Response of the primary lesion in gastric cancer to chemotherapeutic trials

Abstract

Background

We wish to clarify some points in the evaluation of primary tumors in gastric cancer trials, particularly the response rate and patient survival.

Methods

This study includes 226 patients with advanced gastric cancer who had no prior treatment except surgery, and who had been enrolled into 1 of 4 Japan Clinical Oncology Group trials. The regimens for these 226 patients were tegafur and mitomycin C in 50 a combination of tegafur and uracil and mitomycin C in 39, 5′-deoxy-5-fluorouridine and cisplatin in 49, etoposide, doxorubicin, and cisplatin in 42, and 5-fluorouracil and cisplatin in 46 patients. Antitumor responses were evaluated by the Japanese evaluation criteria.

Results

Of the 226 patients, 192 (85%) had primary cancers. Only 57 of 192 had roentgenographically measurable tumors. The response rate of the primary cancers was significantly lower than that of measurable metastatic lesions (P<0.01). Forty-five overall responders who had both primary and metastatic tumors were divided into 31 responders and 14 nonresponders, with reference to primary cancers. The 31 patients who had a response in the primary cancer lived significantly longer (P<0.05) than the 14 nonresponders, even though there was no significant difference in patient backgrounds between the 2 groups. This difference in survival became even more remarkable after 1 year.

Conclusions

Although some questions remain unresolved, evaluation of primary cancer can be meaningful, and the response of primary cancers may be an indicator for long-term survival.