Carcinoma of the stomach in a large community hospital

Preoperative "basal" chemotherapy in the management of cancer of the stomach

Twenty-seven patients with infiltrating gastric carcinoma received chemotherapy as the first stage in management to reduce tumour extent and viability in preparation for subsequent surgery. All patients who had received no previous treatment for their cancers were included in the study, regardless of the type or extent of the primary gastric lesion; there was no patient selection. In 25 patients chemotherapy was administered by intra-arterial infusion, while in two patients it was given intravenously. Of 21 patients who underwent repeat gastroscopy before surgery, 11 (52%) showed endoscopic improvement. Gastric resection was carried out in 24 of the 27 patients. The perioperative mortality was 11% (three of 27 patients). Of the 27 patients, 14 were initially assessed as having advanced incurable lesions. Only two of these remain well and apparently free of tumour. The other 13 patients were considered to have resectable and potentially curable lesions at the time of referral. Of these, 11 remain well and apparently free of tumour between one and five years after diagnosis; the other two patients in this group died from postoperative complications.

The treatment of gastric cancer with combined surgical resection and chemotherapy

A series of 156 patients with gastric cancer during a 15-year period were reviewed retrospectively to determine the effectiveness of combined surgery and adjuvant chemotherapy. The patients were divided into a 9-year prechemotherapy period and a 6-year chemotherapy period. Review of the data revealed an increase in the incidence of distant disease. The utilization of surgery as the only mode of treatment declined. Combination surgery and adjuvant chemotherapy utilization increased. Comparison of survival for surgery vs. adjuvant chemotherapy, expressed as percentage of survivors for each year, revealed an increase at 1 and 2 years with no difference at 3 years for all stages. A similar comparison for patients with regional spread showed an increase at 1,2 and 3 years with no difference therafter. The 5-year survival was 5% for both groups. The data has suggested that surgery and adjuvant chemotherapy increases 1-,2-, and 3-year survival rates but does not affect the longterm results.