Chemotherapy followed by gastric endoscopic submucosal dissection

Chemotherapy followed by gastric endoscopic submucosal dissection chemotherapy, endoscopic submucosal dissection, gastric cancer We report a unique case of gastric cancer successfully resected by endoscopic submucosal dissection (ESD) after chemotherapy. A 75-year-old male had double independent primary cancers of hypopharynx (T3N2M0, stage IVA) and stomach. Gastric cancer had ulceration, the sudden cutting and blending of converging folds, and the estimated depth of invasion was deep submucosa (Fig. 1). At first, chemo-radiotherapy was performed for hypopharyngeal cancer (70 Gy 35 fraction; cisplatin 40 mg/m2 day 1, 15, 22, 29), and achieved complete remission. In the gastroscopy after 4 months, the ulceration and thick folds of gastric cancer disappeared without anti-ulcer drugs such as proton pump inhibitor, and the estimated depth of invasion seemed to be mucosa (Fig. 2). We performed gastric ESD. The pathologic examination of resected specimen showed intramucosal well-differentiated tubular adenocarcinoma with focally submucosal invasion (1300 μm), free vertical and horizontal margins and no lympho-vascular invasion (Fig. 3). Leichman et al. (1) reported the effect of cisplatin alone for gastric cancer. Four of the 12 (33%) patients had objective remissions. One remission was complete, lasting 60 weeks. Cisplatin alone could have activity in gastric cancer. Coccolini et al.(2) performed a meta-analysis of randomized controlled trials of neoadjuvant chemotherapy + surgery vs. surgery in patients with advanced gastric cancer. Neoadjuvant chemotherapy + surgery reduced the overall mortality at 3 and 5-years in (risk ratio = 0.74; 0.82 respectively). Neoadjuvant chemotherapy seems to have a potential to down-stage the tumor and increase the curative resection rate. In the future, neoadjuvant chemotherapy followed by ESD might become a promising option for gastric cancer with deep submucosal invasion. Figure 1. View largeDownload slide Gastric cancer before chemotherapy. 75-year-old male had gastric cancer with ulceration, thick folds and redness, and the estimated depth of invasion was deep submucosa. Figure 1. View largeDownload slide Gastric cancer before chemotherapy. 75-year-old male had gastric cancer with ulceration, thick folds and redness, and the estimated depth of invasion was deep submucosa. Figure 2. View largeDownload slide After chemotherapy, the ulceration and thick folds of gastric cancer disappeared, and the estimated depth of invasion seemed to be mucosa. We performed gastric ESD. Figure 2. View largeDownload slide After chemotherapy, the ulceration and thick folds of gastric cancer disappeared, and the estimated depth of invasion seemed to be mucosa. We performed gastric ESD. Figure 3. View largeDownload slide The pathologic examination of resected specimen showed well-differentiated tubular adenocarcinoma with focal submucosal invasion (1300 μm). Both the vertical and horizontal margins were negative. Figure 3. View largeDownload slide The pathologic examination of resected specimen showed well-differentiated tubular adenocarcinoma with focal submucosal invasion (1300 μm). Both the vertical and horizontal margins were negative. Acknowledgements The authors wish to thank Junichi Shiraishi for the assessment of pathology. Conflict of interest statement Authors declare no conflict of interests for this article. References 1 Leichman L , McDonald B , Dindogru A , Samson M , Vaitkevicius VK . Cisplatin. An active drug in the treatment of disseminated gastric cancer . Cancer 1984 ; 53 : 18 – 22 . Google Scholar CrossRef Search ADS PubMed 2 Coccolini F , Nardi M , Montori G , et al. . Neoadjuvant chemotherapy in advanced gastric and esophago-gastric cancer. Meta-analysis of randomized trials . Int J Surg 2018 ; 51 : 120 – 127 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Japanese Journal of Clinical Oncology Oxford University Press

Chemotherapy followed by gastric endoscopic submucosal dissection

Loading next page...
 
