Neoadjuvant Systemic Chemotherapy for Advanced Gastric Cancer with Noncurative Clinical Factors

  • Atsushi Nashimoto
  • Hiroshi Yabusaki
  • Juei Sasaki
  • Otsuo Tanaka
  • Mitsuhiro Tsutsui
  • Yoshiaki Tsuchiya


The recent results of treatment of advanced gastric cancer have improved owing to the progress of surgical procedures. The effects of extensive resection and systematic lymphadenectomy have reached their limit in survival benefit [1], however, gastric cancer remains a leading cause of death in Japan. An analysis of prognostic factors clearly shows that the parameters associated with poor survival in patients with gastric cancer are distant metastases, lymph node metastases, and incomplete surgical resection [2, 3, 4, 5].


Gastric Cancer Clin Oncol Median Survival Time Advanced Gastric Cancer Paraaortic Lymph Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Maruyama K, Okabayashi K, Kinoshita T (1987) Progress gastric cancer surgery in Japan and its limits of radicality. World J Surg 11:418–425PubMedCrossRefGoogle Scholar
  2. 2.
    Allum WH, Powell DJ, McConkey CC (1989) Gastric cancer: a 25-year review. Br J Surg 76:535–540PubMedCrossRefGoogle Scholar
  3. 3.
    Akoh JA, Maclntyre IMC (1992) Improving survival in gastric cancer: review of 5-year survival rates in English language publication from 1970. Br J Surg 79:293–299PubMedCrossRefGoogle Scholar
  4. 4.
    Roder JD, Bottcher K, Siewert JR, Busch R, Hermanek P, Meyer HJ (1993) Prognostic factors in gastric cancer: results of the German Gastric Carcinoma Group study 1992. Cancer 72:2089–2097PubMedCrossRefGoogle Scholar
  5. 5.
    Siewert JR, Roder JD, Bottcher K, Busch R, Hermanek P, Meyer HJ (1993) Prognostic relevanced of systemic lymph node dissection in gastric carcinoma. Br J Surg 80:1015–1018PubMedCrossRefGoogle Scholar
  6. 6.
    Wilke H, Preusser U, Gunzer U, Meyer HJ, Sievert JR, Achterrath W, Lenaz L, Knipp H, Schmoll HJ (1989) Preoperative chemotherapy in locally advanced and nonresectable gastric cancer; a phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol 7:1318–1326PubMedGoogle Scholar
  7. 7.
    Preusser P, Wilke H, Achterrath W, Fink U, Lenaz K, Heinicke A, Meyer J, Meyer HJ, Buente H (1989) Phase II study with combination etoposide, doxorubicin and, cisplatin in advanced measurable gastric cancer. J Clin Oncol 7:1310–1317PubMedGoogle Scholar
  8. 8.
    Moertel CG, Rubin J, O’Connell MJ, Schutt A, Wieand HS (1986) A phase II study of combined 5-fluorouracil, doxorubicin, and cisplatin in the treatment of advanced upper gastrointestinal adenocarcinomas. J Clin Oncol 4:1053–1057PubMedGoogle Scholar
  9. 9.
    Bruckner HW, Cheseer MR, Wong H, Mandeli J (1991) Folate biochemical modulation regimen for the treatment of gastric cancer. J Clin Gastroenterol 13:384–3892PubMedCrossRefGoogle Scholar
  10. 10.
    Frei E III (1982) Clinical cancer research: an embattled species. Cancer 50:1979–1992PubMedCrossRefGoogle Scholar
  11. 11.
    Miller AB, Hoogstratten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214PubMedCrossRefGoogle Scholar
  12. 12.
    Japanease Research Society for Gastric Cancer (1995) Japanese classification for gastric carcinoma, 1st English edition. Kanahara, TokyoGoogle Scholar
  13. 13.
    Nashimoto A, Sasaki J (1994) Mitomycin C + sequential methotrexate and 5-fluorouracil therapy for stage III, IV advanced or recurrent gastric cancers. J Jpn Soc Cancer Ther 29:27–35Google Scholar
  14. 14.
    Nakajima T (1990) Adjuvant chemotherapy for gastric cancer in Japan: present status and suggestions for rational clinical trials. Jpn J Clin Oncol 20:30–42PubMedGoogle Scholar
  15. 15.
    Hermans J, Bonenkamp JJ, Boon MC, Bunt AMG, Ohyama S, Sasako M, Van de Velde CJH (1993) Adjuvant therapy after curative resection for gastric cancer: metaanalysis of randomized trials. J Clin Oncol 11:1441–1447PubMedGoogle Scholar
  16. 16.
    Yonemura Y, Sawa T, Kinosita K, Matsuki N. Fushida S, Tanaka S, Ohoyama S, Takashima T, Kimura H, Kamata T, Fujimura T, Sugiyama K, Shima K, Miyazaki I (1993) Neoadjuvant chemotherapy for high-grade advanced gastric cancer. World J Surg 17:256–262PubMedCrossRefGoogle Scholar
  17. 17.
    Plukker JT, Mulder NH, Sleijfer DT, Grond J, Verschueren RCJ (1991) Chemotherapy and surgery for locally advanced cancer of the cardia and fundus: phase II study with methetrexate and 5-fluorouracil. Br J Surg 78:955–958PubMedCrossRefGoogle Scholar
  18. 18.
