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Aims and objectives. The aim of this survey was to examine changes of satisfaction with appearance and working status of head and neck tumour patients after tumour excision and micro-reconstructive surgery. Background. Most research related to head and neck tumour reconstruction deals with surgical techniques and complications. No reports discussed impact on personal appearance and working status. Design. This is a retrospective cross-sectional study design with systematical sampling. Methods. One questionnaire which included three instruments was mailed to patients selected systematically from a patient list; 525 questionnaires were mailed to the potential participants and 125 returned. However, only 97 effective questionnaires were analysed. Non-parametric statistics such as Spearman correlation, Wilcoxon signed rank test, Kolmogorov–Smirnov Z test and Kruskal–Wallis test were performed as the data were not normally distributed. Results. Participants reported that they were least satisfied with their face (mean = 2·88 SD 1·34). Compared with presurgery condition, the satisfaction with current appearance was significantly lower (Wilcoxon signed rank test, Z = −6·39, p

Aims. The purpose of this study was to compare the effectiveness between ice towel (moist cryotherapy) and ice-pack (dry cryotherapy) in postoperative care. Background. Orthognathic surgery is often performed to modify the facial appearance of individuals. Cryotherapy was used to reduce the postoperative discomfort, such as local heat, pain and swelling. However, studies to compare the difference in effectiveness between moist and dry cryotherapy are lacking. Design. A quasi-experimental design with follow-ups at regular intervals was conducted. The study involved data collection at the preoperative, postoperative 60, 90, 120, 180 minutes, 24 hours and 48 hours. Methods. Subjects were recruited and assigned to group I (n = 27) and group II (n = 21) by locations. Group I received ice towels whereas group II used ice-packs as a strategy to reduce postoperative discomfort. Subjective indicators of local heat, pain and swelling were measured on postoperative days 1 and 2. When subjects went to postoperative recovery room, local temperatures on both sides of four facial areas and forehead were measured and repeated at scheduled intervals. Results. Both subjective and objective indicators changed during the research period in these two groups. Group I subjects reported less postoperative discomfort, such as heat, swelling and pain. Group II subjects had higher reduction of local temperature in certain areas within 180 minutes. Conclusions. Both moist- and dry cryotherapy reduced postoperative discomfort effectively. The moist cryotherapy was more effective in reducing subjective discomfort caused by the operation. The dry cryotherapy reduced local temperature more effectively in certain areas after surgery. Relevance to clinical practice. Cryotherapy could reduce postoperative discomfort, such as local heat, pain and swelling. When patient comfort is the major outcome of nursing intervention, moist cryotherapy is strongly suggested.

The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice.Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naive patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2-5 after chemotherapy, respectively.In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists', residents', and nurses' estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naive patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively.Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.

Background. Thyroid cancer patients have a survival rate of over 90% after thyroidectomy. However, quality of life with a generic focus has rarely been studied in thyroid cancer survivors. Aim. This paper reports a study to examine and describe factors associated with quality of life among patients with thyroid cancer after operation. Methods. Adult patients who had a thyroidectomy for cancer between January 1999 and June 2001 in a Taiwan city participated in the study. Telephone interviews was completed with 146 (67%) of those 218 eligible, asking about sociodemographic variables, disease/treatment characteristics and social support. Quality of life was measured by the Chinese version of the Quality of Life Index. Multivariate analyses were performed using multiple linear regressions. Result. The regression model showed that patients at 19–36 months after operation had lower quality of life compared with those within 18 months of operation. Current symptoms of fatigue and chills were negatively associated with quality of life. Those who rated the impact of operational scar on activities as ‘high’ had lower quality of life scores. Social support from families and friends had positive effects on quality of life. The model r2 was 48·1%. Conclusions. Nurses could improve quality of life among patients with thyroid cancer by strengthening their social support and educating them in self-management of uncomfortable symptoms. Surgeons should consider types of operation in which the scar would be less likely to influence the patients’ activities.

Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B quarantines. Ninety-eight percent of the students at the university live in dormitories; thus the prevention of SARS became an important issue. Preventive strategies are classified into primary, secondary, and tertiary prevention, with a different focus and strategy for each level of prevention. The university emphasized personal hygiene and a healthy lifestyle as the key to SARS prevention. Our experiences as school nurses during this crisis can help other school nurses to prevent the spread of SARS during similar situations.

Studies exploring the mediating and predictive factors of anxiety and depression for prostate cancer patients in Eastern countries are scant. Guided by the transactional model of stress and coping, this study determined the predictors and mediators of anxiety and depression in prostate cancer patients. The participants comprised 115 prostate cancer patients and 91 partners. The patients and partners completed questionnaires regarding physical symptoms, disease appraisals, coping behaviours, anxiety and depression in the period before confirmation of treatment decisions and 1, 3, 6 and 12 months after treatment. The results revealed that partner anxiety engendered a stressful situation and aggravated patient anxiety. Patients' threat appraisals and affective-oriented coping behaviours mediated the relationships between their anxiety levels and those of their partners. The patients' most recent prostate-specific antigen (PSA) levels and hormonal symptoms were key predictors of their anxiety and depression levels. The patients' harm appraisals mediated the relationships between their most recent PSA levels and hormonal symptoms and depression. Their threat appraisals and affective-oriented coping behaviours mediated the relationships between their hormonal symptoms and anxiety and depression. To manage those key factors, reframing, appraising disease and improving coping behaviours may reduce anxiety and depression levels in prostate cancer patients.

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre-diagnosis, 1 month and 6 months post-treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post-treatment. However, the adjustment to health-care orientation was worst at the time of pre-diagnosis and improved during post-treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health-care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre-diagnosis.

Studies have shown that having breast reconstruction has a positive influence on patient satisfaction and health-related quality of life (HRQoL) at the conclusion of treatment. However, no study has critically evaluated changes to these patient-reported outcomes during the process of undergoing breast reconstruction. This study was to prospectively evaluate changes to patient-centered metrics through the progression of breast reconstruction. An IRB-approved prospective, multi-institutional study was performed for all patients undergoing breast reconstruction between 2009 and 2011. The Breast-Q reconstruction questionnaire was used for evaluation of HRQoL and was administered at five intervals in the perioperative period. Longitudinal evaluation was performed to assess changes to HRQoL metrics during this perioperative interval. One hundred and ten patients were enrolled, and 100 patients (91.9 %) completed appropriate follow-up. Preoperative HRQoL scores were higher in patients electing to forgo reconstruction (P < 0.004), while postoperative HRQoL scores consistently deteriorated at multiple time points following mastectomy as compared to reconstructed patients. On subgroup analysis, results indicated lower initial HRQoL scores in delayed reconstruction (P < 0.05) as compared to immediate reconstruction. These scores did, however, merge at approximately 9 months postoperatively. Changes to HRQoL outcomes occur through progression of breast reconstruction. Within the first year of surgery, early decreases are mirrored by significant increases at later time points above baseline levels when evaluating most forms of reconstruction. Choosing against reconstruction will likely result in continued deterioration of HRQoL for patients undergoing cancer surgery, but steady improvements can be expected if delayed reconstruction is chosen.

