First-line fluorouracil-based chemotherapy for patients with severe peritoneal disseminated gastric cancer

Treatment with an oral fluoropyrimidine plus cisplatin is widely used for advanced gastric cancer, but patients with severe peritoneal metastasis often cannot tolerate such treatment, due to inadequate oral intake or massive ascites. The aim of this study was to assess the efficacy and safety of systemic chemotherapy for advanced gastric cancer with severe peritoneal metastasis.

The cases of 92 patients with advanced gastric cancer and severe peritoneal metastasis who received first-line chemotherapy at our hospital between May 2001 and February 2007 were retrospectively analyzed. Severe peritoneal metastasis was defined as massive ascites or inadequate oral intake due to peritoneal dissemination. Inadequate oral intake was defined as having required an intravenous drip infusion.

All 92 patients received 5-fluorouracil (5-FU)-based chemotherapy; 40 of the patients had massive ascites, 34 had inadequate oral intake, and the remaining 18 had both conditions. Among the 86 patients having assessable ascites, 23 (27%) patients showed an improvement in ascites. Of the 52 patients with inadequate oral intake, 17 (33%) patients improved to the point of ingesting without intravenous drip infusion after receiving the chemotherapy. Median time to treatment failure and overall survival time were 1.9 months [95% confidence interval (CI) 1.3-2.5 months] and 4.6 months (95% CI 3.9-5.3 months), respectively. Major grade 3 or 4 adverse events were anorexia (26%), neutropenia (26%), and anemia (22%).

The treatment regimen of 5-FU-based chemotherapy for advanced gastric cancer with severe peritoneal metastasis was feasible, but its efficacy was not sufficient.