Pathological complete response from oral chemotherapy combined with trans-arterial chemotherapy and embolization in an unresectable gastric cancer patient: A case report

Abstract

Rationale: Gastric cancer is still one of the most common cancer in East Asia. More than 70% gastric cancer patients are diagnosed at an advanced stage in China. Moreover, about 10% cases are unresectable which usually suffer a poor prognosis with a median survival time of 5 to 12 months. In recent years, some clinical studies found that many unresectable gastric cancer cases could get opportunity for surgery after treatment that improve prognosis significantly PATIENT CONCERNS:: 64-year-old male patient was admitted with upper abdominal pain. Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body. Histopathological examination showed it was moderately differentiated adenocarcinoma. Computed tomography (CT) scan image showed a large bulging mass with internal ulcer at the lesser curvature wall, left gastric artery and coeliac trunk were surrounded by fused lymph nodes.

Diagnoses: Based on the histopathological examination and imaging findings, patient was diagnosed advanced gastric cancer and hardly to resect radically.

Intervention: Oral chemotherapy combined with trans-arterial chemotherapy and embolization (TACE) was initiated. Eight weeks after initial therapy, radical laparoscopy-assisted total gastrectomy with D2 lymph node dissection and Roux-en-Y anastomosis were performed successfully.

Outcomes: Patient was discharged on postoperative day 11 without complications. Histological analysis of the specimen and resected 31 lymph nodes revealed no malignancy. The patient experienced a pathological complete response (pCR).

Lessons: In this case, oral chemotherapy combined with TACE which was rarely reported in the treatment of unresectable gastric cancer achieves a great therapeutic benefit. Although further clinical studies will be needed to establish, it may be a potent strategy for degrading stage and supplying a new chance for surgery.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1

Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body.

Figure 2

CT showed a large bulging mass with internal ulcer at the lesser curvature wall of the gastric upper body near the cardia (A), left gastric artery and coeliac trunk were surrounded by fused lymph nodes (C). After conversion treatment, the primary tumor (B) and enlarged lymph nodes were significantly reduced (D). CT = computed tomography.

Figure 3

GSPs was injected into the tumor blood vessels under the guidance of DSA. DSA = digital subtraction angiography, GSPs = gelatin sponge particles.

Figure 4

The laparoscopic view showed the gastric serosal surface of lesion was smooth.

Figure 5

Specimen examination showed a 4 cm × 5 cm cicatricial lesion located at the lesser curvature wall of the gastric upper body near the cardia.

Figure 6

Histological analysis of the specimen from the scar revealed no malignancy.