[A Case of Long-Term Survival in a Patient with Adrenal Metastasis from Gastric Cancer Who Achieved Two Complete Responses from Chemotherapy Following Resection].

The patient was a 70-year-old male with highly advanced gastric cancer, 2 liver metastases(S3 and S8), and pancreatic invasion. Three courses of S-1+L-OHP(SOX therapy)were administered as conversion surgery chemotherapy, and total gastrectomy and combined resection of the body and tail of the pancreas and spleen and partial resection of the liver(S3 and S8)were performed as conversion surgery. S-1 therapy was continued for 1 year as postoperative adjuvant chemotherapy. A left adrenal metastasis was detected on CT 1 year and 6 months after the operation. PET-CT revealed no other areas suspicious of recurrence; therefore, left adrenalectomy was performed through the retroperitoneal space. Radical resection was not performed because of severe adhesions and scarring from the previous surgery. Paclitaxel+ramucirumab chemotherapy was initiated, and after 10 courses, tumor disappearance was observed on enhanced CT and PET-CT. The re-enlargement was observed 1 year later. The patient underwent re-administration of paclitaxel+ramucirumab, SOX+ nivolumab therapy, and nivolumab monotherapy, but all showed PD on imaging. After 8 courses of CPT-11 monotherapy, CR was again observed on imaging. Five years and 3 months after the initial surgery and 3 years and 8 months after adrenal metastasis resection, the patient was alive and well without recurrence.