Long-Term Survival of a Patient with Unresectable HER2-Positive Gastric Cancer with Multiple Liver and Para-Aortic Lymph Node Metastases Treated with Multimodal Therapy

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  • 多発肝転移および傍大動脈リンパ節転移を伴うHER2陽性胃癌に対してconversion surgeryを施行し7年以上生存している1例

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Abstract

<p>A 64-year-old male patient was found to have a type 3 tumor invading the esophagogastric junction with a main locus in the anterior wall of the lesser curvature of the upper stomach in endoscopy. Contrast-enhanced CT and PET-CT of the abdomen revealed a primary tumor that was suspected to be serous invasion from the gastric cardia to the lesser curvature of the stomach, multiple liver metastases in S5 and S7, and para-aortic lymph node metastases extending from the celiac artery root to the near aortic bifurcation. Histopathological examination of biopsy specimens revealed a HER2 score of 3+. The patient was administered capecitabine+cisplatin+trastuzumab (8 mg/kg initially and preoperatively). After 25 courses, liver and lymph node metastases significantly reduced and open total gastrectomy and D2 lymph node dissection with splenectomy were performed. Histopathological examination revealed pT2, N0, ly1, v0, and pStage IB. The patient has been treated with 26 courses of trastuzumab alone (6 mg/kg) every month postoperatively and has survived without recurrence for 7.5 years since the initial diagnosis. We report this case as an example of long-term survival of a patient with unresectable HER2-positive gastric cancer with multiple liver and para-aortic lymph node metastases treated with multimodal therapy.</p>

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