Stenting and radiotherapy for malignant tracheal stenosis due to mediastinal lymph node recurrence from gastric cancer--a case report

The case is a 74-year-old woman,who underwent curative resection six years earlier for stomach cancer in the cardia extending to the esophagus (Stage IIIA). She noticed hoarseness and cough in September 2004, and CT revealed lymph node metastasis of the cancer in the upper mediastinum. The tumor pressured the SVC, the esophagus,and especially the trachea that narrowed up to a diameter of 5 mm.To secure the air way, first, a self-expandable metallic stent was placed in the narrowed trachea under general anesthesia. Irradiation to the upper mediastinal tumor was further applied for a total of 46 Gy from October to November, 2004.Symptom relief was obtained over the course by a marked reduction in the size of the metastatic tumor, and the disease remained stable for 5 months. In general,a stomach cancer that is mostly adenocarcinoma has been recognized to have low receptivity for radiotherapy. Nevertheless,this case suggests that radiotherapy can play an important role in local control and symptom relief for symptomatic stomach cancer patients.