What happened, in summary

A 74-year-old woman was diagnosed with esophagogastric junction cancer and underwent total gastrectomy with splenectomy and D2 lymph node dissection. Pathology showed a 70 × 50 mm moderately differentiated tubular adenocarcinoma with 2 involved lymph nodes and Stage II disease. Six weeks after surgery, she started adjuvant S-1 at 120 mg/kg. She developed grade 2 anorexia and systemic malaise, stopped treatment after 2 weeks and declined alternative chemotherapy. Five months after her first presentation, she was urgently hospitalized with dizziness, double vision and difficulty speaking. Brain imaging showed a solitary lesion in the left cerebellum with hydrocephalus. The tumor was removed by craniotomy, and pathology confirmed that it was a metastasis from the gastrointestinal primary. The cerebellar metastasis represented Stage IV disease. After recovery from surgery, she received Gamma Knife stereotactic radiosurgery with 20 Gy delivered to the surgical margins. She then underwent systemic surveillance every 6 months. Five years after the cerebellar metastasis was removed and treated with radiosurgery, she remained asymptomatic with no evidence of recurrence and good quality of life.