Postoperative intraperitoneal chemotherapy as adjuvant treatment of resectable gastric cancer

Most gastric cancer patients suffer tumor recurrence after gastrectomy. Prognosis seems to be closely correlated to the presence of free cancer cells in the peritoneal washing liquid at the time of surgery. The gastric resection itself permits the release of tumor emboli that are more easily implanted on the abraded peritoneal surfaces during the immediate postoperative period. Postoperative intraperitoneal chemotherapy, if administered in an effective dose, should provide a broad drug distribution to all the abdominal surfaces and so change the outcome of the disease. A phase II study was conducted to evaluate regional and systemic toxicity of postoperative intraperitoneal chemotherapy. Twenty four patients with locally advanced gastric cancer were treated with intraperitoneal 5-fluorouracil (5-FU) and folinic acid, following radical surgery. In 10 patients, the drug was infused at a dose of 20 mg/Kg/day, together with folinic acid, 125 mg/m2/day for 5 days every 28 days (maximum: 6 cycles), starting on the 21st postoperative day. Toxicity was moderate and no anastomotic leakage was observed. In remaining 14 patients, treatment started on the first postoperative day for 5 days with 5-FU dose reduced to 13.5 mg/Kg/day without changing the folinic acid doses. This second group showed a lower myelotoxicity rate than the first, although the incidence of both diarrhea and abdominal pain was higher. Overall toxicity was greater than grade 1 in only 2 patients, in one of whom treatment was discontinued. Nineteen patients are alive and apparently disease-free at a median follow-up of 22.5 months.