/lp/ou_press/chemotherapy-followed-by-gastric-endoscopic-submucosal-dissection-aAwThol5T2
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
ISSN
0368-2811
eISSN
1465-3621
D.O.I.
10.1093/jjco/hyy058
Publisher site
See Article on Publisher Site

Abstract

chemotherapy, endoscopic submucosal dissection, gastric cancer We report a unique case of gastric cancer successfully resected by endoscopic submucosal dissection (ESD) after chemotherapy. A 75-year-old male had double independent primary cancers of hypopharynx (T3N2M0, stage IVA) and stomach. Gastric cancer had ulceration, the sudden cutting and blending of converging folds, and the estimated depth of invasion was deep submucosa (Fig. 1). At first, chemo-radiotherapy was performed for hypopharyngeal cancer (70 Gy 35 fraction; cisplatin 40 mg/m2 day 1, 15, 22, 29), and achieved complete remission. In the gastroscopy after 4 months, the ulceration and thick folds of gastric cancer disappeared without anti-ulcer drugs such as proton pump inhibitor, and the estimated depth of invasion seemed to be mucosa (Fig. 2). We performed gastric ESD. The pathologic examination of resected specimen showed intramucosal well-differentiated tubular adenocarcinoma with focally submucosal invasion (1300 μm), free vertical and horizontal margins and no lympho-vascular invasion (Fig. 3). Leichman et al. (1) reported the effect of cisplatin alone for gastric cancer. Four of the 12 (33%) patients had objective remissions. One remission was complete, lasting 60 weeks. Cisplatin alone could have activity in gastric cancer. Coccolini et al.(2) performed a meta-analysis of randomized controlled trials of neoadjuvant chemotherapy + surgery vs. surgery in patients with advanced gastric cancer. Neoadjuvant chemotherapy + surgery reduced the overall mortality at 3 and 5-years in (risk ratio = 0.74; 0.82 respectively). Neoadjuvant chemotherapy seems to have a potential to down-stage the tumor and increase the curative resection rate. In the future, neoadjuvant chemotherapy followed by ESD might become a promising option for gastric cancer with deep submucosal invasion. Figure 1. View largeDownload slide Gastric cancer before chemotherapy. 75-year-old male had gastric cancer with ulceration, thick folds and redness, and the estimated depth of invasion was deep submucosa. Figure 1. View largeDownload slide Gastric cancer before chemotherapy. 75-year-old male had gastric cancer with ulceration, thick folds and redness, and the estimated depth of invasion was deep submucosa. Figure 2. View largeDownload slide After chemotherapy, the ulceration and thick folds of gastric cancer disappeared, and the estimated depth of invasion seemed to be mucosa. We performed gastric ESD. Figure 2. View largeDownload slide After chemotherapy, the ulceration and thick folds of gastric cancer disappeared, and the estimated depth of invasion seemed to be mucosa. We performed gastric ESD. Figure 3. View largeDownload slide The pathologic examination of resected specimen showed well-differentiated tubular adenocarcinoma with focal submucosal invasion (1300 μm). Both the vertical and horizontal margins were negative. Figure 3. View largeDownload slide The pathologic examination of resected specimen showed well-differentiated tubular adenocarcinoma with focal submucosal invasion (1300 μm). Both the vertical and horizontal margins were negative. Acknowledgements The authors wish to thank Junichi Shiraishi for the assessment of pathology. Conflict of interest statement Authors declare no conflict of interests for this article. References 1 Leichman L , McDonald B , Dindogru A , Samson M , Vaitkevicius VK . Cisplatin. An active drug in the treatment of disseminated gastric cancer . Cancer 1984 ; 53 : 18 – 22 . Google Scholar CrossRef Search ADS PubMed 2 Coccolini F , Nardi M , Montori G , et al. . Neoadjuvant chemotherapy in advanced gastric and esophago-gastric cancer. Meta-analysis of randomized trials . Int J Surg 2018 ; 51 : 120 – 127 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Japanese Journal of Clinical OncologyOxford University Press

Published: Apr 25, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off