Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2020; 8(18): 4177-4185
Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.4177
Neoadjuvant chemoradiotherapy for locally advanced gastric cancer with bulky lymph node metastasis: Five case reports
Eiji Nomura, Hajime Kayano, Takashi Machida, Hideki Izumi, Soichiro Yamamoto, Akitomo Sugawara, Masaya Mukai, Terumitsu Hasebe
Eiji Nomura, Hajime Kayano, Takashi Machida, Hideki Izumi, Soichiro Yamamoto, Masaya Mukai, Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
Akitomo Sugawara, Terumitsu Hasebe, Department of Radiology, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
Author contributions: Nomura E collected the patients’ clinical data and drafted the manuscript; Sugawara A, Nomura E, Kayano H and Yamamoto S helped in the management of the patients; Machida T, Izumi H and Mukai M collected the patients’ clinical data; Hasebe T made revisions and supervised the study; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from all five patients for publication of this report and any accompanying images.
Conflict-of-interest statement: No conflict of interest exists in relation to this manuscript.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eiji Nomura, MD, PhD, Doctor, Professor, Surgeon, Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji 192-0032, Tokyo, Japan. nomura@hachioji-hosp.tokai.ac.jp
Received: June 29, 2020
Peer-review started: June 29, 2020
First decision: July 24, 2020
Revised: August 1, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 26, 2020
Processing time: 84 Days and 21.1 Hours
Abstract
BACKGROUND

Neoadjuvant chemoradiotherapy (NACRT) has not been accepted as a general therapy for gastric cancer because of its localized effect and toxicity for radiosensitive organs. However, if radiation therapy could compensate for the limited or inadequate treatment choices available for elderly patients and/or those at high risk, the available therapeutic options for advanced gastric cancer might increase. From this perspective, we present our experiences of five patients with advanced gastric cancer in whom we used NACRT therapy with interesting results.

CASE SUMMARY

We admitted five patients with clinical Stage III gastric cancer and bulky lymph node metastasis or adjacent organ invasion at the time of diagnosis. A total of 50 Gy of preoperative intensity modulated radiation therapy was delivered to the patients in doses of 2.0 Gy/d, together with a regimen of concomitant chemotherapy comprising two courses of oral tegafur/gimeracil/oteracil (S-1; 65 mg/m2 per day) for three consecutive weeks followed by two weeks of rest, starting at the same time as radiotherapy. All patients underwent no residual tumor resection and a pathological complete response of the primary tumors was achieved in two patients. The incidence of hematological toxicity was low, although the digestive toxicities of anorexia and diarrhea developed in three of the five patients, necessitating termination of radiation therapy at 30 Gy and S-1 at three weeks. However, even 30 Gy of irradiation and half the dose of S-1 resulted in sufficient downstaging, indicating that even a reduced amount of NACRT could confer considerable effects.

CONCLUSION

Slightly reduced NACRT might be useful and safe for patients with locally advanced gastric cancer.

Keywords: Advanced gastric cancer; Neoadjuvant chemoradiotherapy; Intensity modulated radiation therapy; Tegafur/gimeracil/oteracil; Curative resection; Case report; Gastrectomy

Core Tip: Cancer patients at very high risk are difficult to treat with powerful preoperative chemotherapies, and extensive lymph node dissection might not always be an option. If radiation therapy is found to be safe and effective in these patients, it might increase the therapeutic options available for advanced gastric cancer. Preoperative intensity modulated radiation therapy together with a regimen of concomitant chemotherapy with tegafur/gimeracil/oteracil was delivered to five patients with clinical Stage III gastric cancer, bulky lymph node metastasis, and adjacent organ invasion. All patients subsequently underwent no residual tumor resection. Slightly reduced doses of neoadjuvant chemoradiotherapy might be useful and safe for patients with locally advanced gastric cancer.