Combination 5-fluoruracil/cisplatinum versus 5-fluoruracil/leucovorin adjuvant chemotherapy efficacy for R0 gastric resection in locally invasive gastric cancer.

BACKGROUND: The efficacy of adjuvant chemotherapy for advance resectable gastric cancer is controversial. Recently, less than 20% of the patients that received surgery can survive locally advance gastric cancer for 5 years. The purpose of the present study was to compare the therapeutic efficacy of the combination 5-fluoruracil (5-FU) with cisplatinum based and single 5-FU based regimen for the treatment of gastric cancer after post-operative gastric resection.

MATERIAL AND METHOD: Patients were recruited if they underwent curative RO gastric resection surgery with standard Dl or D2 lymph node dissection. Between 2002 and 2007, we conducted a cohort study, and collected prospective data of 88 patients with advanced gastric cancer They were analyzed for median survival time and rate, recurrence rate, and chemotherapy toxicity prevalence. The median survival time was the primary study endpoint. The median survival time was compared between groups by a log-rank test.

RESULTS: In the present study, combined 5-FU based regimen did not show a significantly superior survival time to single 5-FU regimen, both poor stage groups had better median survival in both combined 5-FU and single 5-FU regimen when compared to surgery. There was more than 50 months median survival in the first group, and 52 months in the latter However, in cisplatinum with 5-FU group, there are only a small number of signet ring cells. In addition, those have poorer clinical profile before treatment (p = 0.003). No difference on mortality rate related to toxicity.

CONCLUSION: Both regimens are useful regimens with efficient benefit for gastric cancer patients as well as a cheaper regimen than other new combination drug regimens. However second line drug or other combined second generation based chemotherapy regimen that has similar action to cisplatinum such as oxaliplatin may be safer for toxicity, and may get better out outcome. 5-FU regimen is still the reference group in future clinical trial for advanced gastric cancer treatment. The value of any new adjuvant treatment approach could be proven by a randomized study comparing it with cisplatinum based regimen plus 5-FU or single 5-FU regimen.