Kodera Yasuhiro, Fujiwara Michitaka, Koike Masahiko, Nakao Akimasa
Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
World J Gastroenterol. 2006 Apr 7;12(13):2000-5. doi: 10.3748/wjg.v12.i13.2000.
Prognosis of locally advanced gastric cancer remains poor, and several multimodality strategies involving surgery, chemotherapy, and radiation have been tested in clinical trials. Phase III trial testing the benefit of postoperative adjuvant chemotherapy over treatment with surgery alone have revealed little impact on survival, with the exception of some small trials in Western nations. A large trial from the United States exploring postoperative chemoradiation was the first major success in this category. Results from Japanese trials suggest that moderate chemotherapy with oral fluoropyrimidines may be effective against less-advanced (T2-stage) cancer, although another confirmative trial is needed to prove this point. Investigators have recently turned to neoadjuvant chemotherapy, and some promising results have been reported from phase II trials using active drug combinations. In 2005, a large phase III trial testing pre- and postoperative chemotherapy has proven its survival benefit for resectable gastric cancer. Since the rate of pathologic complete response is considered to affect treatment results of this strategy, neoadjuvant chemoradiation that further increases the incidence of pathologic complete response could be a breakthrough, and phase III studies testing this strategy may be warranted in the near future.
局部晚期胃癌的预后仍然很差，一些涉及手术、化疗和放疗的多模式治疗策略已在临床试验中进行了测试。测试术后辅助化疗相对于单纯手术治疗的益处的III期试验显示，除了西方国家的一些小型试验外，对生存率几乎没有影响。美国一项探索术后放化疗的大型试验是这一领域的首个重大成功案例。日本试验的结果表明，口服氟嘧啶的适度化疗可能对进展期较轻（T2期）的癌症有效，不过还需要另一项验证性试验来证实这一点。研究人员最近转向了新辅助化疗，使用活性药物组合的II期试验已报告了一些有前景的结果。2005年，一项测试术前和术后化疗的大型III期试验已证明其对可切除胃癌的生存益处。由于病理完全缓解率被认为会影响该治疗策略的治疗效果，进一步提高病理完全缓解发生率的新辅助放化疗可能是一个突破，测试该策略的III期研究可能在不久的将来是必要的。
