Neoadjuvant chemotherapy combining docetaxel, cisplatin and S-1 in gastric cancer with para-aortic lymph node metastases: report of five cases

We report on five patients with a median age of 56 years (range, 53-68 years) who were diagnosed as advanced gastric cancer with para-aortic lymph node metastases, determined by gastrofiberscope and abdominal spiral computed tomography. These patients received intravenous docetaxel (30 mg/m2) and cisplatin (30 mg/m2) on day 1, 15 and oral S-1 (40 mg/m2 bid) on days 1-14 every 4 weeks. After two cycles of neoadjuvant chemotherapy, all patients received total gastrectomy with D2 lymphadenectomy plus para-aortic lymph nodes dissection. No patient revealed hematological or non-hematological toxicities associated with the chemotherapy (more than grade 2). The postoperative courses were uneventful without major surgery-related complications. Pathological complete response was confirmed one patient in primary lesion and three patients in metastatic lymph nodes including para-aortic lymph nodes. All of five patients are alive without recurrence (median: 36 months, 21-46 months). Thus, neoadjuvant chemotherapy described here may be rather promising regimen for advanced gastric cancer with para-aortic lymph node metastases, considering its low grade toxicities and pathological responses.