Mitomycin C as an Adjuvant Treatment to Resected Gastric Cancer

Abstract

Seventy consecutive patients were entered in a two-arm randomized trial after surgical resection for locally advanced gastric cancer. In the first arm, 37 patients were included as a control group, receiving no further treatment after surgery. In the second arm, 33 patients were treated with adjuvant chemotherapy consisting of mitomycin C (MMC), 20 mg/m2 administered intravenously once every 6 weeks for four consecutive cycles. All patients in both arms were followed in the same way for 5 years. At 5 years 23 of 37 patients in the control arm and 7 of 33 patients in the treatment arm were dead because of relapse. Actuarial survival curve was statistically significant in favor of patients given adjuvant MMC (p less than 0.001). After 10 years follow-up, 31 of 37 patients in the control arm and 16 out of 33 patients in the treatment arm were dead because of relapse, the statistical differences continuing in the actuarial survival curve in favor of treated patients (p less than 0.01). The best advantages of adjuvant treatment were observed in the T3N0M0 stage. The most frequent relapse site was the peritoneal cavity and the relapse pattern shows special decrease in liver metastases in treated patients. Toxicity was acute and mild. No delayed toxicity or second malignancies were observed. These data suggest that adjuvant MMC after resected surgery of gastric cancer is a successful treatment and its effects are still evident after 10 years of follow-up.

Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study

“…The treated patient group, moreover, had relatively fewer hepatic metastases than the controls, which, in agreement with Coombes et al (1990) and Estape et al (1991), suggests a protective effect of adjuvant chemotherapy on blood-borne cancer dissemination. Acute toxicity was mild and treatment was well tolerated by patients, all of whom were treated on an outpatient basis.…”

“…The attempt to reduce recurrences and prolong survival in patients with gastric carcinoma has led to intensive study of adjuvant chemotherapy after surgical gastric resection by cooperative groups and others (The Gastrointestinal Tumor Study Group 1982;Engstrom et al, 1985;Coombes et al, 1990;Estape et al, 1991). Although the overall results of these trials failed to demonstrate a general advantage and no clearcut benefits have emerged from trials involving random assignment to various adjuvant chemotherapy schedules (Alexander et al, 1993), such an approach seemed to be effective for certain subgroups of patients (de Braud et al, 1992).…”

A Systematic Overview of Chemotherapy Effects in Gastric Cancer

“…If the drugs have a more pronounced antitumour effect and if the amount of residual tumour after surgery is smaller, there ought to be a more apparent effect in earlier stages. This was seen in one Japanese study in 1984 (38), but in an earlier study the same authors found a better effect in more advanced stages, which is in accordance with several more recently published studies (26,31,43,51). Thus, there is no clear indication that a more pronounced drug effect is correlated to more extensive surgery or earlier disease.…”

“…No attempt was made to identify ongoing trials with unpublished results. For studies published more than once during follow-up, only the last: nal version, or the one presenting the most detailed results, have been included (24)(25)(26)(27)(28)(29)(30)(31). Two studies included in the earlier meta-analysis (23), one using immuno-therapy and the other only published in Japanese, were excluded in this analysis.…”

Adjuvant therapy in resectable gastric cancer

“…The 5-year survival was 30% for surgery alone compared to 80% for MMC treated patients. The effect of treatment is still evident after 10 years of follow-up (Estape et al, 1991). The treatment was well tolerated and toxicity was only acute and mild.…”