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Persons who have early-stage stomach cancer often undergo surgery to remove the cancer. When the cancer has spread locally, to the area around the stomach (but not to other parts of the body), all of the cancer may not be able to be removed surgically. Researchers have been working on developing chemotherapy regimens that can be given before surgery, to shrink the cancer to a size at which it can then be removed more successfully. However, Dutch researchers may have ruled out 1 chemotherapy combination investigated for this purpose. Their results from a recent study show that the administration of fluorouracil, doxorubicin, and methotrexate to persons with localized stomach cancer before surgery showed no benefit over surgery alone.

Persons who have cancer of the stomach are frequently treated with surgical removal of part or all of the stomach (called a

gastrectomy), to control the cancer and prevent recurrence (or return) of the cancer.

Lymph nodes (parts of the body’s

lymph system) around the stomach are also removed and examined to determine whether or not the cancer has spread to these areas. Treatment options depend on the stage (extent of disease at diagnosis) of the cancer. The term

localized stomach cancer refers to cancer that may have spread throughout the stomach area, but not to other parts of the body. The term metastatic stomach cancer is used to describe cancer that has spread outside the stomach and to other parts of the body. Treatment with chemotherapy drugs before or after surgery may be an option for some persons; however, there is some controversy about whether this additional therapy provides any benefit. Doctors in The Netherlands conducted a study to determine whether a particular chemotherapy regimen given before surgery would improve the outcome for persons with non-metastatic stomach cancer.

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The researchers assigned 56 persons with non-metastatic stomach cancer (cancer that had not spread to other parts of the body) to receive either A) 4 courses of chemotherapy with fluorouracil plus doxorubicin plus methotrexate followed by surgery or B) surgery only. The goal was to increase the number of patients in whom all cancer could be removed by surgery. The results showed that 44% of patients taking the chemotherapy had progression of cancer, such that the chemotherapy was discontinued. Overall, 56% of those who received the chemotherapy ultimately had complete surgical removal of the cancer, compared with a more favorable 62% of those who did not have the chemotherapy.

These findings suggest that fluorouracil plus doxorubicin plus methotrexate before surgery is not an effective regimen, and more active anti-cancer treatments are needed to justify giving chemotherapy before surgery. Persons who have stomach cancer may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which other new treatments (before or after surgery) are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( and the Clinical Trials section and service offered by Cancer ( (

European Journal of Cancer, Vol 35, No 4, pp 558-562, 1999)

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