Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Advanced Gastric Cancer Associated with Disseminated Intravascular Coagulation Successfully Treated with 5-fluorouracil and Oxaliplatin

  • Lee, Dong Seok (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Yoo, Seung Jin (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Oh, Ho Suk (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Eun Jung (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Oh, Kwang Hoon (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Lee, Sang Jin (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Park, Jong Kyu (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Ahn, Yong Chel (Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Eom, Dae-Woon (Department of Pathology, Gangneung Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Heui June (Department of Internal Medicine, University of Ulsan College of Medicine)
  • Received : 2013.04.17
  • Accepted : 2013.05.28
  • Published : 2013.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-yearold man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.

Keywords

References

  1. Hohenberger P, Gretschel S. Gastric cancer. Lancet 2003;362:305-315. https://doi.org/10.1016/S0140-6736(03)13975-X
  2. Colman RW, Rubin RN. Disseminated intravascular coagulation due to malignancy. Semin Oncol 1990;17:172-186.
  3. Pasquini E, Gianni L, Aitini E, Nicolini M, Fattori PP, Cavazzini G, et al. Acute disseminated intravascular coagulation syndrome in cancer patients. Oncology 1995;52:505-508. https://doi.org/10.1159/000227520
  4. Rhee J, Han SW, Oh DY, Im SA, Kim TY, Bang YJ. Clinicopathologic features and clinical outcomes of gastric cancer that initially presents with disseminated intravascular coagulation: a retrospective study. J Gastroenterol Hepatol 2010;25:1537- 1542. https://doi.org/10.1111/j.1440-1746.2010.06289.x
  5. Yeh KH, Cheng AL. Gastric cancer associated with acute disseminated intravascular coagulation: successful initial treatment with weekly 24-hour infusion of high-dose 5-fluorouracil and leucovorin. Br J Haematol 1998;100:769-772.c https://doi.org/10.1046/j.1365-2141.1998.00613.x
  6. Tokar M, Bobilev D, Ariad S, Geffen DB. Disseminated intravascular coagulation at presentation of advanced gastric cancer. Isr Med Assoc J 2006;8:853-855.
  7. Hironaka SI, Boku N, Ohtsu A, Nagashima F, Sano Y, Muto M, et al. Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with bone metastasis. Gastric Cancer 2000;3:19-23. https://doi.org/10.1007/PL00011684
  8. Kusumoto H, Haraguchi M, Nozuka Y, Oda Y, Tsuneyoshi M, Iguchi H. Characteristic features of disseminated carcinomatosis of the bone marrow due to gastric cancer: the pathogenesis of bone destruction. Oncol Rep 2006;16:735-740.
  9. Etoh T, Baba H, Taketomi A, Nakashima H, Kohnoe S, Seo Y, et al. Diffuse bone metastasis with hematologic disorders from gastric cancer: clinicopathological features and prognosis. Oncol Rep 1999;6:601-605.
  10. Yoshikawa T, Tsuburaya A, Kobayashi O, Sairenji M, Motohashi H, Noguchi Y. A combination immunochemotherapy of 5-fluorouracil, cisplatin, leucovorin, and OK-432 for advanced and recurrent gastric carcinoma. Hepatogastroenterology 2003;50:2259-2263.
  11. Makino H, Naito K, Tsuruta A, Kan K, Toda S, Yoshimura N, et al. A case of complete remission of metastatic skin carcinoma (erythema type) from advanced gastric cancer by CDDP administration. Gan To Kagaku Ryoho 1993;20:2225-2228.
  12. De Vita F, Orditura M, Matano E, Bianco R, Carlomagno C, Infusino S, et al. A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as firstline treatment of advanced gastric cancer patients. Br J Cancer 2005;92:1644-1649. https://doi.org/10.1038/sj.bjc.6602573
  13. Al-Batran SE, Hartmann JT, Probst S, Schmalenberg H, Hollerbach S, Hofheinz R, et al; Arbeitsgemeinschaft Internistische Onkologie. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol 2008;26:1435-1442. https://doi.org/10.1200/JCO.2007.13.9378
  14. Ferrand FR, Gontier E, Guymar S, Fagot T, Ceccaldi B, Malfuson JV, et al. Effectiveness and safe use of modified FOLFOX-6 for metastatic gastric cancer with signet ring cell components complicated by disseminated intravascular coagulation and diffuse bone marrow carcinomatosis. Onkologie 2012;35:118-120. https://doi.org/10.1159/000336971
  15. Huang TC, Yeh KH, Cheng AL, Hsu CH. Weekly 24-hour infusional 5-fluorouracil as initial treatment for advanced gastric cancer with acute disseminated intravascular coagulation. Anticancer Res 2008;28:1293-1297.

Cited by

  1. Routine Hemostasis and Hemogram Parameters: Valuable Assessments for Coagulation Disorder and Chemotherapy in Cancer Patients vol.129, pp.15, 2016, https://doi.org/10.4103/0366-6999.186637