INTENSIVE WEEKLY CHEMOTHERAPY FOR LOCALLY ADVANCED GASTRIC-CANCER USING 5-FLUOROURACIL, CISPLATIN, EPIDOXORUBICIN, 6S-LEUCOVORIN, GLUTATHIONE AND FILGRASTIM - A REPORT FROM THE ITALIAN GROUP FOR THE STUDY OF DIGESTIVE-TRACT CANCER (GISCAD)

Local extension prevents curative resection in more than two-thirds of gastric cancer patients. Unfortunately, resectability is one of the m ain prognostic factors in these patients, and survival is longer when tumours are completely removed. Preoperative chemotherapy is an attrac tive concept for obtaining curative resection. Thirty-two locally adva nced unresectable gastric cancer patients were enrolled in five Italia n Group for the Study of Digestive Tract Cancer (GISCAD) centres. For 16 patients, surgical unresectability was based on computerized tomogr aphy scan evaluation of tumour size (four patients) and invasion of ad jacent structures (12 patients), whereas in another 16 patients locall y advanced disease was confirmed by laparotomy. They received weekly a dministration of cisplatin 40 mg m(-2), 5-fluorouracil 500 mg m(-2), e pidoxorubicin 35 mg m(-2), 6S-stereoisomer of leucovorin 250 mg m(-2) and glutathione 1.5 g m(-2). From the day after to the day before each chemotherapy administration, filgrastim was administered by subcutane ous injection at a dose of 5 mu g kg(-1). One cycle of therapy consist ed of eight weekly treatments. Fifteen of 32 patients (47%) responded to chemotherapy, whereas 13 (41%) had stable disease and four (12%) pr ogressed on therapy. Of the 15 responding patients, 13 were completely resected after chemotherapy and two of them had a complete pathologic al response. Two clinically responding patients were found unresectabl e at operation because of peritoneal seeding. At a median follow-up fr om the start of treatment of 24 months (range 11-39 months), 10 of 13 resected patients are alive and eight are relapse free. Three patients died after 11, 12, and 14 months respectively. Toxicity was acceptabl e: side-effects consisted mainly of grade II National Cancer Institute common toxicity criteria (NCICTC) leucopenia and thrombocytopenia in ten patients. Neither treatment-related death nor surgical complicatio ns in patients undergoing surgery were observed. This weekly intensive regimen enabled resection in half of previously inoperable tumours wi th a moderate toxicity. It can be offered to patients with locally adv anced unresectable gastric cancer to obtain curative resection.