Horváth Ors Péter, Papp András, Kalmár Katalin, Cseke László, Yousuf Al-Farhat, Esik Olga
Pécsi Tudományegyetem OEC AOK Sebészeti Klinika.
Magy Seb. 2006 Oct;59(5):333-41.
Formerly the treatment of gastrointestinal cancers was exclusively surgical. Though the results were improved by increased radicality, the real progress was achieved by the introduction of multimodal therapy, particularly by the neoadjuvant concept. The basic prerequisite for neoadjuvant treatment is precise staging and risk assessment. According to staging patients can be divided into three categories: (1) Early cancers, confined to the mucosal and submucosal layers, are approached with primary surgery. (2) Systemically metastasized tumors receive merely palliative treatment. (3) Locally advanced cancers are treated by neoadjuvant therapy. Due to neoadjuvant treatment the tumor can be downsized (or downstaged) in some patients. These are the responders benefiting from the therapy, because of the increased RO-resection rate, decreased recurrence rate and improved survival. The non-responders, by contrast have poor prognosis. Neoadjuvant treatment considerably improved the chance for cure for patients with gastrointestinal cancers, thus this method became an evidence based treatment for locally advanced gastrointestinal cancers.
以前，胃肠道癌症的治疗完全依靠手术。尽管通过提高根治性改善了治疗结果，但真正的进展是通过引入多模式治疗，特别是新辅助治疗概念实现的。新辅助治疗的基本前提是精确分期和风险评估。根据分期，患者可分为三类：（1）局限于黏膜和黏膜下层的早期癌症，采用一期手术治疗。（2）发生全身转移的肿瘤仅接受姑息治疗。（3）局部进展期癌症采用新辅助治疗。由于新辅助治疗，一些患者的肿瘤可以缩小（或降期）。这些是从治疗中受益的反应者，因为根治性切除率提高、复发率降低且生存率提高。相比之下，无反应者预后较差。新辅助治疗显著提高了胃肠道癌症患者的治愈机会，因此这种方法成为局部进展期胃肠道癌症的循证治疗方法。