To evaluate the effectiveness of clinical pathways (CPs) for paediatric asthma on length of hospital stay, additional visits due to asthma exacerbations, hospital cost, manpower and workload required for implementing CPs.Studies were eligible if they met the following criteria: children (≦18 years) with asthma, hospital or emergency department based, and study designs were (1) randomised controlled trial, (2) controlled clinical trial or (3) controlled before and after study. Two reviewers independently screened references, extracted data and assessed the risk of bias. We resolved disagreement by discussion between authors. Due to an insufficient number of studies and the heterogeneity of interventions and outcomes, we conducted a narrative systematic review with forest plots but did not pool results.About 3155 relevant articles were identified through a literature search, 628 were duplicates removed, 2037 were excluded based on review of titles and abstracts and 117 were excluded because they did not meet inclusion criteria. Seven studies involving 2600 participants met the inclusion criteria. Using asthma CPs may decrease the length of hospital stay; however, CPs did not appear to reduce additional visits due to asthma exacerbations or reduce hospital costs. No eligible studies were found that quantified the manpower and workload for implementing CPs.Current studies suggest CPs may reduce the length of hospital stay, but insufficient evidence is available on total costs or readmissions to justify extensive uptake of asthma CPs in paediatric inpatient care. Higher quality, large randomised controlled trials are required that measure costs and a wider range of outcomes.

The effect of biochemical modulation of weekly high-dose 5-fluorouracil (5-FU) 24 h infusion by leucovorin (LV) in the treatment of 39 consecutive patients with advanced gastric cancer without prior chemotherapy from October 1996 to August 1997 was examined. There were 21 male and 18 female patients with a median age of 56 years. The regimen consisted of 5-FU 2600 mg/m2 and LV 150 mg administered by 24 h infusion weekly for 6 weeks followed by a 2 week break. The treatment was repeated every 8 weeks until disease progression, patient refusal or unacceptable toxicity. Placement of a central vascular device and a portable external infusion pump was required in all patients and was used for outpatient treatment. The response to treatment was evaluated every 8 weeks. A total of 395 chemotherapy treatments were given with a mean of 10 (2-24). This response rate was: 33% (12 of 36) partial response (PR) rate, 33% (12 of 36) stable disease (SD) and 33% (12 of 36) progressive disease (PD). In general, the toxicity was mild but two toxic deaths occurred, one due to neutropenic sepsis and the other due to hyperammonemia. The median time to progression was 4 months. The overall median survival was 7 months. The survivals of the PR, SD and PD were 12, 8 and 5 months, respectively. This regimen showed a modest activity against gastric cancer with acceptable toxicity. Weekly 24 h infusion of high-dose 5-FU with LV in an outpatient setting for patients with gastric cancer is feasible and deserves further study as a basis for combination therapy.

Psychosocial strategies are commonly used to alleviate anxiety and depression in patients with prostate cancer. However, previous studies have shown inconsistent results.This study examined the effects of psychosocial strategies on anxiety and depression in prostate cancer patients.A systematic literature review was conducted using 4 English databases (Pubmed, Cochrane Central Register of Controlled Trials, Cinahl, and PsycInfo) and 2 Chinese databases (Wanfang data and Chinese Electronic Periodical Service) with predetermined keyword searches. We first evaluated 8144 titles and/or abstracts. Fourteen studies that met the inclusion criteria were selected. The criteria for study inclusion were as follows: (1) randomized controlled trial design; (2) control group received usual or standard care; (3) focus on testing psychosocial strategies to improve anxiety and depression symptoms; and (4) studies conducted with prostate cancer patients at any stage of the disease.The quality of the studies was assessed using the Jadad scoring system. Only 35.7% of studies were regarded as high quality. The majority of studies (85.7%) delivered informational and educational or cognitive-behavioral interventions. The results show that psychosocial strategies have a substantial effect on reducing anxiety 3 months after intervention (standard mean difference -1.13, p0.0001) and have a short-term effect on depression symptoms (immediately after intervention: standard mean difference -0.43, p0.001; 3 months after intervention: standard mean difference -0.78, p=0.04).The results indicate that psychosocial strategies were more effective in reducing anxiety and depression compared with routine care, although the effect was not sustainable. However, high-quality methodologies, longer follow-up designs, and innovative psychosocial strategies are suggested for further study.

