J Gastric Cancer.  2013 Jun;13(2):121-125.

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

• Lee DS
• Yoo SJ
• Oh HS
• Kim EJ
• Oh KH
• Lee SJ
• Park JK
• Ahn YC
• Eom DW
• Ahn HJ

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-year-old 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.

Keyword

Stomach neoplasms; Disseminated intravascular coagulation; Fluorouracil; Oxaliplatin

MeSH Terms

Abdominal Pain
Disseminated Intravascular Coagulation
Drug Therapy, Combination
Dyspnea
Fluorouracil
Hemorrhage
Humans
Melena
Organoplatinum Compounds
Prognosis
Stomach Neoplasms
Fluorouracil
Organoplatinum Compounds

Figure

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  Fig. 1 Initial (A) and follow up (B) gastroscopic finding: (A) Ulcerofungating mass with spontaneous oozing on the posterior wall of mid body. (B) Ulcer scar without definite mass-like lesion, and biopsy finding revealed chronic active gastritis with mild intestinal metaplasia without tumor cells.

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  Fig. 2 (A) Initial positron emission tomography-computed tomography (PET-CT) scan showed stomach cancer in body, multiple perigastric, periaortic, multiple liver metastases, and disseminated bone metastasis. (B) After 6 cycles of first line chemotherapy, follow up PET-CT scan showed nearly complete remission of stomach cancer and metastatic sites. (C) After 4 months of drug vacation, PET-CT scan showed multiple spine lesions were aggravated. (D) After 4 cycles of second line chemotherapy, PET-CT scan showed multiple spine lesions improved. (E) After 6 cycles of second line chemotherapy, PET-CT scan showed that multiple bone metastases and both adrenal metastases were aggravated.

Reference

1. Hohenberger P, Gretschel S. Gastric cancer. Lancet. 2003. 362:305–315.

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.

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.

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.

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.

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 first-line treatment of advanced gastric cancer patients. Br J Cancer. 2005. 92:1644–1649.

13. Al-Batran SE, Hartmann JT, Probst S, Schmalenberg H, Hollerbach S, Hofheinz R, et al. 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.

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.

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.