Gastric Cancer with Virchow's and Multiple Lung Metastases Showing a Remarkable Response to Preoperative Chemotherapy: Report of a Case

Abstract

We report herein a rare case with advanced gastric cancer combined with group 4 lymph node and lung metastases that responded remarkably to neoadjuvant chemotherapy. A 65-year-old man was found to have a well-differentiated type 3 gastric cancer that invaded the duodenum locally and was accompanied with Virchow's, para-aortic lymph nodes, and multiple lung metastases based on physical, endoscopic, and radiological examinations. In addition, his carbohydrate antigen (CA) 19-9 was elevated to 3965U/ml, and CA72-4 to 46U/ml. Prior to surgery, he was treated with 5-fluorouracil (5-FU; 500mg/body per day) and low-dose cisplatinum (CDDP; 10mg/body per day) as neoadjuvant chemotherapy for 6 weeks. As a result, a partial response was obtained in all lesions, and CA19-9 and CA72-4 decreased to 463U/ml and 9.4U/ml, respectively. Four weeks after the completion of neoadjuvant chemotherapy, a distal gastrectomy was performed, and a histopathological examination of the resected specimen showed a grade 2 response to chemotherapy. Immunohistochemically, the thymidylate synthase expression level was very low in the tumor tissues, which might account for the good response to the combination chemotherapy with 5-FU and CDDP observed in the present case.

Local Granulocyte-Macrophage Colony-Stimulating Factor Improves Incisional Wound Healing in Adriamycin-Treated Rats

“…Neoadjuvant treatment is commonly used to treat advanced tumors. [13][14][15][16][17] Consequently, many patients must undergo major surgery while chemotherapy is active; however, it is well known that chemotherapy impairs wound healing, which increases morbidity and prolongs hospitalization. 3,[18][19][20][21][22][23][24] Adriamycin is a wide-spectrum anthracycline group chemotherapeutic agent, which is frequently used but has many side effects.…”