Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
letter
. 1986 Aug;78(8):753–766.

Update in Cancer Chemotherapy: Gastrointestinal Cancer, Cancer of the Small Intestines, Gallbladder, Liver, and Esophagus

Jane C Wright
PMCID: PMC2571339  PMID: 3531532

Abstract

This article updating cancer chemotherapy of gastrointestinal cancer completes the fivepart series begun in the April issue of the Journal. Treatment of cancer of the small intestine, the gallbladder and bile duct, primary cancer of the liver, and the esophagus are reviewed in this concluding article.

Treatment of choice of cancer of the small intestine is surgical resection. Small bowel cancer is less responsive than gastric cancer to chemotherapy. While chemotherapy may produce temporary partial remissions in patients with gallbladder and bile duct cancer, there is no evidence that it produces longterm survival time. In primary liver cancer, surgery is the only curative treatment, but only 30 percent of patients are diagnosed with resectable lesions, and the surgical mortality rate is high. The most active single agents appear to be doxorubicin, fluorouracil, and neocarcinostatin. Data on combination chemotherapy are limited.

With carcinoma of the esophagus, 95 percent of patients die of the condition. The standard treatment for locoregional disease is surgical resection and/or radiation therapy. Chemotherapy has been slow to develop; single-agent chemotherapy has been reported to be active in 15 percent of cases with durations of 2 to 5 months. Combination chemotherapy is so recent that data are incomplete as to long-term results of disease-free and total survival times, but polychemotherapy appears to be more effective than single agents.

With earlier detection, prompt surgery, earlier chemotherapy, improved dose scheduling, and further exploration of combination therapy, better overall results with a major impact years later may be expected. Because of the lack of data, there remains uncertainty as to the place of chemotherapy in the treatment of gastrointestinal cancer.

