EPIRUBICIN, CISPLATIN AND CONTINUOUS-INFUSION 5-FLUOROURACIL (ECF) ASNEOADJUVANT CHEMOTHERAPY IN GASTROESOPHAGEAL CANCER

High response rates have been reported in the treatment of advanced ga stric cancer with epirubicin, cisplatin and continuous infusion 5-fluo rouracil (ECF), including instances of unresectable disease being rend ered operable by chemotherapy. We report our experience with ECF as ne oadjuvant treatment in gastric and lower oesophageal carcinoma. Twenty -seven patients were treated, of whom ten (37%) had carcinoma of the s tomach and 17 (63%) tumours of the lower oesophagus. Histology in the majority of cases, 21 (78%), was adenocarcinoma. Before chemotherapy t en patients (37%) had evidence of Initially unresectable locally advan ced disease, 16 (59%) had localised disease only and one patient (4%) had a localised primary with a single Liver metastasis. Epirubicin (50 mg m(-2) i.v.) and cisplatin (60 mg m i.v.) were administered every 3 weeks for four cycles together with a continuous 12 week infusion of 5-fluorouracil (200 mg m(-2) day(-1)). Fifteen of 24 assessable patien ts (62%) had symptomatic improvement on chemotherapy. On combined surg ical and/or radiological assessment, 15 of the 27 patients (56%) had o bjective evidence of tumour response. In all patients assessment for r adical surgery was made following chemotherapy. Eighteen patients (67% ) proceeded to operation: of these, II had complete resection of their disease, one had a histologically incomplete resection and six were f ound to have unresectable disease. No pathological complete responses were observed. Only one of the ten patients with locally advanced dise ase achieved complete surgical resection after chemotherapy. At a medi an follow-up of 36 months from date of diagnosis (range 30-47 months), 19 of the 27 patients (70%) have died. Of 11 patients who had a compl ete surgical resection, one died post-operatively, three have subseque ntly relapsed (of whom two have died) and seven remain disease free. T oxicity from treatment was mild and included emesis, myelosuppression, stomatitis and exfoliation. Myelosuppression caused modification of t reatment in 14 of 108 chemotherapy cycles (13%). There was one surgica l death but no chemotherapy-related deaths. These early results show e ncouraging symptomatic and objective responses of gastro-oesophageal c arcinoma to ECF, but provide no instances of ECF achieving complete pa thological response. Only randomised trials can establish the role of neoadjuvant ECF chemotherapy in both initially resectable and unresect able carcinoma of the stomach and lower oesophagus.