Adjuvant Chemotherapy with Etoposide, 5-Fluorouracil and Leucovorin(ELF) in Gastric Cancer

다국어 초록 (Multilingual Abstract)

Background: Gastric cancer is one of a major health problem and leading cause of cancer mortality despite worldwide decline in incidence. Surgical resection is the only treatment modality of proven effectiveness. Many phase III trials of adjuvant therapy have been conducted, however postoperative treatment modalities have not proven to be superior to postsurgical observation alone. We evaluated the effect of etoposide, leucovorin, 5-fluorouracil(ELF) regimen on the prevention of relapse and survival benefit after postoperative adjuvant chemotherapy.
Material and Methods: Our study is retrospective, non-randomized study without controlled group. Between March 1998 and January 2005, 41 patients with completely resected gastric cancer received six courses of ELF chemotherapy of 4 weeks cycle. Endpoints were toxicities of treatment, overall survival, disease free survival.
Results: Fourty one patients were entered into the trial. According to American Joint Comittee for Cancer screening(AJCC) TNM stage, 5 cases were in stage IB, 14 II, 13 IIIA, 5 IIIB, respectively and 4 cases were in stage IV without distant metastasis. With a median follow-up time of 40.3 months, 4-years overall survival and disease free survival was 68%, 63.7%, respectively. Severe neutropenia was observed in 19.5%, anemia was 2.4%, and thrombocytopenia was 2.4%. Severe nausea and vomiting was observed in 7.3%, but diarrhea, mucositis, alopecia, convulsion, edema and therapy related death was not observed.
Conclusions : The ELF adjuvant chemotherapy may be effective for resectable gastric cancer with minimal toxicities, but randomized multicenter controlled phase III study is needed to confirm its efficacy and safety.