Bölke E, Peiper M, Knoefel W T, Baldus S E, Schauer M, Matuschek C, Gerber P A, Hoff N-P, Budach W, Gattermann N, Erhardt A, Scherer A, Buhren B A, Orth K
Klinik für Strahlentherapie und Radiologische Onkologie, Universitätsklinik Düsseldorf.
Dtsch Med Wochenschr. 2011 Oct;136(43):2205-11. doi: 10.1055/s-0031-1292034. Epub 2011 Oct 18.
Locally advanced gastric cancers are characterized by poor prognosis. Clinical outcome can be improved if surgery becomes part of a multimodal treatment approach. The purpose of neoadjuvant treatment includes downsizing of the primary tumor, improvement of the T- and N- categories, and early therapy of micrometastasis. Several controlled clinical trials showed that neoadjuvant chemotherapy as well as neoadjuvant combined radio-chemotherapy, especially for tumors of the gastroesophageal junction, can improve the rate of primary R0 resections, relapse-free survival, and overall survival. While patients with locally advanced tumors clearly benefit from this strategy, the approach is still controversial in patients with early stage disease. Nonresponders do not benefit from neoadjuvant therapy. Therefore, response evaluation and response prediction are of great importance. After successful neoadjuvant chemotherapy, patients should undergo gastrectomy with D(2)-lymphadenectomy because of a high probability of lymph node metastasis. This article summarizes current developments in this field.
局部进展期胃癌的特点是预后较差。如果手术成为多模式治疗方法的一部分，临床结局可以得到改善。新辅助治疗的目的包括缩小原发肿瘤大小、改善T分期和N分期，以及对微转移进行早期治疗。多项对照临床试验表明，新辅助化疗以及新辅助放化疗，尤其是对于胃食管交界部肿瘤，可提高R0根治性切除率、无复发生存率和总生存率。虽然局部进展期肿瘤患者明显从该策略中获益，但该方法在早期疾病患者中仍存在争议。无反应者无法从新辅助治疗中获益。因此，疗效评估和疗效预测非常重要。新辅助化疗成功后，由于存在淋巴结转移的高可能性，患者应接受D（2）淋巴结清扫的胃切除术。本文总结了该领域的当前进展。