    Leichman L, Silberman H, Leichman CG, Spearss CP, Ray M, Muggia FM, Kiyaabu M, Radin R, Laine L, Stain S, Fuerst M, Groshen S, Donovan A (1992) Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: University of Southern California piliot program. J Clin Oncol 10:1933–1942PubMedGoogle Scholar
  19. 19.
    Shirao K, Shimada Y, Kondo H, Saito D, Yamao T, Ono H, Yokoyama T, Fukuda H, Oka M, Watanabe Y, Ohtsu A, Boku N, Fujii T, Oda Y, Muro K, Yoshida S (1997) Phase I-II study of irinotecan hydrochloride combined with cisplatin in patients with advanced gastric cancer. J Clin Oncol 15:921–927PubMedGoogle Scholar
  20. 20.
    MacDonald JS, Schein PS, Wolley PV, Snythe T, Ueno W, Hoth D, Smith F, Boison M, Gisselbrecht D, Brunei R, Lagarde C (1980) 5-Fluorouracil, doxorubicin and mitomycin C (FAM) combination chemotherapy for advanced gastric cancer. Ann Intern Med 93:533–536PubMedGoogle Scholar
  21. 21.
    Machover D, Goldschmidt E, Chollet P, Metzger G, Zittoun J, Marquet J, Vandenbulcke JM, Misset JL, Schwarzenberg L, Fourtillan JB, Gaget H, Mathe G (1986) Treatment of advanced colorectal and gastric adenocarcinomas with 5-fluorouracil and high-dose folinic acid. J Clin Oncol 4:685–696PubMedGoogle Scholar
  22. 22.
    Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, Hughes M, Mansi J, Findlay M, Hill A, Oates J, Nicolson M, Hickish T, O’Brien M, Iveson T, Watson M, Underhill C, Wardley A, Meehan M (1997) Epirubicin, cisplatin and fluorouracil versus fluorouracil dioxorubicin and methotrexate. J Clin Oncol 15:261–267PubMedGoogle Scholar
  23. 23.
    Wils JA, Klein HO, Wagener DJ, Bleiberg H, Reis H, Korsten F, Conroy T, Fickkers M, Leyvraz S, Buyse M, Duez N for EORTC (1991) Sequential high-dose methotrexate and fluorouracil combined with doxorubicin: a step ahead in the treatment of advanced gastric cancer; a trial of the EORTC Gastrointestinal Tract Cooperative Group. J Clin Oncol 9:827–831PubMedGoogle Scholar
  24. 24.
    Ajani JA, Ota DM, Jessup M, Ames FC, McBride C, Boddie A, Levin B, Jackson DE, Roh M, Hohn D (1991) Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy. Cancer 68:1501–1506PubMedCrossRefGoogle Scholar
  25. 25.
    Rougier P, Mahjoubi M, Lesser P, Ducreux M, Oliveira J, Ychou M, Pignon JP, Elias D, Bellefqih S, Bognel C, Lusinchi A, Cvitkovic E, Droz JP (1994) Neoadjuvant chemotherapy in locally advanced gastric carcinoma: a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum. Eur J Cancer 30:1269–1275CrossRefGoogle Scholar
  26. 26.
    Nakajima T, Ota K, Ishihara S, Oyama S, Nishi M, Ohashi Y, Yanagihara A (1997) Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol 4:203–208PubMedCrossRefGoogle Scholar
  27. 27.
    Kelsen D, Karpeh M, Schwartz G, Gerdes H, Lightdale C, Botet J, Lauers G, Klimstra D, Huang Y, Leonard S, Quan V, Brennan M (1996) Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracilcisplatin plus intravenous fluorouracil. J Clin Oncol 14:1818–1828PubMedGoogle Scholar
  28. 28.
    Lerner A, Gonin R, Steele GD, Mayer RJ (1992) Etoposide, doxorubicin, and cisplatin chemotherapy for advanced gastric adenocarcinoma: results of a phase II trial. J Clin Oncol 10:536–540PubMedGoogle Scholar
  29. 29.
    Kelsen D, Atiq OT, Saltz L, Niedzwiecki D, Ginn D, Chapman D, Heelan R, Lightdale C, Vinciguerra V, Brennan M (1992) FAMTX versus etoposide, adriamycin and cisplatin: a randomized assignment trial in gastric cancer. J Clin Oncol 10:541–548PubMedGoogle Scholar
  30. 30.
    Fink U, Schuhmacher C, Stein HJ, Busch R, Ffeussner H, Dittler HJ, Helmberger A, Bottcher K, Siewert JR (1995) Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection. Br J Surg 82:1248–1252PubMedCrossRefGoogle Scholar
  31. 31.
    Nashimoto A, Sasaki J, Tanaka O, Tsutsui M, Tsuchiya Y, Makino H (1998) Neoadjuvant chemotherapy for advanced gastric carcinoma with non-curative clinical factors. Jpn J Gastroenterol Surg 31:2199–2205CrossRefGoogle Scholar
  32. 32.
    Nashimoto A, Sasaki J, Akai S (1992) Ambulatory combination chemotherapy with cisplatin and 5-fluorouracil for advanced gastric cancer patients. J Jpn Soc Cancer Ther 27:654–664Google Scholar

Copyright information

© Springer Japan 1999

Authors and Affiliations

  • Atsushi Nashimoto
    • 1
  • Hiroshi Yabusaki
    • 1
  • Juei Sasaki
    • 1
  • Otsuo Tanaka
    • 1
  • Mitsuhiro Tsutsui
    • 1
  • Yoshiaki Tsuchiya
    • 1
  1. 1.Division of SurgeryNiigata Cancer Center HospitalNiigataJapan

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