title: A case of disseminated carcinomatosis of the bone marrow originating from gastric cancer 3 years after intraperitoneal chemotherapy against peritoneal carcinomatosis.
abstract: BACKGROUND
  Clinical studies of intraperitoneal chemotherapy with paclitaxel in patients of gastric cancer with peritoneal carcinomatosis is well tolerated and effective, and rare cases of metastasis and recurrence have experienced during the treatment. Disseminated carcinomatosis of the bone marrow is highly rare in gastric cancer and associated with a poor prognosis.
  
  
  METHODS
  A 59-year-old woman of gastric cancer with peritoneal carcinomatosis received five courses of chemotherapy with intraperitoneal administration of paclitaxel, and laparoscopy showed disappearance of the peritoneal carcinomatosis. She subsequently underwent total gastrectomy, and the histopathological findings showed a complete response to the chemotherapy. Postoperatively, chemotherapy with intraperitoneal administration of paclitaxel was continued for 30 months, without apparent recurrence. However, the gastric cancer recurred as disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation, and we hence changed the chemotherapy regimen to weekly irinotecan. Remission was achieved, and she did not experience any major symptoms; however, she died 6 months after the diagnosis of disseminated carcinomatosis of the bone marrow.
  
  
  CONCLUSIONS
  Since intraperitoneal paclitaxel administration can strongly suppress peritoneal carcinomatosis of gastric cancer, careful attention should be paid not only to peritoneal recurrence but also for rare site metastases, such as bone marrow metastases.
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan. OKUNOT-SUR@h.u-tokyo.ac.jp.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Okuno
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.affiliation: Department of Chemotherapy, The University of Tokyo, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishigami
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Tanaka
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Kiyomatsu
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hata
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nozawa
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Kazama
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Sunami
authors.affiliation: Department of Surgical Oncology, The University of Tokyo, 7-3-1 Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D019046:Bone Marrow Neoplasms / Q000209:etiology* / Q000473:pathology; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007274:Injections, Intraperitoneal; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors
keywords: Disseminated carcinomatosis of the bone marrow; Gastric cancer; Intraperitoneal chemotherapy