A case report of advanced gastric cancer with bulky lymph node metastases successfully treated with induction chemotherapy followed by curative resection

The patient was a 74-year-old woman with advanced gastric cancer in the greater curvature of the antrum and lesser curvature of the angle. Abdominal computed tomography revealed bulky lymph node metastases of No. 3, 8a, and 11p. She was diagnosed with clinical Stage IIIA gastric cancer (cT3N2M0) and underwent surgery. Laparotomy findings revealed invasion of bulky lymph nodes to the common hepatic artery and pancreas. Since radical resection was not feasible, exploratory laparotomy was performed. After the surgery, she received 1 course of S-1 monotherapy and 3 courses of S-1/cisptatin (CDDP) therapy. The therapeutic response, as assessed by imaging studies, was partial for the primary lesions and complete for the enlarged lymph nodes. Distal gastrectomy and D2 lymph node dissection were performed. Histopathological findings showed no evidence of lymph node involvement, allowing the patient to undergo radical surgery. The patient received postoperative adjuvant chemotherapy with S-1. She is alive 11 months after the surgery, with no evidence of recurrence. Induction chemotherapy appears to be a promising option for advanced gastric cancer with significant lymph node involvement.