Recent Advances in Cytotoxic Therapy for Gastrointestinal Carcinoma: A Review

A prospective trial of 5-FU and BCNU in the treatment of advanced gastric cancer

This study was undertaken to investigate the efficacy of a combination of 5-FU and BCNU in the treatment of advanced gastric cancer. Patients whose cancer was recurrent following surgery or in whom surgery was deemed inappropriate were entered in the study and given the two-drug combination at six-weekly intervals until either death or clear progression of disease occurred. Five of twenty-eight patients had unequivocal regression of their disease. The early optimism for this form of therapy in advanced gastric cancer is not supported by this study.

Colorectal cancer: the modern treatment of disseminated disease - a review

Most patients who develop cancer of the large bowel will eventually develop recurrence and will therefore be considered for treatment of that recurrence. There exists very great confusion as to the efficacy of the various treatment options available. This review has attempted to evaluate critically the claim for therapeutic efficacy of the various treatment options, with particular regard to patients with liver metastases from primary tumours of the large bowel. A case can be made out for surgical removal of recurrent or disseminated colorectal cancer, but there is no evidence that any form of treatment other than total surgical excision will result in prolonged patient survival. All forms of treatment can be effective in palliating symptomatic patients. Therefore, with the exception of total surgical excision of recurrent tumour, treatment should be reserved for those patients with symptoms, and the choice of treatment offered should be weighed against possible side-effects.

Chemotherapy in advanced gastric cancer: a controlled, prospective, randomised multi-centre study

Seventy-six patients with advanced gastric adenocarcinoma were studied in a prospecitive, randmoised, controlled trial using vincristine, methotrexate, cyclophosphamide, and 5-fluorouracil in an initiation course and mitomycin-C with 5-fluorouracil as maintenance therapy. Thirty-seven patients were inoperable and 39 had the primary tumour resected with histological evidence of residual disease. Survival in the inoperable group was short and showed no significant difference between treated and control patients. The median survival times for treated and control groups were 9.5 and 9.0 weeks respectively. In the resected patients there was no difference in ultimate overall survival between the groups but up to 20 weeks there was a suggestion that the probability of survival in treated patients was higher (P = 0.06). The patients were well-matched and it is concluded that chemotherapy has had an early effect but that a further trial with more detailed stratification, particularly of staging and histological grade, is needed. No patient received treatment for longer than two years and unacceptable toxicity occurred in only two patients. Nausea occurred more frequently in the treated group but was short-lived and clinically manageable.