Treatment of peritoneal dissemination of gastric cancer with sequential methotrexate and 5-fluorouracil.
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.
Konishi
Toshiro
T
Department of Surgery, Kanto Teishin Hospital, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-0022, Japan.
Noie
Tamaki
T
Yoshida
Junji
J
Mafune
Kenichi
K
Makuuchi
Masatoshi
M