Evaluation of neoadjuvant chemotherapy with paclitaxel, 5-fluorouracil and cisplatin for advanced gastric cancer with pyloric stenosis

S-1 is currently recognized as one of the standard treatments for advanced and recurrent gastric cancer in Japan. However, there are some patients who can not take oral medication due to pyloric stenosis. We performed a critical evaluation of neoadjuvant chemotherapy (NAC) with paclitaxel (PTX), 5-fluorouracil (5-FU) and cisplatin (CDDP); (PTX+FP) for patients with advanced gastric cancer with pyloric stenosis. Since September 2001, 13 patients with far advanced or non-curative respectable gastric cancer with pyloric stenosis received NAC. These patients were treated with paclitaxel 40 mg/m(2) infusions on days 1 and 8, combined with CDDP (6.5 mg/m(2)) and 5-FU (350 mg/m(2)) on days 1 through 8 followed by 2 weeks rest as one course. After at least 2 courses of treatment, the patients underwent gastrectomy with lymphadectomy. The overall response rate was 38.5% (CR: 0, PR: 5), 7 patients had SD and 1 patient had PD. Seven patients had received staging laparoscopy before NAC and 6 patients had free cancer cells in the peritoneal cavity. Of 6 patients with positive cytology at laparoscopy, 4 had no free cancer cells at operation. The MST was 405 days and one-year survival rate was 55.6%. Toxicities were generally mild, and no serious adverse reactions were observed. There were only 2 cases of grade 3 neutropenia. In conclusion, combination of PTX+FP for NAC appears to be an effective treatment for patients with advanced gastric cancer with pyloric stenosis.