Neoadjuvant Systemic Chemotherapy For Gastric Cancer Followed By Postoperative Adjuvant Intraperitoneal Therapy: A University Of Southern California Pilot Program

Fifty-nine patients with invasive primary gastric adenocarcinoma appearing resectable for cure entered a trial in which they received two cycles of protracted infusion 5-fluorouracil and cisplatin chemotherapy followed by surgery; three to four weeks following the operation, two cycles of intraperitoneal (IP) 5-fluoro-2'-deoxyuridine (FUdR) and cisplatin were administered. Fifty-eight patients (98%) received two cycles of systemic chemotherapy. Fifty-six patients (95%) had surgery: 42 patients (71%) had resections intended to cure (stages O-IIIB); 13 patients (22%) had stage IV gastric cancer; one patient died intraoperatively without being staged. Two patients refused an operation; one patient died of progressive cancer prior to operation. Thirty-seven patients (63%) received at least one cycle of IP chemotherapy. Three patients (5%) died secondary to treatment complications. Nine of 42 patients (21%) resected for cure have relapsed. With median follow-up of 50 months, median survival is greater than 4 years.