HIS COMMUNICATION reports a case of a T nonresectable carcinoma of the cardia of the stomach with visceral metastases, treated with triethy lenethiophosphoramide (TSPA) f ollowed by resolution of the visceral and nodal metastatic lesions so that resection of a previously nonresectable fixed tumor was possible.
REPORT OF A CASE
This 57-year-old white man was admitted for the first time to the Roswell Park Memorial Institute, Buffalo, N.Y., on Feb. 21, 1957, because of dysphagia for 4 months. This was associated with a 13-lb. weight loss. An upper gastrointestinal roentgenographic study and esophagoscopy performed at another hospital 1 month prior to admission were reported as normal. T h e past history was unremarkable. Physical examination revealed no abnormality. His weight on admission was 51.6 kg.
An esophogram taken on Feb. 21, 1957, revealed marked constriction in the terminal esophagus, with irregularity of the mucosal pattern at the area of constriction. This was interpreted as carcinoma of the lower esophagus or gastric cardia. Esophagoscopy on Feb. 25, 1957, disclosed evidence of esophagitis at a level 40 cm. below the upper incisor teeth. T h e esophagoscopic examination was repeated on March 15, 1957. A fiery-red mucosa with thick white exudate but without evidence of tumor was noted at the terminal esophagus. A biopsy at this area was reported as gastric mucosa. .4 Papanicolaou smear was negative for malignant cells.
Because of the continuing dysphagia, a left thoracoabdominal exploration was carried out on April 9, 1957. At the time of the operation, the thoracic esophagus was found to be normal. A tumor mass at the cardiac end of the stomach was found with linitis plastica-like infiltration involving primarily the posterior wall of the stomach, encroaching upon both