Disseminated intravascular coagulation at presentation of advanced gastric cancer

Background: Disseminated intravascular coagulation associated with malignant bone marrow involvement has been described as a rare complication of gastric carcinoma and most patients die within 1-4 weeks. Effective chemotherapy of the underlying malignancy may be the only way to control acute DIC. Objectives: To assess the benefit of infusional 5-fluorouracil as the primary treatment of metastatic gastric carcinoma and DIC at diagnosis. Methods: From February 2001 to January 2005, six women (median age 48 years) with gastric carcinoma who presented with diffuse bone marrow metastases and acute DIC were treated in our department. Diagnosis was based on primary gastric and bone marrow biopsies. DIC was confirmed by laboratory findings. Initial treatment consisted of infusional 5FU 200 mg/m(2)/day. When the bleeding tendency stopped, cisplatin 60 mg/m(2) and epirubicin 50 mg/m(2) every 3 weeks were added. Results: Within one week of starting the treatment, the clinical and laboratory signs of acute DIC were resolved in five of six patients. Upon clinical improvement, five patients subsequently received epirubicin and cisplatin. Survival, however, was short (mean 15 weeks). All patients died with symptoms of bleeding , showing clinical and laboratory signs of DIC. Conclusions: Based on our experience, infusional 5FU is an effective regimen with negligible myelosuppression; thus, it may be a good choice as initial therapy for this group of patients. The response induced by protracted 5FU was usually short and lasted for only a few weeks. Therefore once DIC symptoms are controlled the addition of newer cytotoxic drugs may be necessary to consolidate the remission.