title: Treatment of peritoneal dissemination of gastric cancer with sequential methotrexate and 5-fluorouracil.
abstract: BACKGROUND: Pretreatment with methotrexate (MTX) followed by 5-fluorouracil (5-FU) (sequential MTX and 5-FU), exerts biochemical modulation in which the antitumor effect of 5-FU is enhanced by the preceding MTX. Since the early 1980s, the sequential MTX/5-FU regimen has been employed clinically for gastric cancer in Japan, with high response rates for undifferentiated type gastric carcinoma.METHODS: Peritoneal dissemination is more frequent in undifferentiated type carcinoma, we therefore employed sequential MTX and 5-FU for the treatment of 39 gastric cancer patients with peritoneal dissemination. We also investigated MTX levels in blood and ascitic fluid during the treatment.RESULTS: Partial response (PR) was achieved in 6 of 26 patients (23%) who had evaluable lesions. PR lesions included abdominal wall tumors, primary gastric foci, inguinal lymph node, and rectal stenosis. Ascites was eliminated in 50% of the patients, and pleural effusion disappeared in 2 patients.CONCLUSIONS: In our study, sequential MTX and 5-FU had low toxicity and was beneficial for advanced gastric cancer patients with peritoneal dissemination. Further investigation of this treatment as induction and postoperative adjuvant chemotherapy for Borrmann type 4 gastric cancer seems warranted.
authors.affiliation: Department of Surgery, Kanto Teishin Hospital, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-0022, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Konishi
authors.forename: Tamaki
authors.initials: T
authors.lastname: Noie
authors.forename: Junji
authors.initials: J
authors.lastname: Yoshida
authors.forename: Kenichi
authors.initials: K
authors.lastname: Mafune
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi