What happened, in summary

A 60-year-old woman was diagnosed with gastric cancer and extensive peritoneal carcinomatosis. Laparoscopy showed tumor deposits throughout the abdomen, and biopsy identified moderately to poorly differentiated adenocarcinoma. The peritoneal spread made this Stage IV disease.

She began a regimen combining oral S-1 with intraperitoneal and intravenous paclitaxel. After 9 courses over 7 months, repeat laparoscopy showed that the visible peritoneal nodules had disappeared and washings had become negative for cancer cells. She then underwent total gastrectomy with D2 lymph-node dissection and continued the same intraperitoneal treatment.

Over 4 years 6 months, she received 67 courses. The peritoneal disease remained suppressed for this prolonged period. Later imaging showed enlarged ovaries considered to be Krukenberg metastases, while bone scans revealed multiple bone metastases. After intraperitoneal chemotherapy stopped, the peritoneal cancer recurred and treatment changed to an irinotecan-based regimen. She had survived 5 years 2 months from the diagnosis of peritoneal carcinomatosis.