SYSTEMIC CHEMOTHERAPY FOR GASTRIC-CARCINOMA FOLLOWED BY POSTOPERATIVEINTRAPERITONEAL THERAPY - A FINAL REPORT

BACKGROUND, Because only approximately 50% of gastric carcinomas are r esectable for cure, the authors hypothesized that effective systemic p reoperative (neoadjuvant) chemotherapy, aimed at decreasing the size a nd extent of the primary tumor and eradicating distant microscopic dis ease, may increase the rate of resectability and have a greater impact on survival than postoperative (adjuvant) treatment alone. In additio n, because the peritoneal cavity is the most common site of first recu rrence after successful gastric cancer resection, intraperitoneal (IF) chemotherapy seemed a logical choice for postoperative (adjuvant) tre atment. METHODS, Fifty-nine patients with invasive primary gastric ade nocarcinoma who were deemed resectable for cure entered a clinical tri al that called for 2 cycles of protracted infusion 5-fluorouracil with weekly leucovorin and cisplatin chemotherapy followed by surgery. App roximately 3-4 weeks after potentially curative surgery, patients were scheduled to receive two cycles of IP 5-fluoro-2' deoxyuridine and ci splatin. RESULTS, Of the 59 patients studied, 58 (98%) received both c ycles of systemic chemotherapy. Fifty-six patients (95%) underwent sur gery: 40 patients (71%) had resections intended to cure for Stage O-II IB disease, 15 patients (27%) had palliative surgery for Stage IV gast ric carcinoma, and one patient died intraoperatively without being sta ged. Two patients refused surgery, and the remaining patient died of p rogressive disease prior to surgery. Thirty-one of the 40 patients who underwent curative surgery completed both cycles of postoperative IP therapy; 4 patients received only 1 cycle. Three patients (5%) died se condary to treatment complications. There were two operative deaths, a nd one patient died of peritonitis associated with Grade 4 granulocyto penia. Nine of the 40 patients (23%) whose carcinomas were resected fo r cure had recurrent carcinoma. With a median follow-up period now exc eeding 45 months, the calculated median survival for the 59 patients e ntered into the trial is >4 years. CONCLUSIONS, This program of preope rative systemic and postoperative IP chemotherapy has been found to be safe and appears to decrease gastric carcinoma recurrence rates and i ncrease survival compared with historic controls. (C) 1997 American Ca ncer Society.