Full text

PDF
753

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appelqvist P. Carcinoma of the oesophagus and gastric cardia. A retrospective study based on statistical and clinical material from Finland. Acta Chir Scand Suppl. 1972;430:1–92. [PubMed] [Google Scholar]
  2. Baker L. H., Saiki J. H., Jones S. E., Hewlett J. S., Brownlee R. W., Stephens R. L., Vaitkevicius V. K. Adriamycin and 5-fluorouracil in the treatment of advanced hepatoma: a Southwest Oncology Group study. Cancer Treat Rep. 1977 Nov;61(8):1595–1597. [PubMed] [Google Scholar]
  3. Bedikian A. Y., Valdivieso M., Bodey G. P., Freireich E. J. Phase II evaluation of vindesine in the treatment of colorectal and esophageal tumors. Cancer Chemother Pharmacol. 1979;2(4):263–266. doi: 10.1007/BF00257192. [DOI] [PubMed] [Google Scholar]
  4. Bonadonna G., De Lena M., Monfardini S., Bartoli C., Bajetta E., Beretta G., Fossati-Bellani F. Clinical trials with bleomycin in lymphomas and in solid tumors. Eur J Cancer. 1972 Apr;8(2):205–215. doi: 10.1016/0014-2964(72)90045-x. [DOI] [PubMed] [Google Scholar]
  5. Coonley C. J., Bains M., Heelan R., Dukeman M., Kelsen D. P. Phase II study of etoposide in the treatment of esophageal carcinoma. Cancer Treat Rep. 1983 Apr;67(4):397–398. [PubMed] [Google Scholar]
  6. Davis S., Shanmugathasa M., Kessler W. cis-Dichlorodiammineplatinum(II) in the treatment of esophageal carcinoma. Cancer Treat Rep. 1980 Apr-May;64(4-5):709–711. [PubMed] [Google Scholar]
  7. Desai P. B., Borges E. J., Vohra V. G., Paymaster J. C. Carcinoma of the esophagus in India. Cancer. 1969 Apr;23(4):979–989. doi: 10.1002/1097-0142(196904)23:4<979::aid-cncr2820230436>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  8. Earlam R., Cunha-Melo J. R. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg. 1980 Jun;67(6):381–390. doi: 10.1002/bjs.1800670602. [DOI] [PubMed] [Google Scholar]
  9. Earlam R., Cunha-Melo J. R. Oesophogeal squamous cell carcinoms: II. A critical view of radiotherapy. Br J Surg. 1980 Jul;67(7):457–461. doi: 10.1002/bjs.1800670702. [DOI] [PubMed] [Google Scholar]
  10. Edsmyr F., Knight E. O., Miller J., Nevill G., Onyango J., Bodo J., Levin A. Clinical efficiency of bleomycin in oesophageal and skin carcinoma in East Africa. East Afr Med J. 1973 Aug;50(8):449–453. [PubMed] [Google Scholar]
  11. Engstrom P. F., Lavin P. T., Klaassen D. J. Phase II evaluation of mitomycin and cisplatin in advanced esophageal carcinoma. Cancer Treat Rep. 1983 Jul-Aug;67(7-8):713–715. [PubMed] [Google Scholar]
  12. Ezdinli E. Z., Gelber R., Desai D. V., Falkson G., Moertel C. G., Hahn R. G. Chemotherapy of advanced esophageal carcinoma: Eastern Cooperative Oncology Group experience. Cancer. 1980 Nov 15;46(10):2149–2153. doi: 10.1002/1097-0142(19801115)46:10<2149::aid-cncr2820461006>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  13. Falkson G. Methyl-GAG (NSC-32946) in the treatment of esophagus cancer. Cancer Chemother Rep. 1971 Apr;55(2):209–212. [PubMed] [Google Scholar]
  14. Falkson G., Moertel C. G., Lavin P., Pretorius F. J., Carbone P. P. Chemotherapy studies in primary liver cancer: a prospective randomized clinical trial. Cancer. 1978 Nov;42(5):2149–2156. doi: 10.1002/1097-0142(197811)42:5<2149::aid-cncr2820420510>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  15. Falkson G., Von Hoff D., Klaassen D., Du Plessis H., Van Der Merwe C. F., Van Der Merwe A. M., Carbone P. P. A phase II study of neocarzinostatin (NSC 157365) in malignant hepatoma. An Eastern Cooperative Oncology Group pilot study. Cancer Chemother Pharmacol. 1980;4(1):33–36. doi: 10.1007/BF00255455. [DOI] [PubMed] [Google Scholar]
  16. Geddes E. W., Falkson G. Malignant hepatoma in the Bantu. Cancer. 1970 Jun;25(6):1271–1278. doi: 10.1002/1097-0142(197006)25:6<1271::aid-cncr2820250604>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  17. Gisselbrecht C., Calvo F., Mignot L., Pujade E., Bouvry M., Danne O., Belpomme D., Marty M. Fluorouracil (F), Adriamycin (A), and cisplatin (P) (FAP): combination chemotherapy of advanced esophageal carcinoma. Cancer. 1983 Sep 15;52(6):974–977. doi: 10.1002/1097-0142(19830915)52:6<974::aid-cncr2820520607>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  18. Huang G. J. Early detection and surgical treatment of esophageal carcinoma. Jpn J Surg. 1981;11(6):399–405. doi: 10.1007/BF02469022. [DOI] [PubMed] [Google Scholar]
  19. Jigyasu D., Bedikian A. Y., Stroehlein J. R. Chemotherapy for primary adenocarcinoma of the small bowel. Cancer. 1984 Jan 1;53(1):23–25. doi: 10.1002/1097-0142(19840101)53:1<23::aid-cncr2820530106>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  20. Kelsen D. P., Ahuja R., Hopfan S., Bains M. S., Kosloff C., Martini N., McCormack P., Golbey R. B. Combined modality therapy of esophageal carcinoma. Cancer. 1981 Jul 1;48(1):31–37. doi: 10.1002/1097-0142(19810701)48:1<31::aid-cncr2820480108>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  21. Kelsen D. P., Bains M., Cvitkovic E., Golbey R. Vindesine in the treatment of esophageal carcinoma: a phase II study. Cancer Treat Rep. 1979 Nov-Dec;63(11-12):2019–2021. [PubMed] [Google Scholar]
  22. Kelsen D. P., Cvitkovic E., Bains M., Shils M., Howard J., Hopfan S., Golbey R. B. cis-Dichlorodiammineplatinum(II) and bleomycin in the treatment of esophageal carcinomas. Cancer Treat Rep. 1978 Jul;62(7):1041–1046. [PubMed] [Google Scholar]
