[A fatal case of meningeal carcinomatosis in a Stage IV gastric cancer patient who responded to multi-line chemotherapy].

A 60-year-old man was diagnosed with Stage IV gastric cancer with pyloric stenosis, peritoneal dissemination and multiple bone metastasis. One course of low dose CDDP and 5-FU, and 3 courses of S-1 and CDDP were carried out. Although a partial response was obtained, a large amount of ascites appeared again. As a third-line chemotherapy for this patient, PTX (60-100 mg/body) was administered to the peritoneal cavity on day 1 and 14, and S-1 (80 mg/body/ day) was given orally for 2 weeks followed by a 14-day rest period. The ascites had completely disappeared after 1 course of the combined chemotherapy. As a fourth-line chemotherapy, combination chemotherapy of biweekly infused PTX and daily oral S-1 was started, because the primary gastric lesion was increased. Subsequently, various neurological symptoms rapidly appeared, including dizziness, hypertension, and convulsion. Meningeal carcinomatosis was diagnosed by an examination of cerebrospinal fluid, and he died of disease rapid progression.