[Report of case who survived more than five years after repeated intraperitoneal chemotherapy with cisplatin and 5-fluorouracil for treatment of macroscopically negative but microscopically positive peritoneal dissemination of gastric cancer].

UNLABELLED

Prognosis of patients with macroscopically negative but microscopically positive peritoneal dissemination is so poor that the two-year survival rate after the surgery was 0% during 1975-1981. It improved to 38% during 1982-1988 but the five year survival rate was 0%.

CASE REPORT

A 57-year-old male underwent distal gastrectomy and lymph node dissection on November 10, 1992 due to Borrmann type 3 gastric cancer measuring 5.4 cm in diameter and locating in the gastric antrum (H0 P0 t3 n3 stage IV a). Peritoneal lavage cytology revealed cancer cells, and, thus, this patient was treated with intraperitoneal chemotherapy using an intraperitoneal infuser port. Through the infuser port, cisplatin and 5-FU were given at a dose of 70 mg/m2 and 700 mg/m2, respectively. Because fluorouracil infusion caused abdominal pain after the second infusion, it was administered i.v. for 24 hours thereafter. The infuser port was removed after the four infusions because the patient developed appendicitis. Fluorouracil was given p.o. at a dose of 300 mg/day from one month after surgery (total dose of fluorouracil 54.6 g). Cytological examination of the ascites revealed no cancer cells after the second intraperitoneal chemotherapy, and the patient fared well five years and four months after the surgery. Therefore, it is suggested that intraperitoneal chemotherapy with cisplatin and fluorouracil is an effective treatment for microscopical peritoneal dissemination, though it may have an adverse effect such as chemical peritonitis.