  23. Kelsen D., Chapman R., Bains M., Heelan R., Dukeman M., Golbey R. Phase II study of methyl-GAG in the treatment of esophageal carcinoma. Cancer Treat Rep. 1982 Jun;66(6):1427–1429. [PubMed] [Google Scholar]
  24. Kelsen D. Chemotherapy of esophageal cancer. Semin Oncol. 1984 Jun;11(2):159–168. [PubMed] [Google Scholar]
  25. Kelsen D., Hilaris B., Coonley C., Chapman R., Lesser M., Dukeman M., Heelan R., Bains M. Cisplatin, vindesine, and bleomycin chemotherapy of local-regional and advanced esophageal carcinoma. Am J Med. 1983 Oct;75(4):645–652. doi: 10.1016/0002-9343(83)90451-5. [DOI] [PubMed] [Google Scholar]
  26. Kolarić K., Maricić Z., Dujmović I., Roth A. Therapy of advanced esophageal cancer with bleomycin, irradiation and combination of bleomycin with irradiation. Tumori. 1976 May-Jun;62(3):255–262. doi: 10.1177/030089167606200302. [DOI] [PubMed] [Google Scholar]
  27. Kolarić K., Maricić Z., Roth A., Dujmović I. Adriamycin alone and in combination with radiotherapy in the treatment of inoperable esophageal cancer. Tumori. 1977 Sep-Oct;63(5):485–491. doi: 10.1177/030089167706300510. [DOI] [PubMed] [Google Scholar]
  28. Kolarić K., Maricić Z., Roth A., Dujmović I. Combination of bleomycin and adriamycin with and without radiation on the treatment of inoperable esophageal cancer. A randomized study. Cancer. 1980 May 1;45(9):2265–2273. doi: 10.1002/1097-0142(19800501)45:9<2265::aid-cncr2820450908>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  29. Launois B., Delarue D., Campion J. P., Kerbaol M. Preoperative radiotherapy for carcinoma of the esophagus. Surg Gynecol Obstet. 1981 Nov;153(5):690–692. [PubMed] [Google Scholar]
  30. Leichman L., Steiger Z., Seydel H. G., Vaitkevicius V. K. Combined preoperative chemotherapy and radiation therapy for cancer of the esophagus: the Wayne State University, Southwest Oncology group and Radiation Therapy Oncology Group experience. Semin Oncol. 1984 Jun;11(2):178–185. [PubMed] [Google Scholar]
  31. McIntire K. R., Vogel C. L., Primack A., Waldmann T. A., Kyalwazi S. K. Effect of surgical and chemotherapeutic treatment on alpha-fetoprotein levels in patients with hepatocellular carcinoma. Cancer. 1976 Feb;37(2):677–683. doi: 10.1002/1097-0142(197602)37:2<677::aid-cncr2820370211>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  32. Moertel C. G. Clinical management of advanced gastrointestinal cancer. Cancer. 1975 Aug;36(2):675–682. doi: 10.1002/1097-0142(197508)36:2+<675::aid-cncr2820360810>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  33. Moertel C. G., Schutt A. J., Reitemeier R. J., Hahn R. G. Therapy for gastrointestinal cancer with the nitrosoureas alone and in drug combination. Cancer Treat Rep. 1976 Jun;60(6):729–732. [PubMed] [Google Scholar]
  34. Olweny C. L., Toya T., Katongole-Mbidde E., Mugerwa J., Kyalwazi S. K., Cohen H. Treatment of hepatocellular carcinoma with adriamycin. Preliminary communication. Cancer. 1975 Oct;36(4):1250–1257. doi: 10.1002/1097-0142(197510)36:4<1250::aid-cncr2820360410>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  35. Panettiere F. J., Leichman L., O'Bryan R., Haas C., Fletcher W. Cis-diamminedichloride platinum(II), an effective agent in the treatment of epidermoid carcinoma of the esophagus. A preliminary report of an ongoing Southwest Oncology Group study. Cancer Clin Trials. 1981;4(1):29–31. [PubMed] [Google Scholar]
  36. Radice P. A., Bunn P. A., Jr, Ihde D. C. Therapeutic trials with VP-16-213 and VM-26: active agents in small cell lung cancer, non-Hodgkin's lymphomas, and other malignancies. Cancer Treat Rep. 1979 Aug;63(8):1231–1239. [PubMed] [Google Scholar]
  37. Soga J., Fujimaki M., Tanaka O., Sasaki K., Kawaguchi M., Muto T. Analysis of preoperative combined bleomycin and radiation therapy for esophageal carcinoma. World J Surg. 1983 Mar;7(2):230–235. doi: 10.1007/BF01656148. [DOI] [PubMed] [Google Scholar]
  38. Steiger Z., Franklin R., Wilson R. F., Leichman L., Seydel H., Loh J. J., Vaishamapayan G., Knechtges T., Asfaw I., Dindogru A. Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy. J Thorac Cardiovasc Surg. 1981 Nov;82(5):713–719. [PubMed] [Google Scholar]
  39. Stephens F. O. Bleomycin--a new approach in cancer chemotherapy. Med J Aust. 1973 Jun 30;1(26):1277–1283. doi: 10.5694/j.1326-5377.1973.tb111117.x. [DOI] [PubMed] [Google Scholar]
  40. Tancini G., Bajetta E., Bonadonna G. Terapia con bleomicina da sola o in associazione con methotrexate nel carcinoma epidermoide dell'esofago. Tumori. 1974 Jan;60(1):65–71. doi: 10.1177/030089167406000107. [DOI] [PubMed] [Google Scholar]
  41. Vogl S. E., Greenwald E., Kaplan B. H. Effective chemotherapy for esophageal cancer with methotrexate, bleomycin, and cis-diamminedichloroplatinum II. Cancer. 1981 Dec 15;48(12):2555–2558. doi: 10.1002/1097-0142(19811215)48:12<2555::aid-cncr2820481202>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  42. Whittington R. M., Close H. P. Clinical experience with mitomycin C (NSC-26980). Cancer Chemother Rep. 1970 Jun;54(3):195–198. [PubMed] [Google Scholar]
  43. Yagoda A., Mukherji B., Young C., Etcubanas E., Lamonte C., Smith J. R., Tan C. T., Krakoff I. H. Bleomycin, an antitumor antibiotic. Clinical experience in 274 patients. Ann Intern Med. 1972 Dec;77(6):861–870. doi: 10.7326/0003-4819-77-6-861. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES