Moehler Markus, Galle P R, Gockel I, Junginger T, Schmidberger H
First Department of Internal Medicine, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany.
Best Pract Res Clin Gastroenterol. 2007;21(6):965-81. doi: 10.1016/j.bpg.2007.10.003.
Although radical surgical R0 resections are the basis of cure for gastric cancer, surgery alone only provides long-term survival in 20-30% of patients with advanced-stage disease. Thus, in Western and European countries, advanced gastric cancer has a high risk of recurrence and metachronous metastases. Very recently, multimodal strategies combining different neoadjuvant and/or adjuvant protocols have improved the prognosis of gastric cancer when combined with surgery with curative intent. As used in palliative regimens, the combination of cisplatin with intravenous or oral fluoropyrimidines has been the integral component of such (neo)adjuvant strategies. However, the cytotoxic agents docetaxel, oxaliplatin and irinotecan and new targeted biologicals such as cetuximab, bevacizumab or panitumumab are currently under investigation, with or without irradiation, in multimodal treatment regimens. These studies may further increase R0 resection rates, and prolong disease-free and overall survival times in the treatment of advanced gastric cancer. This article reviews the most relevant literature on multimodal treatment of gastric cancer, and discusses future strategies to improve locoregional failures.
尽管根治性手术R0切除是胃癌治愈的基础，但仅手术治疗只能使20%至30%的晚期疾病患者获得长期生存。因此，在西方国家，进展期胃癌有很高的复发和异时转移风险。最近，将不同新辅助和/或辅助方案相结合的多模式策略与根治性手术联合应用时，改善了胃癌的预后。在姑息治疗方案中，顺铂与静脉或口服氟嘧啶联合使用一直是此类（新）辅助策略的重要组成部分。然而，细胞毒性药物多西他赛、奥沙利铂和伊立替康以及新的靶向生物制剂，如西妥昔单抗、贝伐单抗或帕尼单抗，目前正在多模式治疗方案中接受研究，无论是否联合放疗。这些研究可能会进一步提高R0切除率，并延长进展期胃癌治疗中的无病生存期和总生存期。本文综述了胃癌多模式治疗的最相关文献，并讨论了改善局部区域失败的未来策略。
