Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2010; 2(6): 282-286
Published online Jun 15, 2010. doi: 10.4251/wjgo.v2.i6.282
Complete response to preoperative chemoradiotherapy in highly advanced gastric adenocarcinoma
Hironori Shigeoka, Haruhiko Imamoto, Yasumasa Nishimura, Taro Shimono, Hiroshi Furukawa, Hiroshi Imamura, Takushi Yasuda, Hitoshi Shiozaki
Hironori Shigeoka, Haruhiko Imamoto, Takushi Yasuda, Hitoshi Shiozaki, Department of Surgery, Kinki University School of Medicine, Osaka 589-8511, Japan
Yasumasa Nishimura, Department of Radiation Oncology, Kinki University School of Medicine, Osaka 589-8511, Japan
Taro Shimono, Department of Radiology, Kinki University School of Medicine, Osaka 589-8511, Japan
Hiroshi Furukawa, Hiroshi Imamura, Department of Surgery, Sakai Municipal Hospital, Osaka 590-0064, Japan
Author contributions: Shigeoka H, Imamoto H, Nishimura Y, Shimono T, Furukawa H, Imamura H, Yasuda T and Shiozaki H contributed to the oncological part; Shigeoka H wrote the paper with the assistance of Shiozaki H.
Correspondence to: Hironori Shigeoka, MD, Department of Surgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. shigeoka@surg.med.kindai.ac.jp
Telephone: +81-72-3660221-3111 Fax: +81-72-3677771
Received: January 21, 2010
Revised: February 20, 2010
Accepted: February 27, 2010
Published online: June 15, 2010
Abstract

This report presents a case of highly advanced gastric cancer that achieved a histologically complete response (CR) to preoperative chemoradiotherapy with S-1 plus low-dose Cisplatin. A 60-year-old male patient underwent FDG positron emission tomography (PET) during a routine health examination. The patient was found to have swollen paraaortic lymph nodes. Shortly thereafter, he was diagnosed with gastric carcinoma with a type 2 tumor in the antrum with paraaortic lymph node metastases based on FDG-PET, endoscopic examination and abdominal computed tomography. After the completion of chemoradiation therapy (CRT), the tumor and the paraaortic lymph node metastases disappeared. The patient underwent surgery 5 wk after the completion of CRT, including a subtotal gastrectomy with Roux-en-Y reconstruction, D3 lymph node dissection and a left adrenalectomy. No cancer cells were detected in the resected specimen either in the primary lesion or lymph nodes, thus confirming a pathologically CR to CRT (CR grade 3). The patient has been stable and well without any evidence of recurrence for 48 mo after surgery. Such a preoperative CRT regimen might therefore be very effective for treatment of some advanced gastric cancers.

Keywords: Complete response; Gastric cancer; Cisplatin; Chemoradiation; Neoadjuvant therapy