Complete Remission after Chemotherapy in Stage IV Gastric Cancer

Cho, Hang Ju; Kim, Wook; Sung, Gi Young; Won, Jong Man

Abstract

Complete remission (CR) following chemotherapy is defined as the disappearance of a previously known-malignancy, with no further development of a new tumor. The treatment of the stage IV gastric cancer, with a distant metastatic or locally advanced-unresectable condition is a surgical dilemma. Many therapeutic modalities including chemoradiation, immunotherapy or intraoperative thermal therapy, have been used for the management of this condition, but their results were still unsatisfactory. Although CR is infrequently reported, pathological confirmation by operation is quite rare. We experienced two cases of CR following FEP (5-FU 500 mg/m2, Epirubicin 50 mg/m2, and Cisplatin 60 mg/m2) chemotherapy; one was a case of locally advanced, unresectable gastric cancer with tumor extension through the adjacent structure, and extensive regional lymph nodes metastasis. We confirmed the pathological CR by a second look operation, a distal gastrectomy with D3 lymph node dissection. The patient is doing well, with no recurrence for 5 years. The other was a case of advanced gastric cancer, with hepatic metastasis, and was treated with the same chemotherapeutic regimens. However, he refused a second operation and recurrence of cancer was detected by a gastrofiberscopic biopsy, with metastatic nodule on liver at 8 and 14 months following CR, respectively. We suggest that although CR is achieved following chemotherapy, subsequent curative resection should be mandatory, as recurrence will develop after a few months.