Histological complete response to a combined docetaxel/cisplatin/fluorouracil neoadjuvant chemotherapy for T4 stage gast
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Histological complete response to a combined docetaxel/cisplatin/fluorouracil neoadjuvant chemotherapy for T4 stage gastric adenocarcinoma Ming gao Guo*, Qi Zheng, Jian zhong Di and Zhe Yang
Abstract Local advanced gastric carcinoma has a very poor prognosis. When a T4 gastric carcinoma has invaded the surrounding tissues and organs, curative resection is unlikely. We present here a case of a 63-year-old woman with a T4 unresectable gastric adenocarcinoma. She underwent two 3-week cycles of docetaxel/cisplatin/fluorouracil chemotherapy, followed by radical gastric resection. Each cycle consisted of 75 mg/m2 docetaxel and 75 mg/m2 cisplatin on day 1, and 200 mg/m2 leucovorin and 500 mg/m2 fluorouracil on days 1 through 5. The patient exhibited a complete histologic response. Our results indicate that docetaxel/cisplatin/fluorouracil neoadjuvant chemotherapy is a promising method of treatment for advanced gastric cancer. Keywords: Gastric cancer, neoadjuvant chemotherapy, docetaxel, cisplatin, fluorouracil
Background Gastric cancer is one of the most common malignancies and leading cause of cancer mortality worldwide, with an estimated 900,000 new cases and more than 700,000 deaths in 2006 alone [1,2]. Radical gastrectomy with extended lymphadenectomy is now recognized as the only potentially curative treatment. Patients who present with stage III or IV disease, however, are not eligible for curative resection and thus have an especially poor prognosis. Moreover, local recurrence or distant metastasis can develop in a short time even after curative resection [3]. Over the past decade, an increasing number of reports have shown that neoadjuvant chemotherapy may be useful for patients with advanced T- and N-category lesions, possibly resulting in downstaging of tumors, improved rate of primary tumor resection with negative surgical margins, and early treatment of micrometastatic disease. We report here a case of a patient with a T4 unresectable gastric adenocarcinoma who exhibited a complete histologic response after docetaxel-based neoadjuvant chemotherapy. * Correspondence: [email protected] Department of Surgery, the Six People’s Hospital of Shanghai, Shanghai Jiaotong University, Shanghai 200233, China
Case presentation A 63-year-old woman presented to our local hospital because of epigastric pain. Endoscopic examination revealed a 45 × 52 mm irregular lesion in the lesser curvature of the antrum of the stomach. A biopsy indicated undifferentiated adenocarcinoma (Figure 1A). Abdominal computed tomography (CT) showed thickening of the gastric wall. Enlarged metastatic lymph nodes could not be found. Obliteration of the fat planes between the gastric tumor and adjacent organs indicated a T4 tumor [4,5] (Figure 2A). A diagnosis of advanced gastric cancer, T4NXM0, Stage ΙΙΙA or Ις, was made in accordance with the current International Union Against Cancer TNM staging system. Because of the difficulty of performing a radical operation, we recommend
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