Multimodality Therapy for Completely Resected (R0) Gastric Cancer (Excluding Japanese Trials)

  • Harold O. DouglassJr.
  • Hector R. Nava
  • Judy L. Smith


In the United States, as in much of the Western world, the incidence of gastric cancer has fallen dramatically over the last half century. Whereas gastric cancer was the single most important cause of cancer death in the United States during the 1930s, it now ranks sixth or lower, with only 15000 to 30000 deaths per year due to this disease. In Japan more than half of those diagnosed with cancer of the stomach are permanently cured of their disease, but in the United States although the cure rate is slowly increasing it is only approaching 20%. In the United States and elsewhere in the West, as in Japan, the increase in the number of long-term survivors is due to diagnosing the disease at an earlier stage. The difference is that in Japan most patients with stomach cancer are diagnosed with disease still confined to the stomach, whereas in the United States flexible endoscopy has increased the incidence of stage I and stage II cancers from 1%–2% to a little more than 20%. For this reason the development of effective surgical adjuvant programs is a critical approach to enhancing the proportion of patients who might be cured of gastric cancer.


Gastric Cancer External Beam Radiation Therapy Intraperitoneal Chemotherapy National Cancer Data Base Resectable Gastric Cancer 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gastrointestinal Tumor Study Group (1982) Controlled trial of adjuvant chemotherapy following curative resection for gastric cancer. Cancer 49:1116–1122CrossRefGoogle Scholar
  2. 2.
    Douglass HO Jr, Stablein DM (1990) Ten-year follow-up of first generation surgical adjuvant studies of the Gastrointestinal Tumor Study Group. In: Salmon SE (ed) Adjuvant therapy of cancer VI. Saunders, Philadelphia, pp 405–515Google Scholar
  3. 3.
    Engstrom PF, Lavin PT, Douglass HO Jr, Brunner KW (1985) Postoperative adjuvant 5-fluorouracil plus methyl CCNU therapy for gastric cancer patients: Eastern Cooperative Oncology Group Study (EST 3275). Cancer 55:1868–1873PubMedCrossRefGoogle Scholar
  4. 4.
    Higgins GA, Amadeo JH, Smith DE, Humphrey EW, Keehn RJ (1983) Efficacy of prolonged intermittent therapy with combined 5-FU and methyl-CCNU following resection for gastric carcinoma. Cancer 52:1105–1112PubMedCrossRefGoogle Scholar
  5. 5.
    Schlag P (1987) Adjuvant therapy in gastric cancer. World J Surg 11:473–477PubMedCrossRefGoogle Scholar
  6. 6.
    Estape J, Grau JJ, Leobendas F, Curto J, Daniel M, Vinolas N, Pera C (1991) Mitomycin C as an adjuvant treatment to resected gastric cancer: a 10-year follow-up. Ann Surg 213:219–221PubMedCrossRefGoogle Scholar
  7. 7.
    Grau JJ, Estape J, Fuster J, Filella X, Visa J, Teres J, Soler G, Albids, Garcia-Valdecasas JC, Grande L, Bombi J, Bordas J, Alcobendas F (1998) Randomized trial of adjuvant chemotherapy with mitomycin plus ftoxfur versus mitomycin alone in resected locally advanced gastric cancer. J Clin Oncol 16:1036–1039PubMedGoogle Scholar
  8. 8.
    Kim JP, Kwon OJ, Oh ST, Yang HK (1992) Results of surgery on 6589 gastric cancer patients and immunochemosurgery as the best treatment of advanced gastric cancer. Am Surg 216:269–279Google Scholar
  9. 9.
    Carrato A, Diaz-Rubio E, Medrano J, Calpena R, Marcuello E, Sanz J, Cervantes A, for the TACG Group (1995) Phase III trial of surgery vs adjuvant chemotherapy with mitomycin C (MMC) and tegafur plus uracil (UFT), starting within the first week after surgery for gastric adenocarcinoma. Proc ASCO 14:195Google Scholar
  10. 10.
