Stage IV gastric cancer treated with chemotherapy and hyperthermia in a patient with a vagus nerve stimulator

What happened, in summary

A 55-year-old man being evaluated for dermatomyositis was found to have two synchronous gastric cancers, both poorly differentiated adenocarcinomas. Imaging suggested invasion toward the pancreas and enlarged lymph nodes including the para-aortic region. The gastric cancer was clinically classified as Stage IV. A separate in-situ laryngeal cancer was monitored, while the advanced gastric cancer drove treatment decisions.

He started S-1 plus oxaliplatin chemotherapy, but the first course caused appetite loss, further weight loss and worsening anemia. Although the lymph nodes became smaller, surgery showed that pancreatic invasion remained extensive. Radical resection was abandoned, and a palliative gastrojejunal bypass was performed.

After recovery, S-1 chemotherapy was restarted. At his request, weekly radiofrequency hyperthermia was added for 21 weeks. Because he had an implanted vagus nerve stimulator for refractory epilepsy, the device was temporarily suspended during each hyperthermia session with precautions in place. Treatment was later intensified to S-1 plus cisplatin. Five months after treatment began, endoscopy and CT showed smaller gastric tumors and lymph-node disease. Soon afterward, however, his condition deteriorated and imaging showed ascites with peritoneal dissemination. He died from progressive gastric cancer 8 months after treatment began.