Perioperative therapy for locally advanced gastroesophageal cancer: current controversies and consensus of care.
Perioperative therapy for locally advanced gastroesophageal cancer: current controversies and consensus of care.
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DOI：
10.1186/1756-8722-6-66
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发表时间：
2013-09-05
影响因子：
28.5
通讯作者：
Catenacci DV
中科院分区：
文献类型：
--
作者：
Sehdev A;Catenacci DV
胃食管癌（GEC）仍然是肿瘤学中的一个具有挑战性的问题。从解剖学上讲，GEC 由远端胃腺癌 (GC) 组成，通常与幽门螺杆菌相关，而近端食管胃腺癌 (EGJ AC) 的发病率在过去几年中显着增加。尽管远端和近端 GEC 的病因、组织学和分子表型不同，但在许多情况下，围手术期（和转移性）治疗策略趋于相似。对于接受根治性手术的患者，与单独手术相比，手术前和/或手术后围手术期化疗和/或放化疗的进展已证明其生存率有所提高。本综述重点关注 Z 线的“边界”和/或“近端”(EGJ) 与“远端”(GC) 癌症的解剖学区别如何导致临床试验入组的不同纳入/排除标准，包括手术前和/或手术后化疗和放疗的各种组合。因此，每种方法的支持证据导致地理区域和机构/医生根据不同的经验、偏好和临床情况采取许多不同的做法。目前缺乏对这些方法的充分直接比较，但未来几年应该可以获得来自许多共同努力的数据，以进一步指导最佳护理标准。正在评估生物靶向药物的引入，即抗血管生成药物和抗 HER 家族治疗药物，以确定是否可以比单独使用传统的细胞毒性化疗（联合/不联合放疗）获得进一步的治疗效果。迄今为止，新型分子靶向药物尚未在这种情况下显示出益处。在下面的全面综述中，我们将解决局部晚期 GEC 围手术期治疗的复杂性，重点是支持各种围手术期多学科方法的临床试验。
Gastroesophageal cancer (GEC) remains a challenging problem in oncology. Anatomically, GEC is comprised of distal gastric adenocarcinoma (GC), classically associated with Helicobacter Pylori, while proximal esophagogastric adenocarcinoma (EGJ AC) has increased significantly in incidence over the past years. Despite contrasting etiologies, histologies, and molecular phenotypes of distal and proximal GEC, in many cases perioperative (and metastatic) treatment strategies converge to similar approaches. For patients undergoing curative intent surgery, advances in perioperative chemotherapy and/or chemoradiotherapy, either before and/or after surgery, have demonstrated improved survivals compared to surgery alone. This review focuses on how the ‘boundary’ of the Z-line and/or the anatomical distinction of ‘proximal’ (EGJ) vs. ‘distal’ (GC) cancer has led to diverse inclusion/exclusion criteria for clinical trial enrollment, embodying various combinations of chemotherapy and radiation before and/or after surgery. Supporting evidence of each of these approaches consequently has led to a number of varying practices by geographical region and Institution/Physician, based on differing experience, preference, and clinical circumstance. Adequate direct comparison of these approaches is lacking currently, but data from a number of concerted efforts should be available in the next years to further direct best standards of care. Introduction of biologically targeted agents, namely anti-angiogenics and anti-HER family therapeutics are being evaluated to determine whether further therapeutic gains can be realized over classic cytotoxic chemotherapy alone (with/without radiotherapy). To date, novel molecularly targeted agents have yet to demonstrate benefit in this setting. In the following comprehensive review we will address the intricacies of perioperative treatment of locally advanced GEC, with focus on clinical trials supporting the diverse set of perioperative multidisciplinary approaches.
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影响因子：
45.3
作者：
Kelsen, David P.;Winter, Katryn A.;Willett, Christopher G.
通讯作者：
Willett, Christopher G.
影响因子：
51.1
作者：
Gebski, Val;Burmeister, Bryan;Simes, John
通讯作者：
Simes, John
影响因子：
158.5
作者：
Kelsen, DP;Ginsberg, R;Roth, JA
通讯作者：
Roth, JA
影响因子：
45.3
作者：
Allum, William H.;Stenning, Sally P.;Langley, Ruth E.
通讯作者：
Langley, Ruth E.
DOI：
10.1186/1748-717x-7-169
发表时间：
2012-10-15
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Costa WL Jr;Coimbra FJ;Fogaroli RC;Ribeiro HS;Diniz AL;Begnami MD;Mello CA;Fanelli MF;Silva MJ;Fregnani JH;Montagnini AL
通讯作者：
Montagnini AL