Enhanced staging and all chemotherapy preoperatively in patients with potentially resectable gastric carcinoma

Purpose: Patients with local-regional gastric carcinoma have a low rate of curative resection (RO) because of the advanced stage at diagnosis and subo ptimal clinical staging. This study was designed to improve clinical stagin g with the use of laparoscopy and endoscopic ultrasonography (EUS) and to i mprove RO resection rates and tolerance by delivering all chemotherapy preo peratively in patients with potentially resectable gastric carcinoma. Patients and Methods: All patients with histologic proof of localized adeno carcinoma of the stomach underwent a staging laparoscopy before registratio n. EUS was performed when feasible. The intention was to administer up to f ive courses of preoperative chemotherapy consisting of fluorouracil (500 mg /m(2)/d as a continuous infusion on days 1 through 5 and as a bolus on days 12 and 19), interferon alfa-2b (3 million units subcutaneously three times a week for 3 weeks), and cisplatin (15 mg/m(2)/d as a bolus on days 1 thro ugh 5). After chemotherapy, surgery was attempted to remove the primary and regional lymph nodes. Clinical response and EUS staging were correlated wi th surgical pathology. The feasibility of this approach, resection rates, p atient survival, and patterns of failure also were assessed. Results: All 30 patients enrolled were assessed for toxicity, response, and survival. Nineteen men and 11 women were enrolled. The median number of co urses delivered per patient was three (range, one to five courses). Fourtee n patients (47%) received all five preoperative courses of chemotherapy. Th e overall clinical response rate was 34%. Twenty-nine patients (97%) underw ent attempted resection, Twenty-five (83%) had an RO resection. Two patient s (7%) had no evidence of carcinoma in the surgical specimen, and three had only microscopic carcinoma (greater than or equal to 90% necrosis). Posttr eatment EUS findings did not correlate well with surgical pathology. The me dian duration of follow-up was 30 months (range, 5 months to 65+ months). T he median survival time for 30 patients, calculated by the Kaplan-Meier met hod, was 30 months (range, 5 months to 65+ months). There were no cases of grade 4 toxicity. Conclusion: It is feasible to administer prolonged preoperative therapy in patients with potentially resectable gastric carcinoma, Enhanced staging wi th laparoscopy and EUS helped in proper selection of patients and better ch aracterization of the stage. (C) 1999 by American Society of Clinical Oncol ogy.