Neoadjuvant Chemotherapy with FLEP Regimen for Incurable Gastric Cancer
Although the results of treatment for gastric cancer in Japan have improved, the prognosis of advanced stage disease remains poor [1,2]. Neither chemotherapy nor surgery alone has produced long-term survivors among patients with advanced disease. Our database of gastric cancer cases (11489 cases treated in our hospital from 1946 to 1994) shows that median survival time was 6 months for patients with noncurative surgery and 4 months for nonsurgically treated cases . Our conventional strategy for advanced gastric cancer (including extended radical surgery followed by postoperative chemotherapy) yielded a plateau in the survival benefit. However, recent chemotherapy regimens with high response rates [4, 5, 6, 7, 8, 9] seem to allow radical surgery for initially unresectable disease. Since 1989 at the Cancer Institute Hospital, Tokyo, we have attempted to treat advanced unresectable gastric cancer patients with a four-drug combination chemotherapy with systemic and regional delivery followed by radical gastrectomy. The treatment results have been reported elsewhere .
KeywordsGastric Cancer Clin Oncol Advanced Gastric Cancer Peritoneal Dissemination Celiac Artery
Unable to display preview. Download preview PDF.
- 2.Nakajima T, Ota K, Ishihara S, Yamada H, Nishi M (1993) Extended radical surgery for advanced gastric cancer. Surg Oncol Clin North Am 2:467–481Google Scholar
- 3.Nakajima T (1994) Tabular analysis of 10000 cases of gastric cancer (in Japanese). Jpn J Cancer Chemother 21:1813–1897Google Scholar
- 4.Klein HO, Wickrammanayake PD, Farrokh GR (1986) 5-Fluorouracil, adriamycin and methotrexate-a combination protocol (FAMTX) for treatment of metastasized stomach cancer. Proc Am Soc Clin Oncol 5:84Google Scholar
- 6.Levi JA, Fox RM, Tattersall MH, Woods RL, Thomson D, Gill G, Sydney Cooperative Oncology Group (1986) Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies. J Clin Oncol 4:1348–1355PubMedGoogle Scholar
- 19.Petrelli N, Douglass HO Jr, Herrera L, Russel D, Stablein D, Bruckner H, Mayer R, Schinella R, Green MD, Muggia FM, Megibow A, Greenwald ES, Bukowski RM, Harris J, Levin B, Gayner E, Louth A, Kaiser MH, Barkin JS, Benedetto P, Woolley PV, Nauta R, Weaver DW, Leichman LP (1989) The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. J Clin Oncol 7:1419–1426PubMedGoogle Scholar
- 20.Kremer B, Henne-Bruns D, Weh HJ, Effenberger T (1989) Advanced gastric cancer: a new combined surgical and oncological approach. J Hepatogastroenterol 36:23–26Google Scholar
- 21.Kurihara M, Izumi T, Yoshida S, Ohkubo T, Suga S, Kiyohashi A, Yaosaka T, Takahashi H, Ito T, Sasai T, Akiya T, Akazawa S, Betsuyaku T, Taguchi S (1991) A cooperative randomized study on tegafur plus mitomycin C, versus combined tegafur and uracil plus mitomycin C in the treatment of advanced gastric cancer. Jpn J Cancer Res 82:613–620PubMedCrossRefGoogle Scholar
- 22.Wils JA, Klein HO, Wagener DJT, Bleiberg H, Reis H, Korsten F, Conroy T, Fickers M, Leyvraz S, Buyse M, Duez N (1991) Sequential high-dose methotrexate and fluorouracil combined with doxorubicin: a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol 9:827–831PubMedGoogle Scholar
- 25.Taguchi T (1989) Combination chemotherapy with etoposide, adriamycin (A), and cisplatin (P) (EAP) for advanced gastric cancer. Proc Am Soc Clin Oncol 8:108–108Google Scholar
- 26.Rath U, Flechtner H, Selbach J, Harjung H, Manegold C, Kabelitz K, Trux FA, Edler L, Schlag P, Queisser W (1990) Etoposide, adriamycin, and cisplatinum (EAP) combination chemotherapy for advanced gastric cancer: a phase II trial by the “Chemotherapiegruppe Gastrointestinaler Tumoren (CGT).” Onkologie 13:194–197PubMedCrossRefGoogle Scholar
- 32.Leichman L, Silberman H, Leichman C, Spears C, Ray M, Muggia F, Kiyabu M, Radin R, Laine L, Stain S, Fuerst S, Groshen S, Donovan A (1992) Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: a University of Southern California pilot program. J Clin Oncol 10:1933–1942PubMedGoogle Scholar