From February 1988 to April 1994, 75 consecutive patients with unresectable gastric carcinoma were included in this prospective randomized study. Patients were randomized as follows: 26 patients received exploration or palliative surgery alone (S), 24 received pre-operative systemic intravenous chemotherapy and surgery (IVCH+S) and 25 received pre-operative superselective intra-arterial chemotherapy and surgery (IACH+S). In patients whose tumors were located on the lesser curvature, the left gastric artery was catheterized. In all other cases, the right gastroepiploic artery was catheterized. 5-Fluorouracil (5-FU) and doxorubicin (DR) were selected as the chemotherapeutic agents for both IVCH and IACH. Dosages were determined using a actual body surface area (BSA) calculation and a standard height and weight nomogram. The drug infusion was administered in two cycles with a 6 day interval approximately two weeks prior to surgery. The intravenous regimen was given at the same dosage and timing as the intra-arterial regimen. The median survival time after S and IVCH+S was only 91 and 96 days, respectively, as compared to 401 days in patients receiving IACH+S. The results confirmed that IACT + S conferred a highly significant survival advantage compared to S or to IVCH+S, adjusted for all patient characteristics (p > 0.0001).