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An advanced gastric cancer with peritoneal dissemination: complete response achieved with FLOT combination chemotherapy


Introduction: Although chemotherapy is the first recommended treatment of metastatic gastric cancer, a complete response is a rare event.

Case: A 56-year-old male was diagnosed as gastric cancer with gastric outlet obstruction, large bowel obstruction and peritoneal dissemination. The patient underwent gastrojejunostomy bypass and ileostomy diversion, and chemotherapy with FLOT (5FU, leucovorin, oxaliplatin, docetaxel) regimen subsequently. After 6 courses of chemotherapy, a computed tomography showed disappearance of gastric mass and disseminated nodules in pelvic cavity, and no visible lesion in gastric mucosa, suggesting a complete clinical response.

Conclusion: FLOT regiment in our case succeed to achieve complete clinical response.


  1. Nashimoto A, Akazawa K, Isobe Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 2013;16(1):1-27.
  2. Ajani JA, D’Amico TA, Bentrem DJ. Gastric cancer, version 1.2019. NCCN Guidelines 2019 Mar.
  3. Muro K, Cursem EV, Narita Y, et al. Pan-Asian adapted ESMO clinical practice guidelines for the management of patients with metastatic gastric cancer: a JSMO-ESMO initiative endorsed by CSCO, KSMO, MOS, SSO and TOS. Ann Oncol. 2019;(30):19-33. DOI:10.1093/annonc/mdy502.
  4. Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for the first-line treatment for advanced gastric cancer (the SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215-21. DOI:10.1016/S1470-2045(08)70035-4.
  5. Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358:36-36. DOI:10.1056/NEJMoa073149.
  6. Wang Y, Yu YY, Li W. A phase II trial of xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis. Cancer Chemother Pharmacol. 2014;73:1155-61. DOI:10.1007/s00280-014-2449-1.
  7. Suzuki T, Tanabe K, Taomoto J, et al. Preliminary trial of adjuvant surgery for advanced gastric cancer. Oncol Lett. 2010;1:743-7.
  8. Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(5):v38-v49. DOI:10.1093/annonc/mdw350.
  9. Dank M, Zaluski J, Barone C et al. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naïve patients with advanced adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol. 2008;19:1450-7.
  10. Van Cutsem E, Moiseyenko VM, Tjulandin S et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006;24:4991-7.
  11. Al-Batran SE, Hartmann JT, Hofheinz R et al. Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol. 2008;19:1882-7.
  12. Van Cutsem E, Boni C, Tabernero J et al. Docetaxel plus oxaliplatin with or without fluorouracil or capecitabine in metastatic or locally recurrent gastric cancer: a randomized phase II study. Ann Oncol. 2015;26:149-56.
  13. Lim JS, Kim MJ, Yun MJ et al. Comparison of CT and 18-FDG PET for detecting peritoneal metastasis on the preoperative evaluation for gastric carcinoma. Korean J Radiol. 2006;7:249-56. DOI:10.3348/kjr.2006.7.4.249.
  14. Kawanaka Y, Kitajima K, Fukushima K et al. Added value of pretreatment 18F-FDG PET/CT for staging of advanced gastric cancer: comparison with contrast-enhanced MDCT. Eur J Radiol. 2016;85:898-95. DOI:10.1016/j.ejrad.2016.03.003.
  15. Ishigami S, Uenosono Y, Arigami T et al. Clinical utility of perioperative staging laparoscopy for advanced gastric cancer. World J Surg Oncol. 2014;12:350. DOI:10.1186/1477-7819-12-350.
  16. Yang XJ, Huang CQ, Suo T et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomised clinical trial. Ann Surg Oncol. 2011;18:1575-81.

How to Cite

Hartono, A., & Lesmana, T. (2019). An advanced gastric cancer with peritoneal dissemination: complete response achieved with FLOT combination chemotherapy. Bali Medical Journal, 8(3), S547-S549.




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