Prolongation of Survival and Improvement in Performance Status following Palliative Chemotherapy in Gastrointestinal Cancer Patients with a Poor Performance Status

Abstract

Background: The prognosis of advanced gastrointestinal cancer, especially in patients with poor performance status (PS), is generally dismal. Patients with PS 3–4 are almost ineligible for participation in clinical studies. Patients and Methods: From June 2000 to February 2007, 116 patients with poor PS (PS 3 = 73 and PS 4 = 43) were treated with chemotherapy. Retrospective analysis was performed. Results: Of the 107 patients with at least one measurable lesion, a partial response was obtained in 15 patients (14.0%). Of 65 patients with ascites and/or pleural effusion, 12 patients achieved decreased fluid accumulation. A decline in tumor markers was observed in 30 patients. As a result, 38 patients (32.7%) achieved tumor response, a decrease in fluid accumulation or a decline in tumor markers (responders), which resulted in a survival benefit compared to the other 78 patients without effect (6.9 vs. 2.2 months, p < 0.001). PS improvement was seen in 16 patients (13.8%). Conclusions: The results suggest that chemotherapy may be beneficial in gastrointestinal cancer patients with poor PS, as demonstrated by a certain degree of improvement in PS and survival in responders. Further study is required to confirm the benefit of chemotherapy in this patient population.