[A case of advanced gastric cancer responding remarkably to paclitaxel + low-dose FP therapy in a neoadjuvant...

We report a 74-year-old man with advanced gastric cancer that showed a remarkable response to treatment with a combination of paclitaxel and low-dose 5-fluorouracil and cisplatin (FP) as neoadjuvant chemotherapy (NAC). The patient was admitted complaining of epigastral discomfort. Endoscopic examination revealed type 3 advanced gastric cancer with pylorus stenosis. Computed tomography (CT) revealed metastasis to group 2 lymph nodes. Staging laparoscopy was performed for accurate preoperative staging. Although peritoneal seeding was not found, peritoneal washing cytology was positive (Class V). Tumor marker of serum carcinoembryonic antigen (CEA) was elevated to 9 1.2 ng/ml. After the second course of combined chemotherapy, endoscopic examination and CT revealed marked reduction of the primary tumor and metastatic lymph nodes. Shrinkage of the primary tumor was also shown by gastrography. Distal gastrectomy with Billroth-II reconstruction was then performed. The histopathological findings showed disappearance of the carcinoma as primary lesion. Many lymph nodes whose metastatic lesions revealed a complete response, but 6 lymph nodes had remaining viable cancer cells. Paclitaxel and low-dose FP therapy are useful as NAC for advanced gastric cancer.