Gastric Cancer

摘要

The standard of care for resectable gastric cancer for patients who can tolerate a surgical procedure is surgical resection. For patients with lower risk lesions (confined to gastric wall, nodes negative; T1-2N0M0), adjuvant treatment is usually not recommended except in select instances. Since both local and systemic relapses are common after resection of high-risk gastric cancers (beyond wall, nodes positive, or both; T3-4N0, TanyN+), adjuvant treatment is indicated for these patients. The results of phase III trials that demonstrate a survival benefit for preoperative irradiation (Beijing), postoperative chemoradiation (US GI Intergroup 0116), or preoperative chemoradiation (gastroesophageal [GE] junction/esophagus – GI Intergroup CALGB 9781) will be discussed ( Tables 1 – 2 ). Table 1. Surgery ± adjuvant therapy for resected gastric cancer (or gastroesophageal junction). Table 2. Results of tri-modality phase III trials – esophagus/E-G junction cancer. For patients with locally advanced disease that appears unresectable for cure, several treatment options appear to favorably affect disease control and survival. These include primary external beam irradiation (EBRT) plus concurrent chemotherapy, maximal resection plus intraoperative irradiation (IORT), and preoperative chemotherapy or chemoradiation prior to resection. Results of these approaches will be summarized ( Table 3 ). Table 3. Treatment algorithm – gastric cancer/GE junction; Mayo Clinic Cancer Center – Arizona. Gastrointest Cancer Res. 2008 Sep-Oct; 2(5 Suppl 3): S17–S21. ? ABSTR 0836 – Oral Presentation Gastrointest Cancer Res. 2008 Sep-Oct; 2 (5 Suppl 3) : S18. ABSTR 0836 – Oral Presentation Localized Gastric Cancer: Chemoradiation Is Not Always Needed Aaron R. Sasson Department of Surgery, University of Nebraska Medical Center, Eppley Cancer Center, Omaha, NE, USA Author information ? Copyright and License information ? Copyright ? 2008 by the International Society of Gastrointestinal Oncology (ISGIO). All rights reserved