A PILOT-STUDY OF INTRAPERITONEAL CISPLATIN IN THE MANAGEMENT OF GASTRIC-CANCER

Background: This phase II trial was designed to evaluate the feasibili ty, toxicity, relapse pattern and survival following adjuvant intraper itoneal cisplatin in patients with gastric cancer at high risk of rela pse. Patients and methods: Patients who had undergone complete surgica l resection of adenocarcinoma of the stomach and who had positive sero sa and/or regional lymph nodes and/or peritoneal washings has insertio n of either a Tenckhoff catheter or temporary peritoneal dialysis cath eter and were treated with cisplatin 60 mg/m2 intraperitoneally every 21 days for 4-6 courses. Peritoneal lavage or cytology was done before each treatment. Results: Eighteen patients were studied. Seventeen pa tients had serosal involvement, 11 had regional lymph node involvement and 2 had positive peritoneal washings before treatment. The median n umber of courses of chemotherapy was 4 (range 2-6). Radioisotope trace r studies (6 patients) showed good distribution throughout the periton eal cavity. No WHO grade 3/4 toxicity was seen. Twelve patients (67%) have relapsed, 6 (33%) intra-abdominally, 4 (22%) with hepatic metasta ses and 2 (11%) outside the abdominal cavity. The median survival was 17 months. Conclusions: Cisplatin can be administered safely as adjuva nt therapy to patients with gastric cancer, however, as single agent t herapy the pattern of relapse and subsequent death was similar to that expected. The occurrence of distant metastases may argue for systemic rather than local adjuvant treatment.