title: Invisible gastric carcinoma detected by random biopsy: long-term results after photodynamic therapy.
abstract: OBJECTIVE
  Gastric cancer diagnosed from routine gastric biopsies without any evidence of a visible lesion and negative repeated biopsies is an infrequent but serious clinical problem for which gastrectomy has usually been recommended, even if operative specimens do not show cancer either. We report on a series of 22 such patients undergoing long-term follow-up after attempted treatment with photodynamic therapy (PDT).
  
  
  METHODS
  22 patients with invisible gastric cancer (IGC) who presented during a 10-year period (10 men, mean age 56 +/- 15 years) were prospectively included. Initial histopathological findings confirmed by second opinion included 10 well-differentiated adenocarcinomas and 12 signet ring cell carcinomas. After two negative state-of-the art endoscopic reassessments, a single session of PDT using 5-delta-aminolevulinic acid (ALA) was performed in the area from which the biopsy was taken, and patients were followed up regularly.
  
  
  RESULTS
  After a mean follow-up period of 56.2 +/- 27.6 months, three patients had died of causes unrelated to gastric cancer, four had developed mucosal cancer that was successfully treated endoscopically after 4 - 38 months, and the remaining 15 patients remained without evidence of recurrent gastric cancer, lymph-node involvement, or metastases during a follow-up period of 54 +/- 26 months.
  
  
  CONCLUSIONS
  Our results suggest that gastrectomy may not be the only option for IGC, which might follow an uneventful natural course provided careful follow-up is scheduled. The role of PDT in this setting remains unclear and should be studied further.
authors.affiliation: Department of Medicine II, Dr Horst-Schmidt-Kliniken, Academic Teaching Hospital of the University of Mainz, Wiesbaden, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rabenstein
authors.forename: A
authors.initials: A
authors.lastname: May
authors.forename: L
authors.initials: L
authors.lastname: Gossner
authors.forename: H
authors.initials: H
authors.lastname: Manner
authors.forename: O
authors.initials: O
authors.lastname: Pech
authors.forename: E
authors.initials: E
authors.lastname: Günter
authors.forename: J
authors.initials: J
authors.lastname: Huijmans
authors.forename: M
authors.initials: M
authors.lastname: Vieth
authors.forename: M
authors.initials: M
authors.lastname: Stolte
authors.forename: C
authors.initials: C
authors.lastname: Ell
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D018279:Carcinoma, Signet Ring Cell / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents