RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Combining more than one drug and giving them in different ways
may kill more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of chemotherapy before and after surgery
in treating patients with high-risk stomach cancer.
OBJECTIVES: I. Evaluate the efficacy and toxicity of neoadjuvant cisplatin/fluorouracil
(CDDP/5-FU) followed by surgery followed by adjuvant intraperitoneal floxuridine/leucovorin
in patients with high-risk gastric cancer. II. Assess the quality of life and cost-benefit
ratio associated with this treatment. III. Evaluate the sensitivity, specificity, and
overall staging accuracy of laparoscopy with or without laparoscopic ultrasound in
predicting the resectability rate (with and without neoadjuvant CDDP/5-FU), response to
chemotherapy, and accuracy when compared to pathologic findings. IV. Correlate the presence
of mutated vs. wild-type p53 suppressor oncogenes in endoscopic biopsies and resected tumor
specimens with clinical outcome (defined as downstaging, failure pattern, and disease-free
and overall survival) in patients treated with and without neoadjuvant CDDP/5-FU.
OUTLINE: The following acronyms are used: CDDP Cisplatin, NSC-119875 CF Leucovorin calcium,
NSC-3590 5-FU Fluorouracil, NSC-19893 FUDR Floxuridine, NSC-27640 2-Drug Combination
Chemotherapy followed by Surgery followed by Single-Agent Chemotherapy with Drug Modulation.
CDDP/5-FU; followed by total or subtotal radical gastrectomy with D2 dissection; followed by
FUDR; with CF.
PROJECTED ACCRUAL: A total of 50 patients will be entered over 2-2.5 years.
DISEASE CHARACTERISTICS: Microscopically confirmed adenocarcinoma of the stomach or
gastroesophageal junction Reviewed by Department of Pathology of participating institution
Stage II-IV (T2, N1-2, M0 or T3-4, any N, M0) by physical exam, CT, and laparoscopy
Potentially curable by surgery Suspected sites of metastasis proven M0 prior to entry
PATIENT CHARACTERISTICS: Age: Any age Performance status: Karnofsky 60%-100%
Hematopoietic: WBC at least 4,000 Platelets at least 150,000 Hepatic: Bilirubin less than
2 mg/dL Renal: Creatinine no greater than 1.5 mg/dL OR Creatinine clearance greater than
50 mL/min BUN no greater than 30 mg/dL Cardiovascular: No NYHA class III/IV status No
active angina No myocardial infarction within 6 months No significant ventricular
arrhythmia requiring medication No clinically significant conduction system abnormality
Other: No serious intercurrent infection No nonmalignant medical illness that is
uncontrolled or precludes study participation No psychiatric disorder that precludes
informed consent No clinically significant auditory impairment No second malignancy within
5 years except: Basal cell skin cancer Carcinoma in situ of the cervix No pregnant or
nursing women Negative pregnancy test required of fertile women Effective contraception
required of fertile patients
PRIOR CONCURRENT THERAPY: No prior chemotherapy or radiotherapy