A Case of Advanced Gastric Cancer with Para-aortic Lymph Node Metastasis which Showed a Pathological Complete Response after Chemotherapy (S-1 + Oxaliplatin)

Abstract

A53-year-oldfemalepatientpresentedwithgastriccancer.AnupperGIendoscopyshowedatype 2lesioninthelessercurvaturebeneaththecardia.Apathologicalanalysisofabiopsyspecimendemonstratedpoorlydifferentiatedtubularadenocarcinoma.Anabdominalcomputedtomographyscanrevealed para-aorticlymphnodeswellingwithmetastasis.Basedonthesefindings,clinicalstageIVgastriccancer (cT4aN+M1)wasdiagnosed,andthepatientreceivedsixcoursesofchemotherapywithS-1+oxaliplatin(SOX).Thereafter,thetumorshranksignificantly.Thepara-aorticlymphnodehadbecomeindistinct andsmaller.Thechemotherapyinducedapartialresponse,andtotalgastrectomywithD2lymphnode andpara-aorticlymphnodedissectionwasperformed.Subsequenthistopathologicalexaminationrevealed noresidualcancercellsintheareaoranyofthelymphnodes.Thetherapeuticresponsewasgrade3,and apathologicalcompleteresponsewasdiagnosed.ShecontinuestoreceiveoralS-1adjuvantchemotherapyandhasremainedrecurrence-freemorethansevenmonthsaftertheoperation.