Early administration of systemic chemotherapy should be considered for scirrhous gastric cancer: A case report

Scirrhous gastric cancer tends to disseminate to the peritoneum and retroperitoneum, where it induces fibrosis. Retroperitoneal fibrosis (RPF) frequently causes acute renal failure due to ureteral obstruction and it tends to make many of physicians hesitate to initiate systemic chemotherapy. The present study reported the case of a 68-year-old man who was diagnosed with scirrhous gastric cancer with peritoneal and retroperitoneal dissemination, causing acute renal failure due to RPF. Before initiating systemic chemotherapy, the patient became anuric and introduced hemodialysis (HD). Although the patient's performance status was poor, there were no contraindications, such as active infection or severe complications, for systemic chemotherapy. Weekly 5-FU/l LV (5-FU 600 mg/m², l-LV 250 mg/m² on days 1, 8, 15, 22, 29 and 36; 8 weeks/cycle) was selected as the feasible treatment for the patient. After chemotherapy the patient opted to withdraw from HD and suffered from no severe toxicity. This indicates, retrospectively, that earlier systemic chemotherapy administration prior to HD introduction may result in improvement of renal function and avoidance of HD.