Leptomeningeal carcinomatosis (LMC) is a rare complication of
gastric cancer. Case 1. A 57-year-old female was diagnosed with
gastric cancer and underwent distal
gastrectomy with D2
lymph node dissection. Two years later, the patient suffered from para-aortic
lymph node metastases and provided
chemotherapy. During the
chemotherapy, the patient emergently visited our hospital with chief complaints of a severe
headache and
dizziness. The above symptoms promptly abated by meningeal drainage, with a high value of the cerebrospinal fluid (CSF) pressure. Despite the administration of subsequent
chemotherapy, the patient's clinical state rapidly worsened, including gradual progression of both
blindness and
hearing loss. Case 2. A 42-year-old male was diagnosed with Stage IV
gastric cancer due to both distant
lymph node metastases and an
ascites.
Chemotherapy with S-1 plus
docetaxel was initiated. Upon finishing the fifth course of treatment, the patient complained of a severe
headache. The magnetic resonance imaging (MRI) findings were suggestive of LMC. Under suspicion of
carcinomatous meningitis, the patient underwent both cerebrospinal drainage with a high pressure value of 180 mmH2O and a cytological examination with a diagnosis of Class V. Immediately following the cerebrospinal drainage, the patient's symptoms promptly diminished. Case 3. A 66-year-old female was diagnosed with
gastric cancer and underwent total
gastrectomy with D2 dissection. About a year later, the patient suffered from the peritoneal dissemination, and provided serial
chemotherapy regimens for 13 months. Thereafter the patient suffered from mildly stiff shoulders followed by serial severe
headaches, and meningeal drainage was performed. The CSF showed
pleocytosis and the presence of neoplastic cells, leading a diagnosis of LMC. After the placement of an Ommaya reservoir, the intrathecal
chemotherapy was performed. Within two weeks of treatment, the patient's condition improved significantly, and the cell counts in the CSF obtained from the Ommaya reservoir remained low for six months after the first diagnosis of LMC.
CONCLUSIONS: Although gastric LMC-affected patients often exhibit a fatal
clinical course, the administration of intrathecal
chemotherapy may improve survival. Systemic
chemotherapy may be also administered in a limited number of patients with a superior performance status. At present, each case requires the individual making treatment decisions. Further accumulation of clinical cases and improving the overall understanding of the pathogenesis of this disease is needed in order to advance in the treatment of gastric LMC.