Samalin Emmanuelle, Ychou Marc
Department of Digestive Oncology, CRLC Val d'Aurelle, Montpellier, France.
Curr Opin Oncol. 2007 Jul;19(4):384-9. doi: 10.1097/CCO.0b013e3281a73674.
Despite a decline in the incidence of upper gastrointestinal adenocarcinomas in North America and western Europe during the past century, treatment remains a challenging problem for oncologists. The poor outcome associated with surgical resection with curative intent has generated intensive investigation of combined modality treatment approaches including systemic chemotherapy to prevent recurrences and improve overall mortality. This article reviews data on neoadjuvant and perioperative treatment modalities for upper gastrointestinal adenocarcinomas.
Postoperative chemoradiation is favored in the USA for good performance status patients with resected, high-risk gastric or gastroesophageal junction carcinoma (more stage IA). More recently, the UK Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) and Fédération Nationale des Centres de Lutte Contre le Cancer-Fédération Francophone de Cancérologie Digestive trials results, showing survival benefit with perioperative chemotherapy in operable gastric and lower esophageal cancers, have had an impact on the treatment practice in Europe.
Novel strategies, involving induction with chemotherapy followed by preoperative chemoradiation, addition of targeted therapies to perioperative chemotherapy or use of new cytotoxic regimens are under evaluation to improve current standards and try to tailor therapeutic strategies.
尽管在过去一个世纪北美和西欧上消化道腺癌的发病率有所下降，但治疗仍然是肿瘤学家面临的一个具有挑战性的问题。与根治性手术切除相关的不良预后促使人们对包括全身化疗在内的综合治疗方法进行深入研究，以预防复发并提高总体死亡率。本文综述了上消化道腺癌新辅助和围手术期治疗方式的数据。
在美国，对于体能状态良好、已切除的高危胃癌或胃食管交界癌（更多为IA期）患者，术后放化疗更受青睐。最近，英国医学研究委员会辅助性胃癌灌注化疗（MAGIC）试验以及法国国立癌症中心联合会-法语国家消化肿瘤学联合会试验结果显示，可手术的胃癌和下段食管癌患者围手术期化疗有生存获益，这对欧洲的治疗实践产生了影响。
为了提高当前标准并尝试制定个性化治疗策略，正在评估新的策略，包括化疗诱导后进行术前放化疗、在围手术期化疗中添加靶向治疗或使用新的细胞毒性方案。
