International Journal of Clinical Oncology

, Volume 23, Issue 2, pp 275–280 | Cite as

First-line bolus 5-fluorouracil plus leucovorin for peritoneally disseminated gastric cancer with massive ascites or inadequate oral intake

  • Hiroki Hara
  • Shigenori KadowakiEmail author
  • Masako Asayama
  • Akira Ooki
  • Toko Yamada
  • Takako Yoshii
  • Kensei Yamaguchi
Original Article



There are few chemotherapeutic options for advanced gastric cancer with severe disseminated peritoneal metastases, which are usually accompanied by ascites. Bolus 5-fluorouracil (5-FU) plus leucovorin therapy has been widely used against gastrointestinal malignancies, with resulting mild toxicities.


We retrospectively analyzed the efficacy and safety of first-line chemotherapy with bolus 5-FU plus l-leucovorin in 30 advanced gastric cancer patients who had massive ascites and/or inadequate oral intake. This therapy consisted of 5-FU (600 mg/m2 IV bolus) plus l-leucovorin (250 mg/m2 2-h IV infusion) administered on a 6 weeks on/2 weeks off schedule.


Among all the patients, 26 (87%) were unable to eat and 12 (40%) had massive ascites. Major grade 3 or 4 adverse events were neutropenia (17%), nausea (7%), fatigue (7%), and diarrhea (3%); no treatment-related deaths were observed. The median progression-free survival and overall survival (OS) were 2.4 months [95% confidence interval (CI), 0.6–4.1] and 6.0 months (95% CI, 2.1–9.9), respectively. Objective improvement in oral intake was seen in 7 patients (27%). Improvement in ascites occurred in 9 (39%) of 23 patients. In multivariate analyses, the presence of both massive ascites and inadequate oral intake was significantly associated with worse OS (hazard ratio, 5.25; 95% CI, 1.61–17.1). The median OS for patients (n = 22) without this factor was 7.2 months (95% CI, 4.2–10.3).


Our study suggests that bolus 5-FU plus l-leucovorin therapy is feasible and has clinical activity as palliative therapy in patients with severe peritoneal metastases from gastric cancer.


Gastric cancer Peritoneal metastasis Ascites Fluorouracil Leucovorin 



The authors acknowledge the contribution of Dr. Takako Eguchi Nakajima, who provided medical support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  1. 1.Department of GastroenterologySaitama Cancer CenterSaitamaJapan
  2. 2.Department of Clinical OncologyAichi Cancer Center HospitalNagoyaJapan
  3. 3.Department of Gastroenterological ChemotherapyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

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