Multiple salvage radiotherapies for metachronous lymph node metastasis from gastric cancer contributed to long-term management of disease

A 70-year-old man who underwent gastrectomy for Stage HIC gastric cancer developed lymph node (LN) metastasis posterior to the pancreatic head 3 years after the radical surgery. He was first treated with radiotherapy (RT) followed by chemotherapy. The irradiated tumor regressed completely. However, the cancer relapsed in a single para-aortic LN and he was treated with RT to the lesion followed by chemotherapy. Although it completely regressed, later, lung metastasis was observed. The lung lesions were well suppressed by switching to docetaxel; however, the cancer relapsed again in a mediastinal LN, and it was not responsive to docetaxel. The growing mediastinal lesion was irradiated again, which resulted in stable disease. The patient has been treated for 4 years and 7 months with all lesions being well-managed, and chemotherapy is being continued. Recurrent gastric cancer after surgery tends to present as multiple lesions; therefore, the principle therapy is systemic chemotherapy and RT is unlikely to be suitable. However, especially in cases of a solitary lesion that is chemo-resistant, RT could be an optimal option and contribute to long-term survival even in patients with recurrent gastric cancer.