cisplatin (CDDP). Excellent clinical and experimental results have been reported with S-1 for peritoneal dissemination [4], but long-term survival without recurrence is rare, as only a few cases of long-term survival have been reported. Curative surgery is the recommended treatment for gastric cancer. The results of surgery without curability for stage IV patients are generally dismal. It is not known whether or not adjuvant chemotherapy with new anticancer agents such as S-1 is beneficial for the survival of patients with peritoneal dissemination. As curative surgery is considered to be the best therapy for gastric cancer, downstaging with adjuvant chemotherapy and curative surgery is a possibility to improve the prognosis of stage IV gastric cancer patients, after precise preoperative staging.We report the case of a patient with a gastric carcinoma in which peritoneal dissemination disappeared after neoadjuvant chemotherapy with S-1 alone. The patient has survived for over 23 months since the operation, without evidence of recurrence.
Case reportA 60-year-old man with anorexia was referred to our hospital, with advanced gastric cancer, detected at an other hospital by upper gastrointestinal endoscopy. Preoperative abdominal computed tomography (CT) scan showed a small amount of ascites and an infiltrative soft-tissue lesion in the peritoneal fat or on the peritoneal surface, suggesting peritoneal dissemination (Fig. 1A). CT also showed lymphadenopathy, which was indicative of metastases, on the lesser curvature of the stomach. Physical examination revealed no specific problems. The serum carcinoembryonic antigen (CEA) level was 1.2 ng/ml and the carbohydrate antigen (CA) 19-9 level was 5.7 U/ml.Gastrointestinal endoscopy revealed that the tumor was located on the greater curvature of the stomach,