Case Report: Multimodal treatment of cervical intramedullary spinal cord metastasis from gastric adenocarcinoma

Background Intramedullary spinal cord metastasis (ISCM) from gastric adenocarcinoma is extremely rare, and treatment is not standardized. Case presentation A 59-year-old man with a 22-month history of gastric adenocarcinoma developed acute quadriplegia during systemic therapy. Contrast-enhanced MRI showed a C3-C4 intramedullary enhancing lesion with extensive edema, and ISCM was suspected on clinical and radiological grounds. Because of the high cervical location and surgical risk, the patient received intensity-modulated radiotherapy (40 Gy in 20 fractions) with sintilimab, nab-paclitaxel, and capecitabine; dexamethasone and mannitol were used for spinal cord edema. Grade 4 neutropenia with febrile neutropenia occurred on radiotherapy day 3, and chemotherapy was stopped. Neurological function improved by radiotherapy day 10. Follow-up cervical MRI showed complete radiographic resolution of the lesion, and limb strength recovered to grade 5. The patient died approximately 6 months after the suspected ISCM diagnosis, about 3 weeks after the last cervical MRI; death was clinically attributed to cachexia from systemic tumor progression, without autopsy. Conclusion This case showed temporary neurological and radiographic improvement after a multimodal non-surgical approach, but it does not establish the efficacy of an individual treatment component or an overall survival benefit.