Palliative superselective intra-arterial chemotherapy for advanced nonresectable gastric cancer

From November 1988 to May 1996 a prospective randomized stud!: was undertak en to assess the efficacy of superselective intra-arterial chemotherapy for surgically proved unresectable gastric carcinoma. Each patient had undergo ne endoscopy as well as abdominal and pelvic CT scanning for staging. Patie nts with evidence of liver metastasis, peritoneal carcinomatosis, enlarged retroperitoneal lymph nodes, or locally advanced disease beyond curative re section a ere excluded from the study. A total of 386 patients with potenti ally curable disease were randomized to one of three treatment groups: (I) control; (2) systemic intravenous chemotherapy; or (3) superselective intra -arterial chemotherapy. On completion of preoperative chemotherapy, all pat ients underwent operative exploration with curative intent. A total of 74 c onsecutive patients were found to be unresectable, as evidenced by the pres ence of liver metastasis, peritoneal carcinomatosis, enlarged retroperitone al lymph nodes, or locally extensive disease not detected by preoperative C T scanning. The median survival time in the control group and after intrave nous chemotherapy was only 91 and 96 days, respectively, as compared to 401 days in the patients receiving intra-arterial chemotherapy. The results co nfirmed that superselective intra-arterial chemotherapy conferred a highly significant survival advantage compared to control or systemic intravenous chemotherapy adjusted for all patient characteristics (P < 0.0001).