    Coombes RC, Schein PS, Chilvers CED, Wils J, Berrtta G, Bliss JM, Rutten A, Amadori D, Cortes-Fumes H, Villar-Grimalt A, MeArdle C, Rauschecker HF, Boven E, Vassilopoulous P, Welvaart K, Ferrera EP, Wiig J, Gisselbrecht C, Rougier P, Woods EMA, for the International Collaborating Cancer Group (1990) A randomized trial comparing adjuvant fluorouracil, doxorubicin and mitomycin with no treatment in operable gastric cancer. J Clin Oncol 8:1362–1369PubMedGoogle Scholar
  11. 11.
    Lise M, Nilti D, Marchet A, Sahmoud T, Duez N, Fornasiero A, DosSantos JG, Labianca R, Lasser P, Gignoux M (1995) Prognostic factors in resectable gastric cancer: results of EORTC study no. 40813 on FAM adjuvant chemotherapy. Ann Surg Oncol 2:495–501PubMedCrossRefGoogle Scholar
  12. 12.
    Tsavaris N, Tentask, Kosmides P, Mylonakis N, Sakelaropoulos N, Kosmas C, Lisaios B, Soumilas A, Mandrekas D, Tsetis A, Klonaris C (1996) A randomized trial comparing adjuvant fluorouracil, epirubicin, and mitomycin with no treatment in operable gastric cancer. Chemotherapy 42:220–226PubMedCrossRefGoogle Scholar
  13. 13.
    Neri B, deLeonardis V, Romano S, Andreoli F, Pernice LM, Bruno K, Borrelli D, Valeri A, Fabbroni S, Intini C, Cini G (1996) Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicenter randomized study. Br J Cancer 73:549–552PubMedCrossRefGoogle Scholar
  14. 14.
    Krook JE, O’Connell MJ, Wieand HS, Beart RW Jr, Leigh JE, Kugler JW, Foley JF, Pfeifle DM, Tuito DI (1991) A prospective randomized evaluation of intensive course 5-fluorouracil plus doxorubicin as surgical adjuvant chemotherapy for resected gastric cancer. Cancer 67:2454–2458PubMedCrossRefGoogle Scholar
  15. 15.
    Fielding JWL, Fagg SL, Jones BG, Ellis D, Hockey MS, Minawa A, Brookes VS, Craven JL, Mason MC, Timothy A, Waterhouse JAH, Wrigley PFM (1983) An interim report of a prospective randomized controlled study of adjuvant chemotherapy in operable gastric cancer: British Stomach Cancer Group. World J Surg 7:390–399PubMedCrossRefGoogle Scholar
  16. 16.
    Macdonald JS, Fleming TR, Peterson RF, Berenberg JL, McClure S, Chapman RA, Eyrett J, Solanki D, Cruz AB Jr, Galiano R, Estes NC, Tangen CM, Rivlcin S (1995) Adjuvant chemotherapy with 5-FU, adriamycin, and mitomycin C (FAM) versus surgery alone for patients with locally advanced gastric adenocarcinoma: a Southeast Oncology Group Study. Ann Surg Oncol 2:488–494PubMedCrossRefGoogle Scholar
  17. 17.
    Lise M, Nilti D, Marchet A, Sahmoud T, Boyse M, Duez N, Fiorentio M, DosSantos JG, Labranca R, Rougier P, Gignoux M (1995) Final results of a phase III clinical trial of adjuvant chemotherapy with the modified fluorouracil, doxorubicin and mitomycin regimen in resectable gastric cancer. J Clin Oncol 13:2757–2763PubMedGoogle Scholar
  18. 18.
    Sindelar WF, Kinsella TJ, Tepper JE, Delaney TF, Maher MM, Smith R, Rosenberg SA, Glatstein E (1993) Randomized trial of intraoperative radiotherapy in carcinoma of the stomach. Am J Surg 165:178–187PubMedCrossRefGoogle Scholar
  19. 19.
    Shchepotin IB, Evans SR, Chorny V, Osinsky S, Buras RR, Maligonov P, Shabahang M, Nauta RJ (1994) Intensive preoperative radiotherapy with local hyperthermia for the treatment of gastric carcinoma. Surg Oncol 3:37–44PubMedCrossRefGoogle Scholar
  20. 20.
    Moertel CG, Childs DS, O’Fallon JR, Holbrook MA, Schutt AJ, Reitemeier RJ (1984) Combined 5-fiuorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol 2:1249–1254PubMedGoogle Scholar
  21. 21.
    Dent DM, Werner ID, Novis B, Cheverton P, Bria P (1992) Prospective randomized trial of combined oncologic therapy for gastric carcinoma. Cancer 44:385–391CrossRefGoogle Scholar
  22. 22.
    Hallissey MT, Dunn JA, Ward LE, Allum WH, for British Stomach Cancer Group (1994) The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up. Lancet 343:1309–1312PubMedCrossRefGoogle Scholar
  23. 23.
