What happened, in summary

A 55-year-old woman presented in September 2016 after a long history of digestive symptoms. Endoscopy found a diffuse gastric lesion, and biopsy showed signet-ring cell adenocarcinoma. CT and staging laparoscopy confirmed multiple peritoneal metastases, making this Stage IV gastric cancer.

She received 6 cycles of combined systemic and intraperitoneal chemotherapy using the BISIC approach. Endoscopy, CT and repeat laparoscopy showed substantial regression of the gastric and peritoneal disease, although some peritoneal implants remained. Treatment caused nausea, fatigue, neuropathy, reduced appetite and abdominal pain from chemical peritonitis, leading to dose reduction and delays, but no severe toxicity occurred.

In June 2017, she underwent cytoreductive surgery with total gastrectomy, D2 lymph-node dissection and removal of involved peritoneal areas, followed by HIPEC with cisplatin and docetaxel. Pathology still showed signet-ring cell adenocarcinoma, 4 involved lymph nodes among 23 removed, and viable cancer in two peritoneal sites. She then received 4 cycles of FOLFOX. Three months later, peritoneal recurrence was detected, and she was receiving second-line chemotherapy at follow-up.