Neoadjuvant Chemotherapy for Advanced Gastric Carcinoma with Non-Curative Clinical Factors

Atsushi Nashimoto, Juei Sasaki, Otsuo Tanaka, Mitsuhiro Tsutsui, Yoshiaki Tsuchiya, Haruhiko Makino

Division of Surgery, Niigata Cancer Center Hospital

Since 1993, 21 patients with unresectable or non-curatively resectable gastric carcinoma have received FLP neoadjuvant chemotherapy (NAC), consisting of 5-fluorouracil (333 mg/m² continuous intravenous infusion for 8 days) and cisplatin (50 mg/m² as a 2-hour intravenous infusion on day 1 and 8). Patients received at least 2 cycles of FLP. Nineteen out of 21 patients underwent surgical treatment, and stomach resection was performed in 18 (85.7%). There were no deaths and no major morbidity following operation. Clinical response, toxicity, and survival were assessed. Results: There was no complete response (CR), but 12 patients (57.1%) had partial response (PR). The response rate was 64.7% for positive abdominal para-aortic lymph nodes (No. 16), 47.6% for primary regional involvement, 40.0% for liver meatastasis and 11.1% for peritoneal dissemination, respectively. One year survival for all patients was 40.5% and median survival time (MST) was 322 days. MST for responders was 471 days and that for non-responders was 209 days. MST was 835 days for patients who underwent curative resection and 310 days for those who underwent non-curative surgery. there was no treatment related death (TRD) or grade 4 toxicities. Grade 3 leukopenia occurred in 4 patients (19.0%), grade 3 anemia occurred in 3 patients (14.3%), and grade 3 stomatitis in 2 patients (9.5%). We concluded that neoadjuvant chemotherapy with FLP was feasible and useful for tumor reduction, especially for para-aortic lymph node metastases. A little survival benefit was seen for patients whose primary tumor had a PR or who had undergone curative resection.

Key words
neoadjuvant chemotherapy, advanced gastric cancer, abdominal para-aortic lymph node metastasis

Reprint requests
Atsushi Nashimoto Division of Surgery, Niigata Cancer Center Hospital
2-15-3 Kawagishicho, Niigata, 951-8566 JAPAN

Accepted
July 22, 1998

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