The prevalence of peripheral arterial occlusive disease (PAOD) in hemodialysis patients is several times higher than among the general population, and is the main reason for amputations in this group. Patients with peripheral arterial occlusive disease face higher hospitalization and mortality rates associated with cardiovascular disease than non-PAOD patients. The ankle brachial index (ABI) is a widely used PAOD screening tool that may under-estimate PAOD prevalence in the hemodialysis population in the presence of extensive vascular calcification. Studies have demonstrated oxygen saturation in the upper and lower limbs and the "Edinburgh Claudication Questionnaire" as simple screening methods that, in combination with ABI, can increase screening test effectiveness. Early PAOD detection, risk factor modification, medical treatment, and exercise rehabilitation therapy can improve walking function and reduce mortality in PAOD patients.

Background The purpose of this study was to explore the relationship between optimism and life satisfaction among patients with end-stage renal disease who decide to wait or not to wait for kidney transplantation. This cross-sectional, correlation design study was performed from July 2007 to June 2008. Subjects were recruited by purposive sampling in the clinics of kidney transplantation, renal disease, hemodialysis, and peritoneal dialysis. Three hundred fifty questionnaires were distributed, we analyzed the 335 returned including 196 subjects in the waiting group and 139 in the non-waiting group. Parameters included patient basic information, optimism, and life satisfaction scales. Data were analyzed by independent t -student's, chi-square, Pearson correlation, and stepwise multiple regression tests. The subjects in both the waiting and non-waiting groups reported moderate levels of life satisfaction; whereas, the latter reported a greater life satisfaction in general. All participants had good optimism that was positively related to their life satisfaction. Other factors of optimism, age, work ability, waiting transplantation or not, and marriage status were also significantly associated with life satisfaction.

This study is to establish a preliminary computer assisted simulation model for cryoablation of a prostate cancer. It is hoped that the results from this study can supply valuable data for the clinician to refer to before a real cryosurgery or cryotherapy. In order to reach the goal of real implementation, a radiologist and an urologist in a medical center in addition to the engineering specialist from the university participated in this interdisciplinary research program. Firstly, hundreds of the two-dimensional medical imaging photos for the patient are obtained from the magnetic resonance imaging (MRI) in the imaging department of hospital. Through the imaging reconstructive software, these photos are trimmed into building a three-dimensional solid modeling. In this step, the urethra, bladder, prostate and rectum are segmented separately into an engineering graphic solid model with high resolution. Secondly, the number of probes, the position of each probe, and the operating time duration of each probe are determined in advance according to the clinical experience from a surgeon. Meanwhile, these data are transferred into the software package of thermal calculation for numerical simulations. Thirdly, the energy equation in the commercial software is modified to behave bio-heat transfer model by the input of user subroutines. Moreover, the occurrence of phase change during some specified temperature range and the latent heat of fusion are also incorporated into bio-heat transfer model to simulate the clinical situation for cryoablation of prostate cancer. In the simulation model, the three-dimensional transient temperature distributions based on cryosurgery for prostate cancer have been demonstrated precisely. The cryoprobes with various freezing time are considered to observe the temperature distribution. In addition, the frozen rectum is displayed in a region enclosed by a critical isotherm of 0°C. The simulated results for cryosurgery of prostate cancer can be supplied for practicing physicians as reference to greatly improve the effectiveness of cryosurgery.Copyright © 2010 by ASME

