title: Metronomic chemotherapy with 5-fluorouracil and cisplatin for inoperable malignant bowel obstruction because of peritoneal dissemination from gastric cancer.
abstract: BACKGROUND
  Gastric cancer is the 2nd leading cause of cancer death worldwide. Malignant bowel obstruction (mbo) is a common complication in advanced gastric cancer because of peritoneal dissemination. A multicentre prospective study reported that patients with peritoneal dissemination of gastric origin survive for a median of 3.1 months. The aim of the present study was therefore to evaluate the efficacy and safety of metronomic combination chemotherapy with 5-fluorouracil and cisplatin in inoperable mbo from peritoneal dissemination in gastric cancer.
  
  
  METHODS
  Gastric cancer patients diagnosed with inoperable mbo because of peritoneal dissemination were treated with infusional 5-fluorouracil 300 mg/m(2) daily on days 1-5 and 8-12, and cisplatin 5 mg/m(2) daily on days 1-4 and 8-11 every 3 weeks. The primary endpoint was symptom control (remission of obstruction); the secondary endpoint was symptom control time and survival; the tertiary endpoint was adverse effects.
  
  
  RESULTS
  Between January 2013 and December 2014, 26 patients received the study treatment. Before treatment, 18 patients (69.2%) were nil per os, and 8 (30.8%) could consume liquids. After a mean of 3.3 cycles of the study treatment, just 4 patients (15.4%) was still nil per os. Of the remaining 22 patients, 3 (11.5%) could consume liquids, 7 (26.9%) could consume soft solids, and 12 (46.2%) ate a full diet. The improved ability to eat was statistically significant (p < 0.0001). Median duration of remission from mbo was 105 days. Median survival was 182 days. The 3-month survival rate was 69.2%, and the 6-month survival rate was 53.8%. Treatment was well tolerated, with grade iii toxicities consisting of thrombocytopenia in 1 patient (3.84%) and mucositis in 2 patients (7.7%). No abnormalities in serum creatinine were observed.
  
  
  CONCLUSIONS
  Metronomic combination chemotherapy with 5-fluorouracil and cisplatin is well tolerated and shows activity in inoperable mbo because of peritoneal dissemination in gastric cancer. Metronomic combination chemotherapy with 5-fluorouracil and cisplatin provides a rationale for exploring this medical problem in the future.
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: H
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: W
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Medical Oncology, Anhui Provincial Cancer Hospital, Anhui Medical University, P.R.C.
authors.forename: H
authors.initials: H
authors.lastname: Ma
keywords: 5-fluorouracil; Gastric cancer; chemotherapy; malignant bowel obstruction