A case of multiple distant lymph node metastases from advanced gastric cancer treated with adjuvant chemotherapy after total gastrectomy

A 70-year-old woman with advanced gastric cancer (U, type 3, por, pT3, ly3, v2, pN3a [10/92, No. 1, 3], Stage IIIB) underwent total gastrectomy and D2 dissection followed by adjuvant chemotherapy with S-1. Eight months later, computed tomography (CT) showed multiple distant lymph node metastases, including metastases in the para-aortic and supraclavicular( Virchow's nodes) lymph nodes. Chemotherapy with cisplatin( CDDP) and irinotecan( CPT-11) was administered with concurrent radiation therapy for the para-aortic nodes. After 2 courses, the para-aortic lymph nodes showed complete response( CR), but Virchow's nodes showed partial response( PR). Dissection of Virchow's nodes was performed. Histopathological examination revealed a chemotherapeutic effect on the dissected node, and therefore, 2 more courses of chemotherapy were administered after the operation. Adverse events such as grade 3 neutropenia and grade 4 hyponatremia were observed. At present, the patient is well without recurrence, and chemotherapy is not being administered. Local therapy for distant metastasis followed by systemic chemotherapy may have been effective in this case.