Purpose of the research Oral cancer is a common malignant disease in Taiwan. The purpose of this prospective follow-up study was to identify the changes in quality of life for newly diagnosed oral cancer patients during the acute stage. Methods and sample Subjects were recruited from the outpatient department (OPD) in a medical center located in the northern part of Taiwan. 22 subjects completed both the EORTC QLQ-C30 and the EORTC QLQ-H&N35 at diagnosis, postoperative discharge, and the first postoperative follow-up. In addition, 91% of the subjects received surgery only as their main treatment. Key results During the three assessments, as measured by the EORTC QLQ-C30, subjects reported that their physical function was much better at diagnosis than at both postoperative discharge and first postoperative follow-up. Their role functioning was much better at diagnosis than at postoperative discharge. Nevertheless, subjects reported better emotional functioning at the first postoperative follow-up than at the other two points of assessment. Only less financial difficulty was reported in the first postoperative follow-up than at diagnosis and postoperative discharge. For QLQ-H&N35, subjects reported that several symptoms (i.e., swallowing) were more severe at postoperative discharge than at diagnosis. Usage of nutritional supplements at first postoperative follow-up was higher than that at diagnosis. Conclusion Newly diagnosed oral cancer patients reported significant changes in certain domains of both the EORTC QLQ-C30 and QLQ-H&N35. Health professionals need to identify the pattern of changes and to provide supportive care to these new oral cancer patients throughout the treatment process, especially during the planning of discharge.

Cryosurgery is also called as cryoablation or cryoleision. The third generation of cryo-machine use argon gas for cooling and helium for rewarming to destroy cancer cells. The probes may be put into the tumor during surgery or through the skin (percutaneously). After cryosurgery, the frozen tissue thaws and is either naturally absorbed by the body (for internal tumors), or it dissolves and forms a scab (for external tumors). The main purpose of this paper is to establish a preliminary computer assisted simulation in prostate tumor cryosurgery. A radiologist and an urologist in a medical center in addition to the engineering specialist from the university participated in this interdisciplinary research program. The first step of this simulation protocol is to trim hundreds of two-dimensional medical imaging photos from a patient through the imaging reconstructive software into building a three-dimensional solid modeling. The image data for each patient can be obtained from the x-ray computed tomography (CT), or magnetic resonance imaging (MRI) in the imaging department of hospital. It has successfully built up the related knowledge to overcome the complicacy between the medical imaging modalities and engineering graphic solid modeling with high resolution. It is worthy to mention here that the present solid modeling of prostate can demonstrate the variable diameters and courses of the prostate urethra in vivo. The second step focuses on thermal calculation. So far, there has been no existing commercial software for the specific purpose of the bioheat transfer problem. Hence, user subroutines must be added to the existing commercial software to simulate the clinical situation of cryosurgery. For example, the occurrence of phase change during some specified temperature range and the latent heat of fusion are also incorporated into bio-heat transfer model. It has successfully incorporated bioheat transfer model into the software program to fit the reality in thermal medicine. The third step supplies the data and knowledge concerned with the position of a tumor and the related mechanism of metabolism of living tissue and vessels. The number of probes, the position of each probe, and the operating time of each probe will be explored to ensure a complete killing of the tumor tissue while saving as much healthy surrounding tissue as possible. In this study, the three-dimensional transient temperature distributions based on cryosurgery for prostate tumors have been performed for several cases to find the optimal operating conditions. Different cryoprobes with different freezing time are considered to find the temperature distribution. The simulation results for cryosurgery of prostate tumors will be supplied for practicing physicians as reference to greatly improve the effectiveness of cryosurgery.Copyright © 2009 by ASME

This study investigates the transient temperature response in biological tissue with sinusoidal temperature oscillation on the skin surface. Based on the Laplace transform, an exact solution of the Pennes bioheat transfer equation has been derived which includes the whole time domain from the initial transient oscillation to the final steady periodic oscillation. Furthermore, the exact solutions of special cases under no perfusion rate, constant temperature, and the combination of those two assumptions are demonstrated in this study. The primary application for this type of analysis is to assess the blood perfusion rate in the skin by imposing a periodic temperature load onto the skin surface. Through the noninvasive measurement of the maximum heat flux or minimum heat flux on the skin, equation (15) can be utilized to estimate the blood perfusion rate in living tissues. The results show that both the larger perfusion rate and greater tissue depth decrease the amplitude of the sinusoidal temperature response. A larger perfusion rate can also reduce the unstable duration for the estimation of the blood perfusion rate. Meanwhile, the shift of phase angle related to the sinusoidal temperature variation increases with tissue that is deeper and has lower perfusion rate.Copyright © 2008 by ASME

