Norihito, Fukada Junichi, Kawakubo Hirofumi, Takeuchi Hiroya, Shigematsu Naoyuki, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Case Rep Gastroenterol. 2018 Sep 20;12(3):578-585. doi: 10.1159/000492206. eCollection 2018 Sep-Dec.
We report a patient with highly advanced gastric carcinoma who was treated successfully with chemoradiotherapy (CRT) comprising S-1 and cisplatin. The patient was a 71-year-old male who was diagnosed with advanced gastric carcinoma by esophagogastroduodenoscopy (EGD) by medical examination. EGD demonstrated type 3 advanced gastric carcinoma in the posterior wall of the upper gastric body. An abdominal computed tomography (CT) scan showed that the gastric wall was thickened due to gastric primary tumor, and large lymph nodes (LNs) including the lesser curvature LN, anterosuperior LN along the common hepatic artery and some para-aortic LNs were detected. The patient was diagnosed with stage IV advanced gastric carcinoma according to the Japanese classification of gastric carcinoma (cT4a, cN3, cM1 [para-aortic LN], cStage IV). Preoperative CRT was carried out in an attempt to downstage the disease. Remarkable reduction of the primary tumor and metastatic LNs was observed after initial CRT, and radiological examination determined that a partial response had been achieved. Adverse effects included grade 2 anorexia and grade 3 ALP elevation (919 U/ml). No grade 4 or more severe adverse event was observed. After CRT, although we recommended curative surgery, the patient refused surgical treatment and opted for conservative treatment. Thus, we continued S-1 oral administration for 1 year. Five months after beginning CRT, upper endoscopy showed that the tumor had maintained regression and scar formation, in which no cancer cells were detected by endoscopic biopsy. The patient is doing well and has maintained a clinical complete response for more than 42 months without curative surgery. CRT could be considered as an option for treatment of patients with locally advanced gastric carcinoma diagnosed as unresectable, or for those who refuse surgical treatment.
我们报告了一名患有高度进展期胃癌的患者，其接受了包含S-1和顺铂的同步放化疗（CRT）并获得成功治疗。该患者为一名71岁男性，在体检时通过食管胃十二指肠镜检查（EGD）被诊断为进展期胃癌。EGD显示胃体上部后壁为3型进展期胃癌。腹部计算机断层扫描（CT）显示胃壁因胃原发性肿瘤而增厚，并检测到包括小弯侧淋巴结、沿肝总动脉的前上淋巴结和一些腹主动脉旁淋巴结在内的肿大淋巴结。根据日本胃癌分类，该患者被诊断为IV期进展期胃癌（cT4a，cN3，cM1[腹主动脉旁淋巴结]，c期IV）。为了降低疾病分期，进行了术前同步放化疗。初始同步放化疗后观察到原发性肿瘤和转移性淋巴结明显缩小，影像学检查确定达到了部分缓解。不良反应包括2级厌食和3级碱性磷酸酶升高（919 U/ml）。未观察到4级或更严重的不良事件。同步放化疗后，尽管我们建议进行根治性手术，但患者拒绝手术治疗并选择了保守治疗。因此，我们继续口服S-1一年。同步放化疗开始五个月后，上消化道内镜检查显示肿瘤持续消退并形成瘢痕，内镜活检未检测到癌细胞。患者情况良好，在未进行根治性手术的情况下已维持临床完全缓解超过42个月。对于诊断为不可切除的局部进展期胃癌患者或拒绝手术治疗的患者，同步放化疗可被视为一种治疗选择。
