ADJUVANT TREATMENT OF GASTRIC-CANCER

Adenocarcinoma of the stomach represents a significant problem worldwi de. The only known curative treatment of gastric cancer is complete su rgical resection of the stomach tumor with surrounding lymph node-bear ing areas. However, as many as 50% to 90% of patients undergoing gastr ic tumor resection relapse and die of cancer. Adjuvant chemotherapy ha s been used to prevent recurrence of gastric cancer after surgical res ection. Single agents including thiotepa and fluorodeoxyuridine have n o benefit as adjuvant therapy. Likewise, combination chemotherapy incl uding 5-fluorouracil (5-FU) plus methyl-CCNU, 5-FU plus Adriamycin plu s mitomycin C (FAM), and mitomycin C plus 5-FU plus cytosine arabinosi de do not result in overall improved survival. Combined modality irrad iation plus fluorinated pyrimidine, however, has resulted in long-term survival of patients with known residual gastric cancer. The newest c linical trial in postoperative gastric cancer being performed in the U nited States will test 5-FU plus leucovorin plus irradiation in a pros pectively randomized study in patients with resected stage IB through stage TV stomach cancer. This surgical study, designed with excellent prospective quality control, is actively accruing patients and will be completed in 1.5 to 2.0 years.