Oral tumors and their treatment cause obvious changes in disfigurement and functions of cancer patients. Therefore, some kind of strategy to improve personal appearance is important in nursing care. This prospective study intended to verify the effects of a cosmetic rehabilitation program on the body image of oral cancer patients.A single-blind quasi-experimental design with repeated-measures design was used in this study. The experimental group received instruction on cosmetic rehabilitation, whereas the control group received regular nursing care. The experimental group and control group each had 22 subjects who were requested to complete the questionnaires throughout the regular follow-up (during admission, after 6 weeks, and after 12 weeks). The Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) was selected for data collection.The results showed that subjects in both experimental and control groups reported similar levels of body image in each subscale of MBSRQ-AS before conducting cosmetic rehabilitation. The appearance evaluation subscale was the only one that changed significantly in both the experimental and control groups during the research period. Nevertheless, results of item comparison showed that cosmetic rehabilitation had improved the scores of "I like the way I am," "most people think that I am good looking," "body weight," and "face" in the experimental group.Present study confirmed that cosmetic rehabilitation had similar effects on the body image of oral cancer patients. Integration of cosmetic program into the routine nursing care for oral cancer patients is highly recommended.

The purpose of this study was to investigate the participatory experience in the treatment related decision-making process of patients receiving radical prostatectomy or high-dosage brachytherapy for localized prostate cancer. Between March 2005 and May 2005, ten patients diagnosed with localized prostate cancer were recruited by purposive sampling at a medical center outpatient department and ward and included in this study, based on a qualitative study design. Semi-structured, guided interviews were employed to collect data. Data were analyzed by content analysis. Results showed that the decision-making experience of these localized prostate cancer patients included the items of greatest concern to patients as well as addressed the factors that made treatment decision-making difficult. Findings may be referenced by medical personnel when they are charged to select optimal treatment options for patients with prostate cancer.

The purpose of this study was to explore the prevalence of workplace violence (WPV) committed by patients and their family members against healthcare workers in south Taiwan. WPV incident questionnaires were completed by 205 nurses from a medical facility in south Taiwan. Sixty-two percent of the nurses reported experiencing WPV. The majority of the cases consisted of verbal abuse including threats of violence or threatening words from patients or families. The verbal expressions of violence were mainly due to misunderstanding and drunkenness on the part of patients and their families, and personal problems in the nurses' relationships with doctors and co-workers. The cases of physical WPV reported by the nurses were perpetrated by patients who were mentally unstable. The findings of this study may help hospitals and nurses in avoiding, reducing, and controlling incidents of WPV.

Background: A phase II clinical trial was performed to evaluate the activity and toxicity of bimonthly cisplatin and weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin in patients with advanced gastric cancer. Patients and methods: From September 1997 to March 1998, 23 chemo-naive patients of advanced gastric cancer were enrolled in this study. The regimen consisted of weekly 24-h infusion of 5-FU (2600 mg/m 2 ) and LV 150 mg and bimonthly cisplatin (25–50 mg/m 2 ) bolus for 12 weeks followed by a 2-week break. Results: There were 10 male and 13 female patients with a median age of 52 years. A total of 428 chemotherapy treatments were given with a mean of 11. Seventeen patients were evaluable for response. There were 41% (7/17) partial response, 18% (3/17) stable disease and 41% (7/17) progressive disease. The grade III or IV toxicity included anorexia 35% (8/23), fatigue 26% (6/23), vomiting 17% (4/23) and mucositis 9% (2/23). One patient developed perforated duodenal stump after chemotherapy. One patient died of hyperammonemia-related coma. The median times to disease progression and overall survival were 3.5 and 7 months, respectively. Conclusions: This regimen showed modest activity against gastric cancer. However, there was no survival advantage and there was greater toxicity than with weekly high-dose 5-FU–LV alone.