Journal of Clinical Oncology, Vol 10, 1933-1942, Copyright © 1992 by American Society of Clinical Oncology
Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: a University of Southern California pilot program
L Leichman, H Silberman, CG Leichman, CP Spears, M Ray, FM Muggia, M Kiyabu, R Radin, L Laine and S Stain
University of Southern California School of Medicine and Medical Center, Los Angeles.
PURPOSE: A clinical trial for patients with gastric cancer amenable to
curative resection was undertaken to determine feasibility and response to
preoperative systemic chemotherapy followed by postoperative
intraperitoneal (IP) chemotherapy. METHODS AND MATERIALS: Thirty-eight
patients with resectable gastric tumor received two cycles of protracted
intravenous (IV)-infusion fluorouracil (5FU), 200 mg/m2/d, for 3 weeks with
weekly IV leucovorin 20 mg/m2 and IV cisplatin 100 mg/m2 days 1 and 29.
Resection of the gastric tumor followed within 3 weeks of completion of
systemic chemotherapy. Those who had all visible tumor removed with clear
margins received two cycles of IP floxuridine 3,000 mg (total dose) per day
for 3 days and IP cisplatin 200 mg/m2 with IV sodium thiosulfate on the
fourth day of IP therapy. RESULTS: Thirty-seven of 38 patients (97%)
received two cycles of systemic chemotherapy. Thirty-five of 38 patients
(92%) underwent laparotomy for gastric tumor resection. Thirty-three
patients (87%) had gastric resections performed; 29 (76%) had all visible
tumor removed with microscopically negative margins. No operative mortality
was encountered. Twenty-six patients (68%) received IP treatment. IV
neoadjuvant treatment was well tolerated and resulted in 68% of the
patients reporting improvement in abdominal pain, 45% objective remissions
by computed tomography (CT), 38% objective remissions by gastroscopy and
biopsy, and 8% had complete surgical pathologic response. Neutropenic
sepsis during the IP treatment phase contributed to the only
treatment-related death. Four of 29 completely resected patients (14%) have
had tumor recurrence. The median follow-up time of patients remaining alive
is now 19 months. The median survival for 38 patients entered onto this
protocol has not been reached at 17+ months. CONCLUSION: This novel
approach to the treatment of adenocarcinoma of the stomach is feasible. The
neoadjuvant systemic therapy results in significant primary tumor
regression. The determination of whether systemic or IP components of the
program contribute to decreased recurrence or increased survival awaits a
prospectively randomized clinical trial.
