Wils J, Meyer H J, Wilke H
Department of Oncology, Laurentius Hospital, Roermond, The Netherlands.
Ann Oncol. 1994;5 Suppl 3:69-72. doi: 10.1093/annonc/5.suppl_3.s69.
Although extended surgery plus systematic lymphadenectomy may improve the prognosis of patients with stage II/IIIa (UICC classification) tumors, there is no doubt, that the results of surgery of gastric cancer have reached a plateau. An improvement of the current situation can be expected at best by additional treatment modalities in order to reduce local recurrences and distant metastases. For locally advanced gastric cancer (LAGC), which includes approximately two-thirds of patients with locoregionally confined tumors, preoperative chemotherapy represents a promising approach. In surgically or clinically staged inoperable LAGC, approximately half of the patients underwent complete (R0) resection after downstaging induced by active modern chemotherapy. The long-term survival of these patients appears to be about 20%. Well designed randomized studies, however, comparing surgery alone versus preoperative chemotherapy, should be undertaken in LAGC. In view of the high local recurrence rate being observed in published preoperative chemotherapy trials, the inclusion of radiotherapy (intraoperative radiotherapy, simultaneous chemoradiotherapy) or intraperitoneal chemotherapy should be considered for future investigations. In more early stages, curatively resected, adjuvant chemotherapy has no proven impact so far. Whether this will change with the use of more active chemotherapy or better timing of adjuvant treatment remains to be seen. Neoadjuvant chemotherapy has proven to be feasible and active also in potentially resectable tumors. Therefore, preoperative chemotherapy appears to be an attractive tool for clinical investigations also in earlier stages of gastric cancer.
尽管扩大手术联合系统性淋巴结清扫术可能会改善II/IIIa期（国际抗癌联盟分类）肿瘤患者的预后，但毫无疑问，胃癌手术的效果已达到瓶颈。目前最好期望通过增加其他治疗方式来改善现状，以减少局部复发和远处转移。对于局部进展期胃癌（LAGC），约占局部区域局限肿瘤患者的三分之二，术前化疗是一种很有前景的方法。在手术或临床分期为不可切除的LAGC中，约一半的患者在积极的现代化疗诱导降期后接受了根治性（R0）切除。这些患者的长期生存率约为20%。然而，对于LAGC，应开展精心设计的随机研究，比较单纯手术与术前化疗。鉴于在已发表的术前化疗试验中观察到较高的局部复发率，未来的研究应考虑纳入放疗（术中放疗、同步放化疗）或腹腔内化疗。在更早期阶段，对于根治性切除的患者，辅助化疗目前尚未显示出确切疗效。随着使用更有效的化疗或优化辅助治疗的时机，这种情况是否会改变仍有待观察。新辅助化疗在潜在可切除的肿瘤中也已证明是可行且有效的。因此，术前化疗似乎也是早期胃癌临床研究的一个有吸引力的工具。
