Update in cancer chemotherapy: gastrointestinal cancer, cancer of the small intestines, gallbladder, liver, and esophagus.

This article updating cancer chemotherapy of gastrointestinal cancer completes the fivepart series begun in the April issue of the Journal. Treatment of cancer of the small intestine, the gallbladder and bile duct, primary cancer of the liver, and the esophagus are reviewed in this concluding article.Treatment of choice of cancer of the small intestine is surgical resection. Small bowel cancer is less responsive than gastric cancer to chemotherapy. While chemotherapy may produce temporary partial remissions in patients with gallbladder and bile duct cancer, there is no evidence that it produces longterm survival time. In primary liver cancer, surgery is the only curative treatment, but only 30 percent of patients are diagnosed with resectable lesions, and the surgical mortality rate is high. The most active single agents appear to be doxorubicin, fluorouracil, and neocarcinostatin. Data on combination chemotherapy are limited.With carcinoma of the esophagus, 95 percent of patients die of the condition. The standard treatment for locoregional disease is surgical resection and/or radiation therapy. Chemotherapy has been slow to develop; single-agent chemotherapy has been reported to be active in 15 percent of cases with durations of 2 to 5 months. Combination chemotherapy is so recent that data are incomplete as to long-term results of disease-free and total survival times, but polychemotherapy appears to be more effective than single agents.With earlier detection, prompt surgery, earlier chemotherapy, improved dose scheduling, and further exploration of combination therapy, better overall results with a major impact years later may be expected. Because of the lack of data, there remains uncertainty as to the place of chemotherapy in the treatment of gastrointestinal cancer.