S3-Leitlinie „Magenkarzinom” -

Moehler, Markus; Al-Batran, S.; Andus, Tilo; Anthuber, M; Arends, Jann; Arnold, Dirk; Aust, D.; Baier, P.; Baretton, Gustavo; Bernhardt, J.; Boeing, Heiner; Böhle, E.; Bokemeyer, C.; Bornschein, Jan; Budach, Wilfried; Burmester, Eike; Caca, Karel; Diemer, W.; Dietrich, CF; Ebert, Matthias; Eickhoff, A.; Ell, C.; Fahlke, J.; Feussner, H.; Fietkau, Rainer; Fischbach, Wolfgang; Fleig, Wolfgang E.; Flentje, M.; He, Guimei; Galle, PR; Geißler, Michael; Gockel, Ines; Graeven, U.; Grenacher, Lars; Groß, Sophie E.; Hartmann, J; Heike, Michael; Heinemann, Volker; Herbst, Brian T.; Herrmann, Thomas; Höcht, Stefan; Hofheinz, R. D.; Höfler, Heinz; Hawranek, Thomas; Hölscher, A. H.; Horneber, Markus; Hübner, Julia; Izbicki, J. R.; Jakobs, Ralf; Jenssen, Christian; Kanzler, Stephan; Keller, Maren; Kießlich, Ralf; Klautke, Günther; Körber, J.; Krause, BJ; Kühn, Christina; Kullmann, Frank; Lang, Hervé; Link, Hartmut; Lordick, Florian; Ludwig, Kandice K.; Lutz, Manfred P.; Mahlberg, Rolf; Malfertheiner, Peter; Merkel, Susanne; Messmann, Helmut; Meyer, h.c. H.-J.; Mönig, Stefan P.; Piso, Pompiliu; Pistorius, Steffen; Porschen, Rainer; Rabenstein, Thomas; Reichardt, Peter; Ridwelski, K.; Röcken, Christoph; Roetzer, Ingeborg; Rohr, P.; Schepp, Wolfgang; Schlag, P. M.; Schmid, RM; Schmidberger, Heinz; Schmiegel, W; Schmoll, H.-J.; Schuch, Gunter; Schuhmacher, Christoph; Schütte, Katharina; Schwenk, Walter; Selgrad, Michael; Sendler, A.; Seraphin, Jörg; Seufferlein, T; Ståhl, Michael; Stein, H; Stoll, Christoph; Stuschke, Martin; Tannapfel, Andrea; Tholen, Reina; Thuss-Patience, P.; Treml, K.; Vanhoefer, U.; Vieth, Michael; Vogelsang, Heike; Wagner, Dorothea; Wedding, U.; Weimann, Arved; Wilke, H.; Wittekind, Christian

doi:10.1055/s-0031-1273201

Cited by 255 publications

(81 citation statements)

References 122 publications

(109 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgery remains the first-choice treatment for resectable esophageal cancer [1]. Resection of node-negative early esophageal cancer usually allows long-term survival, but the prognosis is poor with esophagectomy alone for advanced stages.…”

Section: Introductionmentioning

confidence: 99%

The Current Evidence in Support of Multimodal Treatment of Locally Advanced, Potentially Resectable Esophageal Cancer

Zacherl¹

2014

Dig Dis

View full text Add to dashboard Cite

Background: Treatment of locally advanced resectable esophageal cancer is challenging. In the past three decades surgical treatment has become safer, chemotherapy more powerful and radiation techniques more precise. Today's stage-dependent treatment relies on modern diagnostic tools such as multidetector helical CT, high-frequency endoscopic ultrasound, PET, image fusion techniques and MRI. Specialists cooperate on multidisciplinary tumor boards that follow transparent decision trees based on the newest evidence. Methods: Results of recent randomized controlled trials are examined with emphasis on their reliability and comparability. Results: Patients with esophagogastric cancer undergoing neoadjuvant chemotherapy, perioperative chemotherapy and neoadjuvant radiochemotherapy plus esophagectomy had a higher R-0 resection rate, fewer involved lymph nodes and better overall survival than with esophagectomy alone. While perioperative morbidity and mortality were not remarkably enhanced by neoadjuvant chemotherapy, several trials showed an increase of mortality after neoadjuvant radiochemotherapy. Adenocarcinoma seems to respond better to chemotherapy than squamous cell cancer, and squamous cell cancer seems to respond better to radiochemotherapy than adenocarcinoma. Conclusion: On the basis of the results of randomized trials, preoperative treatment of esophageal cancer shows a survival benefit and should be recommended as the standard treatment strategy in advanced esophageal cancer. While preoperative radiochemotherapy is the standard for advanced squamous cell cancer, both chemotherapy and radiochemotherapy may be adopted for neoadjuvant/perioperative treatment of adenocarcinoma depending on the patient's general condition. Markers to predict response are urgently needed since only responders benefit from multimodal treatment and nonresponders suffer potential harm when surgery is delayed.

