28248891 Visualization

On December Date 28, Date 2014 Date , a 70 Age - year Age - old Age man Sex complaining of abdominal Biological_structure pain Sign_symptom , dizziness Sign_symptom , and nausea Sign_symptom was referred Clinical_event to the Hebei Nonbiological_location General Nonbiological_location Hospital, Nonbiological_location Hebei, Nonbiological_location China Nonbiological_location .
Gastroscopy Diagnostic_procedure showed irregular Shape hemorrhagic Detailed_description ulcerative Disease_disorder lesions Disease_disorder extending from the gastric Biological_structure body Biological_structure to the lesser Biological_structure curvature Biological_structure and pyloric Disease_disorder stenosis Disease_disorder of the stomach Biological_structure .
Gastric Biological_structure biopsy Diagnostic_procedure revealed adenocarcinoma Disease_disorder .
On January Date 7, Date 2015 Date , palliative Detailed_description gastrectomy Therapeutic_procedure plus Roux Therapeutic_procedure - en Therapeutic_procedure - Y Therapeutic_procedure near esophagojejunostomy Therapeutic_procedure were performed.
Diffuse Qualitative_concept enlarged Qualitative_concept para Biological_structure - aortic Biological_structure and anterior Biological_structure superior Biological_structure pancreatic Biological_structure lymph Biological_structure nodes Biological_structure , as well as lymph Biological_structure nodes Biological_structure around the common Biological_structure hepatic Biological_structure artery Biological_structure , could not be resected Therapeutic_procedure .
Postoperative pathology Diagnostic_procedure demonstrated moderately Severity differentiated Severity gastric Disease_disorder adenocarcinoma Disease_disorder (Fig.1A).
Immunohistochemistry Diagnostic_procedure showed the following: human Diagnostic_procedure epidermal Diagnostic_procedure growth Diagnostic_procedure factor Diagnostic_procedure receptor Diagnostic_procedure 2 Diagnostic_procedure (HER-2) ( + Lab_value ), vascular Diagnostic_procedure endothelial Diagnostic_procedure growth Diagnostic_procedure factor Diagnostic_procedure ( VEGF Diagnostic_procedure ) ( + Lab_value ), CD31 Diagnostic_procedure ( + Lab_value ), CD105 Diagnostic_procedure ( + Lab_value ) (Fig.1B–E), triple Diagnostic_procedure positive Diagnostic_procedure ( TP Diagnostic_procedure ) ( + Lab_value ), glutathione Diagnostic_procedure S Diagnostic_procedure - transferase Diagnostic_procedure π Diagnostic_procedure ( GST Diagnostic_procedure - π Diagnostic_procedure ) ( +++ Lab_value ), topoisomerase Diagnostic_procedure enzyme Diagnostic_procedure II Diagnostic_procedure α Diagnostic_procedure ( TOPOII Diagnostic_procedure α Diagnostic_procedure ), P53 Diagnostic_procedure (–), and Ki-67 ( 70% Lab_value ).
The diagnosis was stage Severity IV Severity gastric Disease_disorder adenocarcinoma Disease_disorder with multiple Qualitative_concept lymphnodes Biological_structure metastases Disease_disorder ( T4N2M1 Severity ).
The patient was administered 1 Dosage cycle Therapeutic_procedure of Therapeutic_procedure chemotherapy Therapeutic_procedure with oxaliplatin Medication and S-1; however, the treatment was terminated Detailed_description , as the patient could not tolerate the associated gastrointestinal Sign_symptom disturbances Sign_symptom .
On February Date 2, Date 2015 Date , adjuvant Therapeutic_procedure radiotherapy Therapeutic_procedure was administered.
Before radiotherapy, positron Diagnostic_procedure - emission Diagnostic_procedure tomography Diagnostic_procedure computed Diagnostic_procedure tomography Diagnostic_procedure ( PET Diagnostic_procedure - CT Diagnostic_procedure ) showed extensive Severity distant Detailed_description metastasis Disease_disorder ( left Biological_structure supraclavicular Biological_structure and mediastinal Biological_structure lymph Biological_structure nodes Biological_structure , and lymph Biological_structure nodes Biological_structure throughout the abdominal Biological_structure cavity Biological_structure ).
The patient's Eastern Diagnostic_procedure Cooperative Diagnostic_procedure Oncology Diagnostic_procedure Group Diagnostic_procedure ( ECOG Diagnostic_procedure ) performance status was 2 Lab_value , and his body Diagnostic_procedure mass Diagnostic_procedure index Diagnostic_procedure ( BMI Diagnostic_procedure ) was 19 Lab_value ; therefore, he was considered to be at risk of malnutrition Sign_symptom .
Oral Administration apatinib Medication 850 Dosage   mg Dosage once Frequency a Frequency day Frequency combined with and following radiotherapy Therapeutic_procedure was prescribed Clinical_event .
Informed consent was obtained from the patient prior to treatment.
