title: [A case of long-term survival of 3-years 4 months after combination chemotherapy of MTX, 5-FU and low-dose CDDP (MFP) for type 4 gastric cancer with pleuritis, peritoneal dissemination and Krukenberg tumor].
abstract: A 41-year-old woman presented to the Department of Obstetrics and Gynecology of our hospital because of abdominal distension and irregular genital bleeding. Computed tomography and ultrasonography of the abdomen revealed bilateral ovarian tumors, massive ascites, and bilateral pleural effusion. Type IV advanced gastric cancer was diagnosed on upper gastrointestinal endoscopy. The patient was admitted to our department. She received 3 courses of combination chemotherapy with methotrexate, 5-fluorouracil, and low-dose cisplatin. Pleural effusion and ascites disappeared. Surgery (total gastrectomy, resection of the tail of the pancreas, lymph-node dissection, total hysterectomy, and adnexectomy) was performed, and the patient was discharged. Chemotherapy was repeated after surgery. Lymph-node metastasis recurred 1 year 8 months after the start of chemotherapy. Treatment was switched to irinotecan plus cisplatin, and the lymph nodes shrank. After 9 months, 3 courses of TS-1 were administered. Two years 10 months after starting chemotherapy, abdominal and low back pain developed. Bone scintigraphy revealed bone metastasis. Lymph node swelling was present. The patient responded to radiotherapy with chemotherapy (cisplatin plus 5-fluorouracil). Subsequently, abdominal computed tomography showed lymph-node swelling, multiple metastases to the liver, ascites, and a right pleural effusion. She was readmitted to the hospital and received intraperitoneal chemotherapy with cisplatin. Her condition deteriorated, and she died. The patient survived for about 3 years 4 months after the start of treatment. Chemotherapy with methotrexate, 5-fluorouracil, and low-dose cisplatin may thus be an effective therapeutic option in patients who have advanced gastric cancer with peritoneal dissemination.
authors.affiliation: Dept. of Gastroenterology, Kitasato University School of Medicine.
authors.forename: Norisuke
authors.initials: N
authors.lastname: Nakayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanabe
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Higuchi
authors.forename: Tohru
authors.initials: T
authors.lastname: Sasaki
authors.forename: Kento
authors.initials: K
authors.lastname: Nakatani
authors.forename: Takuya
authors.initials: T
authors.lastname: Shimoda
authors.forename: Ken
authors.initials: K
authors.lastname: Nishimura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mitomi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005743:Gastrectomy; D006801:Humans; D007044:Hysterectomy; D007725:Krukenberg Tumor / Q000188:drug therapy* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000008:administration & dosage; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery; D010180:Pancreatectomy; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary*; D010998:Pleurisy / Q000188:drug therapy*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017741:Survivors
chemical_list: D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate