Zhou Meng-Long, Xu Ruo-Ne, Tan Cong, Zhang Zhen, Wan Jue-Feng
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
World J Gastrointest Oncol. 2023 Jun 15;15(6):1096-1104. doi: 10.4251/wjgo.v15.i6.1096.
Currently, chemotherapy combined with immunotherapy is the established first-line standard treatment for advanced gastric cancer (GC). In addition, the combination of radiotherapy and immunotherapy is considered a promising treatment strategy.
In this report, we present a case of achieving nearly complete remission of highly advanced GC with comprehensive therapies. A 67-year-old male patient was referred to the hospital because he presented with dyspepsia and melena for several days. Based on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), endoscopic examination and abdominal CT, he was diagnosed with GC with a massive lesion and two distant metastatic lesions. The patient received mFOLFOX6 regimen chemotherapy, nivolumab and a short course of hypofractionated radiotherapy (4 Gy × 6 fractions) targeting the primary lesion. After the completion of these therapies, the tumor and the metastatic lesions showed a partial response. After having this case discussed by a multidisciplinary team, the patient underwent surgery, including total gastrectomy and D2 lymph node dissection. Postoperative pathology showed that major pathological regression of the primary lesion was achieved. Chemoimmunotherapy started four weeks after surgery, and examination was performed every three months. Since surgery, the patient has been stable and healthy with no evidence of recurrence.
The combination of radiotherapy and immunotherapy for GC is worthy of further exploration.
目前，化疗联合免疫疗法是晚期胃癌（GC）既定的一线标准治疗方法。此外，放疗与免疫疗法的联合被认为是一种有前景的治疗策略。
在本报告中，我们呈现了一例通过综合治疗使高度进展期GC几乎完全缓解的病例。一名67岁男性患者因出现数天的消化不良和黑便被转诊至我院。基于氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）、内镜检查及腹部CT，他被诊断为GC伴巨大病灶及两处远处转移病灶。该患者接受了mFOLFOX6方案化疗、纳武单抗及针对原发灶的短程大分割放疗（4 Gy×6次）。完成这些治疗后，肿瘤及转移病灶显示部分缓解。经多学科团队讨论该病例后，患者接受了手术，包括全胃切除术及D2淋巴结清扫术。术后病理显示原发灶实现了主要病理退缩。术后四周开始进行化学免疫治疗，每三个月进行一次检查。自手术以来，患者情况稳定且健康，无复发迹象。
GC的放疗与免疫疗法联合值得进一步探索。
