title: [A Case of Unresectable Advanced Gastric Cancer Treated with Radiotherapy and Trans-Arterial Embolization, Resulting in Effective Hemostasis].
abstract: We report the case of a 70-year-old man with unresectable advanced gastric cancer because of invasion to the pancreas and multiple liver metastases. He could have continued with fourth-line chemotherapy by controlling intermittent bleeding from the cancer by means of 2 rounds of radiotherapy and trans-arterial embolization. The serum hemoglobin level declined to 4.5 g/dL during second-line chemotherapy. As the venous bleeding from the cancer was difficult to control by endoscopic hemostasis, radiotherapy with 40 Gy/20 fractions was applied to the cancer. We were able to restart chemotherapy after the hemostasis, but 6 months later, the serum hemoglobin level declined to 6.1 g/dL. Additional radiotherapy of 20 Gy/10 fractions was delivered to the tumor, and successful hemostasis was achieved; the serum hemoglobin level reached 7.5 g/dL. However, a contrast-enhanced CT, which was performed 3 weeks later, demonstrated extravasation from the cancer into the gastric cavity. We conducted trans-arterial embolization, and the patient no longer required transfusion. We planned to restart chemotherapy soon, but after 1 month, he died of pneumonia.
authors.affiliation: Dept. of Gastroenterological Surgery, Osaka General Medical Center.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Okumura
authors.forename: Junji
authors.initials: J
authors.lastname: Kawada
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.forename: Rie
authors.initials: R
authors.lastname: Nakatsuka
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Syoichi
authors.initials: S
authors.lastname: Fukuda
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Shimamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nomura
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Katsuki
authors.initials: K
authors.lastname: Danno
authors.forename: Masaru
authors.initials: M
authors.lastname: Kubota
authors.forename: Chu
authors.initials: C
authors.lastname: Matsuda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Iwase
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D001158:Arteries; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*