In an attempt to improve tolerance to treatment, palliative Detailed_description intensity Therapeutic_procedure modulated Therapeutic_procedure radiation Therapeutic_procedure therapy Therapeutic_procedure ( IMRT Therapeutic_procedure ) was used.
The patient received a dose of 64 Dosage Gy Dosage in Dosage 30 Dosage fractions Dosage to the mediastinum Biological_structure and doses of 52 Dosage Gy Dosage in Dosage 26 Dosage fractions Dosage to the other abdominal Biological_structure metastatic Disease_disorder lesions Disease_disorder (n = 5).
The left Biological_structure supraclavicular Biological_structure lymph Biological_structure node Biological_structure was treated with apatinib Medication alone (Figs.2 and 3A–C).
A PET Diagnostic_procedure - CT Diagnostic_procedure scan performed 2 Date weeks Date after Date radiotherapy Date showed an 80% Lab_value reduction Lab_value in the maximum Diagnostic_procedure standardized Diagnostic_procedure uptake Diagnostic_procedure value Diagnostic_procedure ( SUVmax Diagnostic_procedure ) of 2 Diagnostic_procedure -deoxy-2-[[18]F]fluoro- d Diagnostic_procedure - glucose Diagnostic_procedure ( FDG Diagnostic_procedure ).
FDG Diagnostic_procedure uptake Diagnostic_procedure was higher Lab_value in the left Biological_structure supraclavicular Biological_structure lymph Biological_structure node Biological_structure compared to the metastatic Biological_structure regions Biological_structure treated with concurrent apatinib Medication and radiation Therapeutic_procedure therapy Therapeutic_procedure .
According to Response Diagnostic_procedure Evaluation Diagnostic_procedure Criteria Diagnostic_procedure in Diagnostic_procedure Solid Diagnostic_procedure Tumors Diagnostic_procedure ( RECIST Diagnostic_procedure ), the clinical effect was partial Lab_value response Lab_value (Fig.2).
The patient received further radiotherapy Therapeutic_procedure ( 66 Dosage Gy Dosage in Dosage 28 Dosage fractions Dosage ) to the left Biological_structure supraclavicular Biological_structure lymph Biological_structure node Biological_structure due to residual Disease_disorder metastasis Disease_disorder .
Tumor Diagnostic_procedure markers Diagnostic_procedure and biochemical Diagnostic_procedure analyses Diagnostic_procedure were evaluated every Frequency 2 Frequency months Frequency .
Two Date months Date after Date therapy Date , chest Biological_structure , and abdominal Biological_structure CT Diagnostic_procedure scans Diagnostic_procedure indicated stable Detailed_description disease Disease_disorder ; anemia Sign_symptom and gastrointestinal Sign_symptom symptoms Sign_symptom had improved Qualitative_concept , ECOG Diagnostic_procedure performance status was 0 Lab_value , and BMI Diagnostic_procedure was 22 Lab_value .
Hematologic Sign_symptom toxicity Sign_symptom , hypertension Sign_symptom , renal Sign_symptom dysfunction Sign_symptom , proteinuria Sign_symptom , and hand Sign_symptom – foot Sign_symptom syndrome Sign_symptom were not observed during apatinib Medication therapy.
In September Date 2015 Date , a follow Diagnostic_procedure - up Diagnostic_procedure examination Diagnostic_procedure showed increased Lab_value carbohydrate Diagnostic_procedure antigen Diagnostic_procedure (CA) Diagnostic_procedure 125 Diagnostic_procedure and ferritin Diagnostic_procedure ; however, gastroscopy Diagnostic_procedure and abdominal Biological_structure CT Diagnostic_procedure revealed no abnormalities Sign_symptom .
In November Date 2015 Date , the patient had difficulty Sign_symptom swallowing Sign_symptom and experienced intermittent Detailed_description hematochezia Sign_symptom .
Apatinib Medication was terminated Detailed_description due to gastrointestinal Sign_symptom bleeding Sign_symptom .
Gastroscopy Diagnostic_procedure revealed anastomotic Sign_symptom stenosis Sign_symptom due to gastric Disease_disorder cancer Disease_disorder and intragastric Disease_disorder hemorrhage (Fig.3D–F).
The patient and his family refused chemoradiotherapy Therapeutic_procedure .
Symptomatic treatment with a hemostatic Medication drug Medication and best supportive Therapeutic_procedure care Therapeutic_procedure were prescribed Clinical_event .
After Date 1 Date week Date of therapy, hemorrhaging Disease_disorder was resolved.
One Date month Date later, Date the patient again experienced intermittent Detailed_description hematochezia Sign_symptom .
On December Date 20, Date 2015 Date , PET Diagnostic_procedure - CT Diagnostic_procedure demonstrated extensive Severity metastasis Disease_disorder .
The patient and his family requested best supportive Therapeutic_procedure care Therapeutic_procedure .
On April Date 16, Date 2016 Date , the patient died Outcome due to pulmonary Biological_structure infection Disease_disorder .