Neoadjuvant chemotherapy for locally advanced gastric cancer: With or without radiation.
Neoadjuvant chemotherapy for locally advanced gastric cancer: With or without radiation.
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DOI：
10.4240/wjgs.v4.i2.27
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发表时间：
2012-02
影响因子：
2
通讯作者：
A. Wu;J. Ji
中科院分区：
文献类型：
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作者：
A. Wu;J. Ji
围手术期化疗在晚期胃癌中的作用已经确立。在世界上大多数地区，甚至在日本和韩国，胃癌根治性切除后的局部复发仍然是一个问题。是否应该在化疗的基础上加入放射治疗，以实现更好的局部和区域控制？目前的证据是什么？关于新辅助化疗在安全性、有效性和生存益处方面的担忧是什么？在认真阅读了文献后，作者得出结论，现在得出明确的答案还为时过早，但辐射似乎是有希望的。可能会带来较高的病理应答率。合理地说，需要更多高水平的临床试验来确认放射治疗在新辅助治疗中的作用，或确定可能从中受益的患者亚群。值得注意的是，外科医生应注意放疗后可能出现的复杂情况，保持适当的营养状况，最大限度地减少术后并发症的发生。由于在日本和韩国获得的数据很少，解释和实施新辅助放射治疗或化学放射治疗应谨慎行事。
The role of perioperative chemotherapy for gastric cancer has been established for gastric cancers in their advanced stage. In most parts of the world, even in Japan and Korea, local recurrence of gastric cancer following curative resection remains a problem. Should radiation be added to chemotherapy to achieve better local and regional control? What is the current evidence? What are the concerns regarding neoadjuvant chemoradiation in terms of safety, efficacy and survival benefit? After a serious review of the literature, the authors conclude that it is still too early to get a definitive answer but radiation seems promising. It may bring a higher pathological response rate. Rationally, more high level clinical trials are needed to confirm the role of radiotherapy in the neoadjuvant setting or to ascertain subsets of patients who may benefit from it. It is of note that surgeons should pay attention to possible complicated circumstances following radiotherapy, maintain proper nutrition status and minimize the occurrence of postoperative complications. As few data are available in Japan and Korea, interpretation and implementation of neoadjuvant radiation or chemoradiation should be done with caution.