Multimodale Therapie bei Tumoren des oberen Gastrointestinaltrakts

Abstract

Adjuvant and neoadjuvant therapeutic principles have in recent years received increasing attention in the management of patients with carcinoma of the upper gastrointestinal tract. A series of randomized prospective trials has demonstrated that adjuvant postoperative radiation or chemotherapy does not result in a convincing survival advantage after complete tumor resection in gastric or esophageal cancer. The available data on the role of neoadjuvant preoperative therapy in these patients as yet permit no conclusion. While neoadjuvant therapy may reduce the tumor mass in a substantial portion of patients, a series of randomized controlled trials has shown that, compared to primary resection, a multimodal approach does not result in a survival benefit in patients with loco-regional, i.e. potentially resectable, tumors. In contrast, in patients with locally advanced tumors, i.e. tumors for which complete removal with primary surgery appears unlikely, neoadjuvant therapy increases the chance for complete tumor resection on subsequent surgery. However, only patients with objective histopathologic response to preoperative therapy appear to benefit from this approach. Compared to preoperative chemotherapy alone, combined radio-chemotherapy increases the rate of response, particularly in squamous cell esophageal cancer, but may also increase postoperative morbidity and mortality. Neoadjuvant therapy should therefore currently only be performed in experienced centers within the context of prospective clinical trials. The identification of factors that would allow prediction of response to neoadjuvant or adjuvant therapy is the focus of ongoing studies.

Microarray-Based Response Prediction in Esophageal Adenocarcinoma

“…A multimodal therapy concept in patients with locally advanced Barrett's carcinoma is still under discussion, because many studies have shown that only patients who respond to a neoadjuvant chemotherapy have a survival benefit (9)(10)(11). In these patients, a neoadjuvant therapy results in a downsizing and a downstaging of the tumor.…”

“…More than 50% of patients present with locally advanced disease (5)(6)(7). In these patients, neoadjuvant chemotherapy seems to increase the chance for a curative resection and enhance survival in responding patients (8)(9)(10)(11). Unfortunately, Barrett's carcinoma shows a very heterogenous behavior in progression and response to neoadjuvant chemotherapy.…”

Bronchoscopy in the preoperative staging of oesophageal cancer below the tracheal bifurcation: a prospective study

“…After the staging, potentially operable patients either proceeded directly to oesophageal resection or received 5-fluorouracil-based neoadjuvant polychemotherapy preoperatively [14]. All patients staged as having tumours potentially resectable for cure were offered surgery.…”

Neoadjuvante Chemotherapie (PELF) beim Magenkarzinom

“…Doch das Karzinom wird bei über der Hälfte der Patienten im fortgeschrittenem Stadium (UICC III/IV) diagnostiziert und die Chance auf eine vollständige Entfernung des Tumors sinkt. Von diesen Patienten werden weniger als 60% kurativ reseziert [19].…”

“…Die 5-Jahres-Überlebensrate (5-JÜR) liegt bei 40-50% in den westlichen Ländern und Japan [14,19,35,59]. Unter kurativer Therapieintention haben frühe Stadien, UICC Ia und Ib, eine 5-JÜR von 83% und 69% sowie 43% im UICC-Stadium II; bei fortgeschrittenen Tumorstadien sinkt sie erheblich und liegt zwischen 28% (UICC III) und 8,7% (UICC IV) [19,33,56,57] [27].…”