Abstract
Cancer chemotherapy in the treatment of advanced gastric cancer provides only palliation with perhaps increased survival time in some patients. The primary treatment of gastric carcinomas is surgical, as this is the only hope for cure. It is estimated that 80 to 85 percent of patients with newly diagnosed cases of stomach cancer will be dead of their disease within five years. Radiation therapy alone is seldom employed, except as a palliative measure to control hemorrhage or pain. There are no data to suggest that postoperative radiation increases survival rates.
Single-agent chemotherapy is of temporary palliative value in 20 to 30 percent of cases with a duration of response from three to five months. Combination chemotherapy has shown a somewhat higher response rate than single-agent therapy. In advanced gastric cancer, there is no evidence of improved long-term disease-free survival rates with any combination yet reported.
The treatment of carcinoid cancer of the intestinal tract is surgical removal, as this offers the only hope of cure. Radiation therapy is of little benefit, except for moderate palliation in cases of extensive liver metasasis. Carcinoid cancers are moderately sensitive to chemotherapy.
While some adjuvant chemotherapy trials suggest improvement, major survival gains remain to be demonstrated. Uncertainty as to the role of chemotherapy in the treatment of gastrointestinal cancers is probably due to lack of data.
Full text
PDF









Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baker L. H., Vaitkevicius V. K., Gehan E. Randomized prospective trial comparing 5-fluorouracil (NSC-19893) to 5-fluorouracil and methyl-CCNU (NSC-95441) in advanced gastrointestinal cancer. Cancer Treat Rep. 1976 Jun;60(6):733–737. [PubMed] [Google Scholar]
- Beer M., Cocconi G., Ceci G., Varini M., Cavalli F. A phase II study of cisplatin in advanced gastric cancer. Eur J Cancer Clin Oncol. 1983 Jun;19(6):717–720. doi: 10.1016/0277-5379(83)90003-2. [DOI] [PubMed] [Google Scholar]
- Bitran J. D., Desser R. K., Kozloff M. F., Billings A. A., Shapiro C. M. Treatment of metastatic pancreatic and gastric adenocarcinomas with 5-fluorouracil, adriamycin, and mitomycin C (FAM). Cancer Treat Rep. 1979 Nov-Dec;63(11-12):2049–2051. [PubMed] [Google Scholar]
- Bruckner H. W., Lokich J. J., Stablein D. M. Studies of Baker's antifol, methotrexate, and razoxane in advanced gastric cancer: A Gastrointestinal Tumor Study Group Report. Cancer Treat Rep. 1982 Sep;66(9):1713–1717. [PubMed] [Google Scholar]
- Bunn P. A., Jr, Nugent J. L., Ihde D. C., Cohen M. H., Eddy J. L., Minna J. D. 5-fluorouracil, methyl-CCNU, adriamycin, and mitomycin C in the treatment of advanced gastric cancer. Cancer Treat Rep. 1978 Sep;62(9):1287–1293. [PubMed] [Google Scholar]
- Buroker T., Kim P. N., Groppe C., McCracken J., O'Bryan R., Panettiere F., Costanzi J., Bottomley R., King G. W., Bonnet J. 5 FU infusion with mitomycin-C vs. 5 FU infusion with methyl-CCNU in the treatment of advanced upper gastrointestinal cancer: a Southwest Oncology Group Study. Cancer. 1979 Oct;44(4):1215–1221. doi: 10.1002/1097-0142(197910)44:4<1215::aid-cncr2820440408>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
- Cullinan S. A., Moertel C. G., Fleming T. R., Rubin J. R., Krook J. E., Everson L. K., Windschitl H. E., Twito D. I., Marschke R. F., Foley J. F. A comparison of three chemotherapeutic regimens in the treatment of advanced pancreatic and gastric carcinoma. Fluorouracil vs fluorouracil and doxorubicin vs fluorouracil, doxorubicin, and mitomycin. JAMA. 1985 Apr 12;253(14):2061–2067. [PubMed] [Google Scholar]
- Cunningham D., Soukop M., McArdle C. S., Carter D. C., Smyth J. F., Allan S. G., Kaye S. B., Sangster G., Calman K. C., Hutcheon A. W. Advanced gastric cancer: experience in Scotland using 5-fluorouracil, adriamycin and mitomycin-C. Br J Surg. 1984 Sep;71(9):673–676. doi: 10.1002/bjs.1800710909. [DOI] [PubMed] [Google Scholar]
- Douglass H. O., Jr, Lavin P. T., Goudsmit A., Klaassen D. J., Paul A. R. An Eastern Cooperative Oncology Group evaluation of combinations of methyl-CCNU, mitomycin C, Adriamycin, and 5-fluorouracil in advanced measurable gastric cancer (EST 2277). J Clin Oncol. 1984 Dec;2(12):1372–1381. doi: 10.1200/JCO.1984.2.12.1372. [DOI] [PubMed] [Google Scholar]
- FRANK W., OSTERBERG A. E. Mitomycin C (NSC-26980)--an evaluation of the Japanese reports. Cancer Chemother Rep. 1960 Nov;9:114–119. [PubMed] [Google Scholar]
- Haim N., Cohen Y., Honigman J., Robinson E. Treatment of advanced gastric carcinoma with 5-fluorouracil adriamycin, and mitomycin C (FAM). Cancer Chemother Pharmacol. 1982;8(3):277–280. doi: 10.1007/BF00254050. [DOI] [PubMed] [Google Scholar]
