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Advanced gastric cancer with peritoneal dissemination successfully treated with paclitaxel and doxifluridine: a case report.

A 50-year-old female presenting with severe ascites and anemia and diagnosed with advanced gastric cancer was admitted to our hospital. Endoscopic examination revealed an edematous lesion with redness and a giant fold in the stomach with poor expansion. The histological examination of biopsy specimens from the edematous lesion revealed signet-ring-cell carcinoma. Computed tomography demonstrated a thickening of the gastric wall, severe ascites, and peritoneal dissemination in the Douglas pouch. Paclitaxel (70mg/m2) was administered to the patient on days 1, 8, and 15, with doxifluridine (533mg/m2) for five days per week, on a 28-day cycle. By completion of the first course of treatment, the ascites had disappeared, the tumor in the Douglas pouch had shrunk, and the thickening of the gastric wall had lessened. In addition, the fold in the stomach appeared by endoscopic examination to have resumed its normal thickness, no malignant cells were detected in a biopsy, and the thymidine phosphorylase activity in the tumor tissue was two-fold greater than that before chemotherapy. After three treatment courses, the number of apoptotic cells had apparently increased compared with the prechemotherapy number. The only adverse drug reactions that were observed were grade 2 alopecia and grade 1 myalgia. After thirteen courses of chemotherapy over the past one year, both primary and metastatic lesions seem to be regressing. This case study suggests that paclitaxel plus doxifluridine therapy is effective and well-tolerated in non-resectable gastric cancer patients.