Zhou ML, Xu RN, Tan C, Zhang Z, Wan JF. Advanced gastric cancer achieving major pathologic regression after chemoimmunotherapy combined with hypofractionated radiotherapy: A case report. World J Gastrointest Oncol 2023; 15(6): 1096-1104 [PMID: 37389115 DOI: 10.4251/wjgo.v15.i6.1096]
Corresponding Author of This Article
Jue-Feng Wan, MD, Assistant Professor, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong’ an Road, Shanghai 200032, China. wjf62313172@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jun 15, 2023; 15(6): 1096-1104 Published online Jun 15, 2023. doi: 10.4251/wjgo.v15.i6.1096
Advanced gastric cancer achieving major pathologic regression after chemoimmunotherapy combined with hypofractionated radiotherapy: A case report
Meng-Long Zhou, Ruo-Ne Xu, Cong Tan, Zhen Zhang, Jue-Feng Wan
Meng-Long Zhou, Ruo-Ne Xu, Zhen Zhang, Jue-Feng Wan, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Meng-Long Zhou, Ruo-Ne Xu, Cong Tan, Zhen Zhang, Jue-Feng Wan, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Meng-Long Zhou, Ruo-Ne Xu, Zhen Zhang, Jue-Feng Wan, Shanghai Key Laboratory of Radiation Oncology, Fudan University, Shanghai 200032, China
Cong Tan, Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Author contributions: Zhou ML and Xu RN collected the pathological, biological, and clinical data; Zhou ML drafted the initial manuscript; Tan C reviewed the pathological results; Wan JF and Zhang Z reviewed or revised the manuscript and approved the final version; Wan JF had full access to all data and had final responsibility for the decision to submit for publication; and all authors contributed to the article and approved the submitted version.
Supported bythe National Natural Science Foundation of China (General Program), No. 81773357.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this manuscript and all accompanying images.
Conflict-of-interest statement: There is no potential conflicts of interest were disclosed.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jue-Feng Wan, MD, Assistant Professor, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong’ an Road, Shanghai 200032, China. wjf62313172@163.com
Received: February 19, 2023 Peer-review started: February 19, 2023 First decision: March 22, 2023 Revised: April 9, 2023 Accepted: April 23, 2023 Article in press: April 23, 2023 Published online: June 15, 2023 Processing time: 116 Days and 1.9 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
The combination of radiotherapy and immunotherapy for GC is worthy of further exploration.
Core Tip: This case report describes a patient with unresectable advanced gastric cancer who received comprehensive treatment including chemoimmunotherapy and hypofractionated radiotherapy that was applied to treat the primary lesion; satisfactory efficacy was achieved. The combination of radiotherapy and immunotherapy is worthy of further exploration, and the dose division of radiotherapy is an important factor. Hypofractionated radiotherapy, compared to conventional fractionated radiotherapy, may better coordinate with immunotherapy.
