COMBINED INTENSIVE CHEMOTHERAPY AND RADICAL SURGERY FOR INCURABLE GASTRIC-CANCER

Background: To improve the poor prognosis of patients with advanced in curable gastric cancer, intensive chemotherapy combined with radical s urgery was used.Patients and Methods: Thirty patients with incurable g astric cancer were treated with a combination of 5-fluorouracil (370 m g/m(2)) and leucovorin (30 mg/person), given intravenously for five co nsecutive days, followed by cisplatinum (70 mg/m(2)) and etoposide (70 mg/m(2)) on days 6 and 20, delivered through a catheter placed either in the aorta with its tip at the level of the ninth thoracic vertebra or in the celiac artery. This treatment (FLEP therapy) was repeated t wice every 5 weeks. Radical or palliative surgery followed chemotherap y.Results: The overall response rate to the chemotherapy was 50.0% (15 of 30 patients, 95% confidence limit 0.305-0.671). Nineteen patients (15 with a partial response, three showing no change, and one with pro gressive disease) underwent surgery. Of these, nine underwent curative surgery and 10 palliative surgery. The median survival time was 6.5 m onths overall, 12.7 months for responders, and 4.7 months for nonrespo nders. Long-term survivors were exclusively found among patients with distant lymph node metastasis treated by curative surgery (55.6% at 5 years). Conclusions: Favorable results of this small phase II study ju stify a phase III trial.