Multimodale Therapie beim lokal fortgeschrittenen Magenkarzinom

Abstract

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.

Neoadjuvant Chemotherapy Followed by Surgery versus Surgery Alone for Gastric Carcinoma: Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…NAC has several advantages including good toleration, better control of micrometastasis, and potentiality to downstage tumor and increase the probability of R0 resection so as to facilitate surgery [61]. NAC has been proven effective against some cancers, especially breast cancer [62]–[65].…”

Phase II study of Epirubcin, Cisplatin and Capecitabine as Neoadjuvant chemotherapy for resectable gastric and gastroesophageal junction cancer

“…The advanced gastroesophagealand gastric cancers (stage III-IVB) without evidence of distant metastasis are potentially curable, but these tumors usually present with a more advanced stage and are associated with a worse prognosis 20 , and a combination therapy, including surgery, chemotherapy and radiotherapy, is often needed. Chemotherapy is an adjuvant treatment modality in the form of adjuvant chemotherapy, NAC and concomitant chemoradiotherapy [21]. NAC has several advantages: (1) it is well tolerated; (2) it can better control the micrometastasis 22 ; and (3) it might downstage the tumor to the greatest extent and increase the probability of R0 resection so as to facilitate the surgery 23 , thus improving the survival rate of the patients with gastroesophageal and gastric cancer.…”