show abstract

Section: Introductionmentioning

confidence: 99%

The Current Evidence in Support of Multimodal Treatment of Locally Advanced, Potentially Resectable Esophageal Cancer

Zacherl¹

2014

Dig Dis

View full text Add to dashboard Cite

show abstract

“…In our opinion, these inclusion criteria were important in order to assess how many patients with cT2 tumors received neoadjuvant treatment and if this preoperative therapy induced a survival benefit. Moreover, according to the German S3 guidelines, the cN category is not relevant for the decision for neoadjuvant treatment, only the cT category [26]. Therefore, in case of a cT2 category, a neoadjuvant treatment ‘can' be applied.…”

Section: Discussionmentioning

confidence: 99%

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Vallböhmer

Sisic²,

Blank³

et al. 2014

Oncol Res Treat

View full text Add to dashboard Cite

Background: Multimodality treatment options in locally advanced adenocarcinomas of the esophagogastric junction (AEGs) have been established in the last years. However, the therapeutic approach in patients with clinically staged cT2 tumors remains controversial. The most important determinant is the accuracy of clinical staging. We aimed to evaluate the association of clinical and histopathological staging in patients with cT2 tumors in respect of possible therapeutic consequences. Patients and Methods: Between 2001 and 2011, 71 patients with AEG tumors were clinically staged as cT2 (cN0 = 48 (68%); cN+ = 23 (32%)) and underwent surgical resection. Results: A primary tumor resection was performed in 59 (83%) patients while 12 (17%) patients received neoadjuvant therapy. Primarily resected patients showed the following pT/pN categories: pT1: 13 (22%), pT2: 35 (59%), pT3: 11 (19%), pN0: 23 (39%), whereas the clinical/histopathological pN category included 55% of the patients. Neoadjuvantly treated patients showed the following pT/pN categories: ypT0: 3 (25%), ypT1: 3 (25%), ypT2: 6 (50%), ypN0: 6 (50%). The overall survival of primarily resected patients compared with patients undergoing neoadjuvant therapy was not significantly different. Conclusions: The accuracy of clinical staging in patients with cT2 tumors of the gastroesophageal junction is poor. As in primarily resected patients, over- and understaging balance each other; correct pretherapeutic staging occurs in just about 60% of the patients. Moreover, our study suggests that a radical surgical resection with adequate lymphadenectomy seems to be appropriate for cT2N0 and even in cT2N+ tumors, since down-categorizing and prognosis are not improved for neoadjuvantly treated patients. However, the data have to be interpreted with caution because of the small patient numbers.

show abstract

“…Nevertheless, based on published data, the EORTC St. Gallen International Expert Consensus Conference recommended preoperative chemoradiotherapy as the preferred treatment for AEG type I/II tumors (Siewert classification) [8]. Other national guidelines support this statement [14] and preoperative chemoradiotherapy is increasingly used in this indication in the West.…”

Section: Preoperative Chemoradiotherapymentioning

confidence: 99%

(Neo)-Adjuvant Chemo(-Radio) Therapy for Adenocarcinomas of the Gastroesophageal Junction and the Stomach in the West

Wilke

Lordick²,

Meyer³

et al. 2013

Dig Surg

View full text Add to dashboard Cite

Worldwide, the treatment of adenocarcinomas of the gastroesophageal junction and stomach has changed over the past decades. It is no longer surgery alone. Nowadays, most patients undergo surgery plus pre- and/or postoperative therapies. However, there are still marked differences in surgical procedures between the East and the West which might influence the surgical prognosis and thereby also the choice of perioperative treatment strategies. In the East, with its more extended surgical procedures, including standard D2 dissections, the current treatment philosophy is primary surgery followed by adjuvant chemotherapy. Neoadjuvant approaches are restricted to really advanced tumors, and perioperative chemoradiation is not routinely used (at least to date). This clearly differs from treatment strategies currently recommended in Western countries. In Europe and North America, pre- plus postoperative chemotherapy has become the recommended treatment for locally more advanced tumors, and preoperative chemoradiation is increasingly administered to patients with adenocarcinomas of the gastroesophageal junction (Siewert type I/II). However, the role of postoperative chemotherapy (despite its increasing use) is still under discussion in the West (especially Europe) and not generally recommended/accepted as a standard treatment. Postoperative chemoradiation, which is one standard treatment in North America, is only regarded as a treatment option for patients after ‘inadequate surgery' (i.e.

show abstract

S3-Leitlinie „Magenkarzinom” -

Cited by 255 publications

References 122 publications

The Current Evidence in Support of Multimodal Treatment of Locally Advanced, Potentially Resectable Esophageal Cancer

The Current Evidence in Support of Multimodal Treatment of Locally Advanced, Potentially Resectable Esophageal Cancer

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

(Neo)-Adjuvant Chemo(-Radio) Therapy for Adenocarcinomas of the Gastroesophageal Junction and the Stomach in the West

Contact Info

Product

Resources

About