Efficacy of current adjuvant and neoadjuvant therapeutic concepts in gastric cancer?

Zentralblatt für Chirurgie
A Kretzschmar, P M Schlag

Abstract

The incidence of gastric cancer in Europe is declining but the prognosis after curatively intended surgery remains dismal. In recent years several studies and meta-analysis concerning the impact of adjuvant postoperative chemotherapy and chemoradiation as well as preoperative chemotherapy were published. This review aims to interpret results and to support decision making in individual patients. Results of trials on adjuvant chemotherapy were inconsistent and the studies were underpowered to detect meaningful but modest advantages. Meta-analyses including more than 3 000 patients revealed a significant survival benefit but no specific chemotherapy protocol can be regarded an optimal regimen. Postoperative adjuvant schedules including cisplatin led to high drop out rates due to toxicity. Applying cisplatin and infusional fluorouracil initially after diagnosis as a so called neoadjuvant therapy is better tolerated. Two trials testing this approach showed a significant survival benefit with preoperative cisplatin and infusional fluorouracil as compared to surgery alone. Postoperative chemoradiation was shown to be effective concerning local regional relapses and survival benefit in a large trial in the US but the majority of patie...Continue Reading

Citations

Jan 12, 2007·Zhong xi yi jie he xue bao = Journal of Chinese integrative medicine·Zhen-ye Xu, Zhan Zheng
Oct 1, 2008·International Journal of Colorectal Disease·Sarah BhargavaHubert G Hotz

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