Neoadjuvant chemotherapy in locally advanced gastric carcinoma-a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum

Ph Rougier, M. Mahjoubi, Ph Lasser, M. Ducreux, J. Oliveira, M. Ychou, J. P. Pignon, D. Elias, S. Bellefqih, C. Bognel, A. Lusinchi, E. Cvitkovic, J. P. Droz

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    Résumé

    Locally advanced gastric adenocarcinomas (LAGC) have a poor prognosis, particularly when tumours are bulky, located in the cardia or in the event of locoregional lymph node involvement. Patients bearing these tumours were entered in a phase II trial of neoadjuvant chemotherapy, combining continuous intravenous 5-fluorouracil (5FU) (1000 mg/m2 for 5 days) and cisplatinum (CDDP) (100 mg/m2 on day 2) repeated every 4 weeks, for one to six cycles according to response and tolerance. 30 patients have been entered, 26 after clinical evaluation (CAT scan and upper gastrointestinal endoscopy) and 4 with unresectable tumours at prior laparotomy. Median age was 60 years, 15 30 patients had a tumour of the cardia, 15 30 had enlarged lymph nodes and 7 30 had linitis plastica (diffuse type). A mean number of three cycles was administered (range 1-6). 27 of the 30 patients were evaluable for response. One patient achieved a complee response (CR) and 14 a partial response (56%; 95% confidence interval 38-74%). No patient had tumour progression, and only 1 6 with linitis plastica responded. 28 patients underwent surgery, and 23 had a macroscopically complete resection (77% of the 30 entered patients); RO resections were performed in 60% of the cases, mainly after an objective response ( 13 15 versus 4 12 in non-responders). No pathological CR were seen. Grade 4 neutropenia was observed in eight cycles (5 patients), with five septic complications and one death due to toxicity. Four postoperative complications were observed: 2 cases of severe pneumonia and 2 subphrenic abscesses. One postoperative death, due to intravascular disseminated coagulation, was observed at day 30. Median survival was 16 months and the 1-, 2- and 3-year survival was 67, 42 and 38%, respectively. Patients with linitis plastica had a significantly shorter survival (P < 0.002). We conclude that neodjuvant chemotherapy is feasible in LAGC, although randomised trials are warranted to demonstrate its efficacy on survival and resection rates.

    langue originaleAnglais
    Pages (de - à)1269-1275
    Nombre de pages7
    journalEuropean Journal of Cancer
    Volume30
    Numéro de publication9
    Les DOIs
    étatPublié - 1 janv. 1994

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