A 75-year-old woman presented with difficulty in swallowing. Esophagogastroduodenoscopy(EGD)revealed a Borrmann type 3 advanced gastric cardia carcinoma. Computed tomography(CT)revealed three lymph node metastases, and thus, the preoperative diagnosis was cT4aN2M0, cStage ⅢB. However, the patient refused resection, and chemotherapy was initiated. The chemotherapy regimen was sequentially changed based on the macroscopic characteristics of the lesion: S-1 plus CDDP followed by S-1 alone, S-1 plus PTX, and PTX alone. We have continued to follow-upthe lesion using EGD and CT, and have observed the macroscopic characteristics of the advanced gastric carcinoma treated without resection for 7 years.