Case Report: A Long Survivor Patient with Stage IV Gastric Adenocarcinoma

Gastric cancer (GC) is the fifth most common malignancy of the world and third leading cause of cancer death. At diagnosis, 35% of GC patients have distant metastases and in these cases the survival rate is very poor with a median overall survival (OS) inferior to 1 year. We report a case of a 67-year-old woman with gastric carcinoma initially deemed limited stage on diagnosis (cT2N0M0), treated surgically with radical subtotal gastrectomy with Billroth II reconstruction. In the staging CT scan, the patient presented a liver image that was considered benign. Three months later, due to abdominal pain, the patient performed another CT scan and the diagnostic of a large single liver metastasis was made; retrospectively it was observed that the lesion was present at diagnosis and that it had increased. A biopsy was performed which confirmed the metastatic origin. In a multidisciplinary team, the lesion was considered unresectable. She was proposed for first line (1st L) palliative chemotherapy (ChT) with FOLFIRI, with partial response as best response. After 30 cycles of FOLFIRI, bone metastases were diagnosed. The patient was submitted to a cementoplasty of D11-12 and L1-2. Afterwards, she started 2nd L ChT with mFOLFOX6 and at the same time she started zoledronic acid every 28 days. The best response to mFOLFOX6 was stable disease. Since November 2018, the patient has been treated with zoledronic acid every 28 days alone and maintains stable disease without ChT.