[A case of advanced gastric cancer showing pylorus stenosis with multiple liver metastases, that respond remarkably to neoadjuvant chemotherapy of combined TXL and low-dose FP].

We report a 65-year-old man with advanced gastric cancer that showed a remarkable response to treatment with a new combination of paclitaxel (TXL) and low-dose 5-fluorouracil and cisplatin (FP) as neoadjuvant chemotherapy (NAC). The patient was admitted to our hospital complaining of epigastric discomfort. Endoscopic examination revealed type 3 advanced gastric cancer, which was confirmed to be adenocarcinoma by biopsy. Tumor markers of serum carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) were elevated to 768.7 ng/ml and 2,782.8 U/ml, respectively. Computed tomography (CT) showed multiple liver metastases, and metastases to group 3 lymph nodes. After three courses of NAC, the CEA and AFP levels decreased to 245.0 ng/ml and 754.0 U/ml, respectively. Computed tomography revealed marked reduction of the primary tumor, liver metastases, and lymph nodes. Shrinkage of the primary tumor was also shown by gastrography and endoscopy. Distal gastrectomy was then performed because of pylorus stenosis. The resected specimen showed tub 2, pSS, pN3, ly2, v2 and Grade 2 histological responses. About half of the nodal metastatic lesions were degenerated. The patient is doing well and undergoing treatment with hepatic arterial infusion chemotherapy as an outpatient. TXL + low-dose FP as NAC may be one of the new tactics against advanced gastric cancer.