Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 May 17;11(2):305-310.
doi: 10.1159/000488978. eCollection 2018 May-Aug.

Complete Response for More than 4 Years following Neoadjuvant FOLFOX and Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for a Patient with Advanced Gastric Cancer with Extensive Peritoneal Carcinomatosis

Renata D'Alpino Peixoto  1 , Tercia Tarciane de Sousa  2 , Pedro Alexandre Ismael Amaral Silva  2 , Luciana Rodrigues de Meirelles  3 , Carlos Henrique Andrade Teixeira  2
Affiliations
Case Reports

Complete Response for More than 4 Years following Neoadjuvant FOLFOX and Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for a Patient with Advanced Gastric Cancer with Extensive Peritoneal Carcinomatosis

Renata D'Alpino Peixoto et al. Case Rep Oncol. .

Abstract

Background: Peritoneal carcinomatosis is usually a terminal disease with short median survival in patients with gastric cancer. Systemic FOLFOX is one of the most used regimens in the first-line treatment of metastatic gastric cancer. However, there is scarce evidence that cytoreductive surgery (CRS) and intraperitoneal heated chemotherapy (HIPEC) improves oncological outcomes of patients with advanced gastric cancer.

Methods: Herein we present a case of a young woman with advanced gastric cancer with omental and peritoneal metastases who achieved an excellent response after 6 months of FOLFOX followed by CRS and HIPEC.

Results: A 53-year-old woman was diagnosed with advanced gastric carcinoma, with extensive omental caking and several peritoneal implants measuring 2 cm at the largest diameter. The patient received mFOLFOX6 for 6 months with excellent clinical and radiographic response. She was then submitted to a D2 total gastrectomy followed by CRS and HIPEC with mitomycin. The final pathology report showed a focal adenocarcinoma in the stomach measuring 0.4 mm with no residual tumor in the peritoneum (ypT1ypN0). The patient has been well and disease free for more than 4 years.

Conclusion: While still controversial, CRS followed by HIPEC may be a curative therapeutic option for highly selected patients.

Keywords: Cytoreductive surgery; Gastric cancer; Intraperitoneal chemotherapy.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
CT scan showing omental caking and several peritoneal implants measuring 2 cm in the maximum diameter.
Fig. 2.
Fig. 2.
a, b Poorly differentiated adenocarcinoma infiltrating the epiplon with signet-ring cells (HE).
Fig. 3.
Fig. 3.
CT scan showing marked reduction of the ascites, omental and peritoneal lesions.
Fig. 4.
Fig. 4.
a–c Sparse clusters of residual neoplastic cells infiltrating the muscular layer of the mucosa. The largest focus measures 0.4 mm.
Fig. 5.
Fig. 5.
a, b Peritoneum (HE, ×200). Areas of peritoneal fibrosis. Absence of residual neoplasia.
See this image and copyright information in PMC

References

    1. Botterweck AA, Schouten LJ, Volovics A, Dorant E, van Den Brandt PA. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol. 2000 Aug;29((4)):645–54. - PubMed
    1. Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004 Apr;5((4)):219–28. - PubMed
    1. Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev. 2010 Mar;((3)) CD004064. - PubMed
    1. Maehara Y, Hasuda S, Koga T, Tokunaga E, Kakeji Y, Sugimachi K. Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg. 2000 Mar;87((3)):353–7. - PubMed
    1. D'Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004 Nov;240((5)):808–16. - PMC - PubMed

Publication types

LinkOut - more resources