title: Successful downstaging by S-1-based chemotherapy followed by surgical resections for gastric carcinoma with extensive distant lymph node metastasis - report of two cases and a review of cases with surgical resection after downstaging by S-1-based chemotherapy.
abstract: We report two cases of gastric carcinoma with successful downstaging using S-1-based chemotherapy followed by surgical resection, which enabled us to confirm the histological effect of chemotherapy. These patients were associated with extensive distant lymph node metastases for which curative resections were unlikely to be performed. We performed anticancer chemotherapy using S-1 with or without concomitant administration of cisplatin in a neoadjuvant setting. After the successful downstaging of these metastatic gastric carcinomas evaluated by imaging analyses, the patients underwent surgical resections. Effect of the chemotherapy was confirmed by the histological analyses. These cases provide further evidence, suggesting that S-1-based chemotherapy enabled downstaging of stage IV gastric carcinoma associated with distant extensive lymph node metastasis and consequently the following possible curative resections. The review of 16 cases of S-1-based chemotherapy followed by surgical resections indicated that, although downstaging may not be expected when N3 lymph node metastases are evident, the S-1-based chemotherapeutic regimens were effective in short cycles for patients in whom potential curative resection is expected. Survival benefit of downstaging followed by surgical resection, however, remains to be further elucidated.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Yoshida
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Sakurai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Komori
authors.forename: Shuhei
authors.initials: S
authors.lastname: Tonomura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Masui
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Shoji
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Imazu
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ochiai
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use / Q000633:toxicity; D002945:Cisplatin / Q000008:administration & dosage / Q000633:toxicity; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010094:Oxonic Acid / Q000627:therapeutic use* / Q000633:toxicity; D011725:Pyridines / Q000627:therapeutic use* / Q000633:toxicity; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005641:Tegafur / Q000627:therapeutic use* / Q000633:toxicity
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D011725:Pyridines; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D002945:Cisplatin