Department of Surgery, School of Medicine, Technical University of Munich, Germany.
Expert Rev Anticancer Ther. 2021 May;21(5):511-522. doi: 10.1080/14737140.2021.1868991. Epub 2021 Jan 8.
To date, all efforts to fight gastrointestinal cancer, regardless of its origin and entity, have resulted in complex therapeutic regimens involving a combination of systemic therapy, radiation therapy and surgery. It is generally accepted across all disciplines that not one, but the combination and the proper timing of all modalities result in the best oncologic outcome.
Here, we provide insight into the current and future value of multimodal therapeutic approaches for upper and lower gastrointestinal cancer. Various aspects of treatment as well as open questions regarding indication and timing of multimodal strategies are addressed in this review.
In order to further improve the survival and quality of life of patients with gastrointestinal tumors in the future, scientifically proven multimodal therapy concepts are needed first and foremost. In addition, markers are pivotal to assign individual patients to a specific concept and to monitor the success of therapy. The main question is in which situation a neoadjuvant, perioperative or adjuvant radio-, chemo- or immunotherapy is superior. In fact, almost every curatively intended concept still contains surgical resection. Thus, improvement in surgical technique is also critical for multimodality concepts.
迄今为止，针对胃肠道癌的所有治疗方法，无论其起源和实体如何，均导致了复杂的治疗方案，包括系统治疗、放射治疗和手术的联合应用。所有学科普遍认为，不是一种治疗方法，而是所有治疗方法的联合应用及其适当的时机，才能带来最佳的肿瘤学疗效。
本文提供了对上下胃肠道癌的当前和未来多模式治疗方法的价值的深入了解。本文综述了治疗的各个方面以及关于多模式策略的适应证和时机的开放性问题。
为了在未来进一步提高胃肠道肿瘤患者的生存和生活质量，首先需要有科学证明的多模式治疗概念。此外，标志物对于将个别患者分配到特定的治疗方案以及监测治疗的成功至关重要。主要问题在于新辅助、围手术期或辅助的放化疗或免疫治疗在何种情况下具有优势。事实上，几乎每一种有治愈意图的方案中仍然包含手术切除。因此，手术技术的改进对于多模式治疗方案也很关键。
