Surgically unresectable cancer of the esophagus or stomach is commonly treated with cisplatin based combinations chemotherapy. Treatment is administered primarily to control symptoms such as difficulty in swallowing and prolonged survival. Since chemotherapy is currently administered primarily for palliation, avoidance of treatment programs with significant side effects is desirable. Two commonly employed treatment regimens for patients with cancer of the esophagus or stomach are: mitomycin, cisplatin and fluorouracil and epirubicin, cisplatin and fluorouracil.

Doctors in England compared these 2 treatment regimens and reported their results at the 1999 meeting of the American Society of Clinical Oncology. They randomly assigned 580 patients with advanced esophageal or gastric (stomach) cancer to receive mitomycin, cisplatin and fluorouracil or the same regimen with the substitution of epirubicin for mitomycin. The overall response rate for the mitomycin regimen was 40% compared to 39% for the epirubicin regimen. The average survival was 9.4 months for the mitomycin group and 8.8 months for the epirubicin group. Side effects of both regimens were tolerable with only 2 treatment-related deaths. The epirubicin group had a higher incidence of low white blood cell counts and the mitomycin group had a higher incidence of low platelet counts. There was less hair loss in patients receiving the mitomycin regimen. Other side effects were similar.

These doctors concluded that a regimen of mitomycin, fluorouracil and cisplatin was as effective as a regimen of epirubicin, fluorouracil and cisplatin for the palliative treatment of patients with cancer of the esophagus or stomach but was associated with a reduction in hair loss. They thought that mitomycin cisplatin and fluorouracil should now be a standard treatment for patients with advanced cancer of the esophagus and stomach.

(Proceedings of the American Society of Clinical Oncology, Vol 18, Abstract 1042, 1999)

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