Treatment of advanced gastric cancer by palliative gastrectomy, cytoreductive therapy and postoperative intraperitoneal chemotherapy.
BACKGROUND
The treatment options for the 10-20 per cent of patients with gastric cancer who present with peritoneal dissemination are extremely limited and no standard approach exists.


METHODS
The feasibility of using intraperitoneal chemotherapy to treat gastric cancer with intra-abdominal gross residual lesions after palliative gastrectomy with maximal cytoreduction was investigated. Early postoperative intraperitoneal chemotherapy started on the day of operation with 5-fluorouracil 500 mg/m2 and cisplatin 40 mg/m2 (days 1-3) over a 4-week interval.


RESULTS
Of the 53 patients enrolled between July 1994 and December 1998, 49 were eligible. The progression-free survival (PFS) was 7 months and the overall survival was 12 months. In multivariate analysis, performance status was the only significant defining factor for PFS (P = 0.009). The predominant toxicity was neutropenia and nausea/vomiting. The relative dose intensity of 5-fluorouracil and cisplatin was 89 and 63 per cent respectively.


CONCLUSIONS
Performance status emerged as a major determining factor for prognosis and patient selection for early postoperative intraperitoneal chemotherapy in patients with advanced gastric cancer after maximally cytoreductive surgery.
Jeung
H C
HC
Cancer Metastasis Research Centre, Yonsei University College of Medicine, Seoul, Korea.
Rha
S Y
SY
Jang
W I
WI
Noh
S H
SH
Chung
H C
HC
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery*
D002945:Cisplatin; D005472:Fluorouracil