An oral anticancer drug, TS-1, enabled a patient with advanced gastric cancer with Virchow's metastasis to receive curative resection

Abstract

considered to be stage IV, with distant metastasis (M1), according to the Japanese classification of gastric cancer [1], and is usually not an indication for surgery. The prognosis of unresectable stage IV gastric cancer is extremely poor, and several chemotherapy regimens have been introduced to attempt to prolong survival [2,3] or to achieve downstaging, followed by curative resection [4,5]. However, to the best of our knowledge, few previous reports have documented chemotherapy that enables the curative resection of gastric cancer with metastasis to Virchow's lymph node, even though the response rate of recent combined chemotherapeutic modalities is 30% to 50%. We encountered a patient with gastric cancer with Virchow's lymph node metastasis, who subsequently received curative resection following treatment with the newly developed oral anticancer drug, TS-1. There were no significant adverse reactions to the chemotherapy. Case reportA 67-year old woman, who had complained of upper abdominal discomfort for 3 months, presented on June 6, 2000, with advanced gastric cancer, with swelling of Virchow's lymph nodes. Gastrointestinal fiberscopy (GIF) and upper gastrointestinal series (UGI) showed a type 2 tumor, i.e., ulcerated carcinomas with sharply demarcated and raised margins, on the greater curvature in the middle third of the stomach (Fig. 1A,C). A biopsy specimen showed poorly-to-moderately differentiated adenocarcinoma. Four swollen lymph nodes, up to 1.5 cm diameter, in the left supraclavicular area were considered to be metastasis to Virchow's lymph node, based on fine-needle aspiration cytology (Fig. 2). Abdominal computed tomography (CT) and ultrasound sonography (USG) showed swelling of several paraaortic lymph nodes ( Fig. 3A; USG is not shown). Abdominal magnetic resonance imaging (MRI) showed Gastric Cancer (2002) 5: 96-101 AbstractWe encountered a patient with advanced gastric cancer, with Virchow's lymph node metastasis, who subsequently underwent curative resection after neoadjuvant chemotherapy with the newly developed oral anticancer drug, TS-1. The patient was a 67-year-old woman who had a type 2 tumor in the middle third of the stomach, and Virchow's lymph node metastasis, which was diagnosed by fine-needle aspiration cytology; she also had swollen paraaortic lymph nodes. Curative resection was considered impossible, and TS-1 (100 mg/day) was administered for 28 days in one course, mainly in the outpatient clinic. Although grade 2 stomatitis interrupted the therapy on day 21 of the second course and on day 7 of the third course, the type 2 tumor showed marked remission (partial response; PR) and the metastasis in the Virchow's and paraaortic lymph nodes had completely disappeared after the third course (complete response; CR). Eleven weeks after the completion of the TS-1 treatment, total gastric resection with D3 lymph node dissection was performed. Histopathological examination revealed tumor involvement only in the mucosal and submucosal layers of the stomach and the no. 4d lymph node. Mos...

Combination chemotherapy of S-1 and low-dose cisplatin for advanced gastric cancer

“…S-1 tended to be more effective for lymph node metastases than for the primary lesion, lung metastases, or liver metastases in the phase II study. Moreover, the response rate for cervical lymph nodes (68%) was higher than that for abdominal lymph nodes (49%) [31]. In the present study, the response rate for lymph node metastases was 39% (5/13) while the prior studies revealed higher response rates (69% and 57%).…”

“…In that patient, although the tumor had invaded the duodenum, pancreas, and transverse colon, involving the regional lymph nodes, the primary tumor was markedly reduced due to the chemotherapy. Another case report of the use of S-1 as neoadjuvant chemotherapy noted that curative resection was successfully performed because of the complete disappearance of metastases in the Virchow's and paraaortic lymph nodes [31].…”

Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer

“…Due to its potent angiogenic activity, VEGF is supposed to contribute to metastasis including peritoneal metastasis, a representative life-threatening condition in gastric cancer. S-1 showed superior therapeutic efficacy against peritoneal metastasis in nude mice (Mori et al, 2003) and clinically, alone (Iwazawa et al, 2002) or in combination with CDDP (Nakamura et al, 2002). The results suggest good therapeutic effect of S-1 in terms of survival benefit and increased QOL, as a result of improving several symptoms related to peritoneal metastasis.…”

Supraclavicular Metastasis from Infraclavicular Organs: Retrospective Analysis of 18 Patients

“…Left supraclavicular lymph nodes might be involved in gastric carcinoma metastasis (Virchow's node) (3,19,20). One of our cases was gastric adenocarcinoma with Virchow's node involvement ( Figure 5).…”