- Haim N., Epelbaum R., Cohen Y., Robinson E. Further studies on the treatment of advanced gastric cancer by 5-fluorouracil, Adriamycin (doxorubicin), and mitomycin C (modified FAM). Cancer. 1984 Nov 1;54(9):1999–2002. doi: 10.1002/1097-0142(19841101)54:9<1999::aid-cncr2820540935>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
- Jamieson G. G., Gill P. G. A prospective trial of 5-FU and BCNU in the treatment of advanced gastric cancer. Aust N Z J Surg. 1981 Feb;51(1):16–19. doi: 10.1111/j.1445-2197.1981.tb05895.x. [DOI] [PubMed] [Google Scholar]
- Karlin D. A., Stroehlein J. R., Bennetts R. W., Jones R. D., Heifetz L. J., Mahal P. S. Phase I--II study of the combination of 5-FU, doxorubicin, mitomycin, and semustine (FAMMe) in the treatment of adenocarcinoma of the stomach, gastroesophageal junction, and pancreas. Cancer Treat Rep. 1982 Aug;66(8):1613–1617. [PubMed] [Google Scholar]
- Kovach J. S., Moertel C. G., Schutt A. J., Hahn R. G., Reitemeier R. J. Proceedings: A controlled study of combined 1,3-bis-(2-chloroethyl)-1-nitrosourea and 5-fluorouracil therapy for advanced gastric and pancreatic cancer. Cancer. 1974 Feb;33(2):563–567. doi: 10.1002/1097-0142(197402)33:2<563::aid-cncr2820330235>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
- Lacave A. J., Izarzugaza I., Antón Aparicio L. M., Valle Pereda M., Gracia Marco J. M., Buesa J. M. Phase II clinical trial of cis-dichlorodiammineplatinum in gastric cancer. Am J Clin Oncol. 1983 Feb;6(1):35–38. [PubMed] [Google Scholar]
- Levi J. A., Dalley D. N., Aroney R. S. Improved combination chemotherapy in advanced gastric cancer. Br Med J. 1979 Dec 8;2(6203):1471–1473. doi: 10.1136/bmj.2.6203.1471. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Longmire W. P., Jr, Kuzma J. W., Dixon W. J. The use of triethylenethiophosphoramide as an adjuvant to the surgical treatment of gastric carcinoma. Ann Surg. 1968 Mar;167(3):293–312. doi: 10.1097/00000658-196803000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MacDonald J. S., Schein P. S., Woolley P. V., Smythe T., Ueno W., Hoth D., Smith F., Boiron M., Gisselbrecht C., Brunet R. 5-Fluorouracil, doxorubicin, and mitomycin (FAM) combination chemotherapy for advanced gastric cancer. Ann Intern Med. 1980 Oct;93(4):533–536. doi: 10.7326/0003-4819-93-4-533. [DOI] [PubMed] [Google Scholar]
- Moertel C. G. Chemotherapy of gastrointestinal cancer. Clin Gastroenterol. 1976 Sep;5(3):777–793. [PubMed] [Google Scholar]
- Moertel C. G., Childs D. S., Jr, Reitemeier R. J., Colby M. Y., Jr, Holbrook M. A. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet. 1969 Oct 25;2(7626):865–867. doi: 10.1016/s0140-6736(69)92326-5. [DOI] [PubMed] [Google Scholar]
- Moertel C. G., Engstrom P., Lavin P. T., Gelber R. D., Carbone P. P. Chemotherapy of gastric and pancreatic carcinoma: a controlled evaluation of combinations of 5-fluorouracil with nitrosoureas and "lactones". Surgery. 1979 May;85(5):509–513. [PubMed] [Google Scholar]
- Moertel C. G., Hanley J. A. Combination chemotherapy trials in metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer Clin Trials. 1979 Winter;2(4):327–334. [PubMed] [Google Scholar]
- Moertel C. G., Lavin P. T. Phase II-III chemotherapy studies in advanced gastric cancer. Eastern Cooperative Oncology Group. Cancer Treat Rep. 1979 Nov-Dec;63(11-12):1863–1869. [PubMed] [Google Scholar]
- Moertel C. G., Mittelman J. A., Bakemeier R. F., Engstrom P., Hanley J. Sequential and combination chemotherapy of advanced gastric cancer. Cancer. 1976 Aug;38(2):678–682. doi: 10.1002/1097-0142(197608)38:2<678::aid-cncr2820380209>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
- Moore G. E., Bross I. D., Ausman R., Nadler S., Jones R., Jr, Slack N., Rimm A. A. Effects of chlorambucil (NSC-3088) in 374 patients with advanced cancer. Eastern Clinical Drug Evualuation Program. Cancer Chemother Rep. 1968 Oct;52(6):661–666. [PubMed] [Google Scholar]
- Nomura A., Yamakawa H., Ishidate T., Kamiyama S., Masuda H., Stemmermann G. N., Heilburn L. K., Hankin J. H. Intestinal metaplasia in Japan: association with diet. J Natl Cancer Inst. 1982 Mar;68(3):401–405. [PubMed] [Google Scholar]
- Ogawa M. A recent overview of chemotherapy for advanced stomach cancer in Japan. Antibiot Chemother (1971) 1978;24:149–159. doi: 10.1159/000401511. [DOI] [PubMed] [Google Scholar]
- Panettiere F. J., Haas C., McDonald B., Costanzi J. J., Talley R. W., Athens J., Oishi N., Heilbrun L. K., Chen T. T. Drug combinations in the treatment of gastric adenocarcinoma: a randomized Southwest Oncology Group study. J Clin Oncol. 1984 May;2(5):420–424. doi: 10.1200/JCO.1984.2.5.420. [DOI] [PubMed] [Google Scholar]
- Serlin O., Wolkoff J. S., Amadeo J. M., Keehn R. J. Use of 5-fluorodeoxyuridine (FUDR) as an adjuvant to the surgical management of carcinoma of the stomach. Cancer. 1969 Aug;24(2):223–228. doi: 10.1002/1097-0142(196908)24:2<223::aid-cncr2820240203>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
