Search

Eleven patients with postoperative-stage IVb gastric cancer were treated by combined administration of CDDP, 5-FU and Lentinan. CDDP was given intravenously at 20 mg/body on days one to five. At the same time, 5-FU was continuously administered 250 or 500 mg/body/day via the central venous catheter for more than two weeks, while Lentinan was given at the dose of 2 mg per week. Two courses were repeated every 3 weeks. The mean response duration and survival period for the eleven patients were 13 and 21 months, respectively, and one- and two year survival rates were 82% and 27%. This combination therapy was thus considered to be very effective. Next, the pharmacokinetics of long-term CDDP and 5-FU was studied. Our method could maintain the optimum serum concentration of total CDDP. Furthermore, the continuous infusion of 5-FU at a daily dose of 250 mg/day could sufficiently maintain the effective plasma concentration, although its peak fluctuated over time. Thus, in the plasma level of 5-FU in patients in poor condition requires periodic measurement.

Three cases of postoperative gastric cancer with peritoneal dissemination were treated by combined administration of CDDP, 5-FU and Lentinan. CDDP was given intravenously at 20 mg/body on days one to five. At the same time, 5-FU was infused continuously 250-500 mg/body per day for more than two weeks, and Lentinan was given at a dose of 2 mg per week. Two courses were repeated every 3 weeks. This combination treatment was very effective because the median survival rate for the three patients was 13 months with no sign of recurrence, and the quality of life has been good.

For the purpose of studying the clinical and pathological specificities of the scirrhous type in gastric carcinoma, 96 patients with gastric carcinoma were studied according to age, sex, stage, macroscopic types and mitotic index. Scirrhous carcinoma was diagnosed in 45 patients. There were higher incidences of scirrhous carcinoma in the younger generation and among women. In the scirrhous type, the percentage of stages III and IV was higher than that of stages I and II (p less than 0.005). In Borrmann's categories III and IV, patients with the scirrhous type were more numerous than those with the other types. Mitotic indices were 18.4 +/- 8.1 in scirrhous type, 52.8 +/- 13.5 in medullary type, 54.1 +/- 16.9 in intermediate type and 53.3 +/- 11.5 in non-cancerous gastric mucosa. The low rate of mitotic index in those with scirrhous carcinoma was statistically significant compared to those of other types and that of the non-cancerous gastric mucosa (P less than 0.001). Mitotic index is apparently related to the extent and the degree of degeneration of interstitial connective tissue. The speed of the growth of the tumor mass in gastric carcinoma is not so closely related to the mitotic index, and relates to a greater extent the number of dissociated cells entering the digestive canal.

An attempt was made to clarify the clinical prognosis of scirrhous type of gastric carcinoma and to improve its treatment. The cases of gastric carcinoma operated and histologically well analyzed from 1969 to 1973 was 178, and scirrhous type was included in 52%. Advanced carcinoma (more than ss alpha) was 80% in scirrhous type and 40% in non-scirrhous type. Five year survival rate in scirrhous type was 45% and 59% in non-scirrhous type. (P divided by 0.09). In pm carcinoma, however, the 5 year survival rate of scirrhous type was higher than that of non-scirrhous type (P divided by 0.06). Between the primary lesions and lymphatic metastasis, histologic type was not the same in 70%. The survival rate of scirrhous type in lymphatic metastasis was again higher than that of the non-scirrhous type. Mitotic index was 18.6 +/- 8.6 in scirrhous type, 52.8 +/- 13.5 in medullary type, 54.1 +/- 16.5 in intermediate type and 53.3 +/- 11.5 in non-cancerous gastric epithelium. For the scirrhous type with a large amount of highly degenerated interstitial and poor blood vessel supplying, many doses of chemotherapeutic agents may be necessary, and, especially, cytostatic agents should be administered for long periods.