We performed a pilot study of combination chemotherapy with TS-1 and cisplatin for highly advanced gastric cancer. From June 2002, 12 patients with multiple liver metastases, carcinomatous lymphangitis or peritoneal dissemination, were enrolled in the study. TS-1 was administered at a daily dose on day 1-21 and an intermediate-dose of cisplatin (60 mg/m2) was administered on day 8. The combination was repeated in a 5-week cycle. The median administered cycles were three (one to eight). An objective response was obtained in 9 cases (75.0%) of primary sites and 6 cases of metastatic sites. No severe hematological toxicity occurred, and grade 3 stomatitis (in one case) and vomiting (in two cases) occurred as non-hematological toxicities. The improvement of clinical symptoms such as appetite loss and abdominal discomfort was obtained in 9 of 10 cases. The median survival time is 244 days. The TS-1/CDDP regimen had almost no survival benefits, but may induce relief of symptoms due to cancer and better quality of life.