    Sautner T, Hofbauer F, Depisch D, Schiessel R, Jakesz R (1994) Adjuvant intraperitoneal cisplatin chemotherapy does not improve long-term survival after surgery for advanced gastric cancer. J Clin Oncol 12:970–974PubMedGoogle Scholar
  24. 24.
    Rosen HR, Jatzko G, Repse S, Potre S, Neudorfer HK, Sandbichler P, Zacherl J, Rabl H, Holzberger P, Lisburg P (1998) Adjuvant intraperitoneal chemotherapy with carbon-absorbed mitomycin in patients with gastric cancer: results of a randomized multicenter trial of the Austrian Working Group for Surgical Oncology. J Clin Oncol 16:2733–2738PubMedGoogle Scholar
  25. 25.
    Yu W, Whang I, Suh I, Averbach A, Chang D, Sugarbaker PH (1998) Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer. Ann Surg 228:347–354PubMedCrossRefGoogle Scholar
  26. 26.
    Douglass HO Jr, Nava HR, Smith JL, Penetrante RB (1995) Intra-peritoneal surgical adjuvant chemotherapy following resection for gastric cancer. Regional Cancer Treat 8:13–19Google Scholar
  27. 27.
    Crooks P, Leichman CG, Leichman L, Tan M, Laine L, Stain S, Baranda J, Casagrande Y, Groshen S, Silberman H (1997) Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report. Cancer 79:1767–1775CrossRefGoogle Scholar
  28. 28.
    Ajani JA, Ota DM, Jessup JM, 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
  29. 29.
    Ajani JA, Roth JA, Ryan B, McMurtrey M, Rich TA, Jackson DE, Abbruzzese JL, Levin B, DeCarol, Mountain C (1990) Evaluation of pre-and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol 8:1231–1238.PubMedGoogle Scholar
  30. 30.
    Lowy Am, Feig BW, JanJan N, Ajani JA, Rich TA, Mansfield PF (1997) A pilot study of preoperative chemoradiation for potentially resectable gastric cancer. Soc Surg Oncol Symp 25(73)Google Scholar
  31. 31.
    Stephen FO, Adams BF, Crea P (1986) Intraureteral chemotherapy given preoperatively in the management of carcinomas of the stomach. Surg Gynecol Obstet 162:370–374Google Scholar
  32. 32.
    Wilke H, Precusser P, Fink U, Gunzer U, Meyer H-J, Siewert JR, Achterrath W, Lenaz L, Knipp H, Schnoll HJ (1989) Preoperative chemotherapy in locally advanced and non-resectable gastric cancer: a phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol 7:1318–1326PubMedGoogle Scholar
  33. 33.
    Cascinu S, Labianca R, Graziano F, Pancera G, Barni S, Frontini L, Luporini G, Cellerno R, Catalano G (1998) Intensive weekly chemotherapy for locally advanced gastric cancer using 5-fluorouracil, cisplatin, epidoxorubicin, 6S leucovorin, glutathione and Ulgastrin: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD). Br J Cancer 78:390–393PubMedCrossRefGoogle Scholar
  34. 34.
    Kelsen D, Karpeth M, Schwartz G, Gerdes H, Lightdale C, Botet J, Lauers G, Klinstra D, Huang Y, Saltz L, Quan V, Breman M (1996) Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMtx and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil. J Clin Oncol 14:1818–1828PubMedGoogle Scholar
  35. 35.
    Estes NC, Macdonald JS, Touijer K, Benedetti J, Jacobson J (1998) Inadequate documentation and resection for gastric cancer in the United States: a preliminary report. Am Surg 64:680–685PubMedGoogle Scholar
  36. 36.
    Hiendahl SA, Menck HR, Mansour EG, Winchester DP (1997) The national cancer data base report on gastric cancer. Cancer 80:2333–2341CrossRefGoogle Scholar
  37. 37.
    Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M (1995) Randomized comparison of fiuorouracil, epidoxorubicin and methotrexate plus supportive care with supportive care alone in patients with non-resectable cancer. Br J Cancer 11:587–591CrossRefGoogle Scholar

Copyright information

© Springer Japan 1999

Authors and Affiliations

  • Harold O. DouglassJr.
    • 1
  • Hector R. Nava
    • 1
  • Judy L. Smith
    • 1
  1. 1.Roswell Park Cancer InstituteBuffaloUSA

Personalised recommendations