[Neoadjuvant Therapy in the Upper Gastro-intestinal Tract. Modern Strategies for Barrett's Cancer]

Overview

Journal Chirurg

Specialty General Surgery

Date 2009 Nov 11

PMID 19902287

Authors

H J Stein

M Feith

J R Siewert

Affiliations

Soon will be listed here.

Abstract

While primary surgical resection with systematic lymphadenectomy remains the treatment of choice for locoregional Barrett's cancer, neoadjuvant chemotherapy is an increasingly accepted treatment modality for patients with locally advanced tumors and patients with extensive lymphatic spread. In contrast to neoadjuvant radiochemotherapy preoperative chemotherapy alone does not seem to increase peri-operative complications and mortality. Responders to pre-operative treatment clearly have a survival advantage as compared to those who do not respond. The use of positron emission tomography to measure changes in glucose metabolism of the primary tumor can predict response early after initiation of neoadjuvant chemotherapy and thus help to select patients who will or will not benefit from this approach. The best treatment strategy for non-responders to neoadjuvant therapy remains to be defined.

References

Lordick F, Ebert M, Stein H . Current treatment approach to locally advanced esophageal cancer: is resection mandatory?. Future Oncol. 2006; 2(6):717-21. DOI: 10.2217/14796694.2.6.717. View

Feith M, Stein H, Siewert J . Pattern of lymphatic spread of Barrett's cancer. World J Surg. 2003; 27(9):1052-7. DOI: 10.1007/s00268-003-7060-2. View

Lordick F, Ott K, Krause B, Weber W, Becker K, Stein H . PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial. Lancet Oncol. 2007; 8(9):797-805. DOI: 10.1016/S1470-2045(07)70244-9. View

Brucher B, Swisher S, Konigsrainer A, Zieker D, Hartmann J, Stein H . Response to preoperative therapy in upper gastrointestinal cancers. Ann Surg Oncol. 2009; 16(4):878-86. DOI: 10.1245/s10434-009-0315-x. View

Lordick F, Ruers T, Aust D, Collette L, Downey R, El Hajjam M . European Organisation of Research and Treatment of Cancer (EORTC) Gastrointestinal Group: Workshop on the role of metabolic imaging in the neoadjuvant treatment of gastrointestinal cancer. Eur J Cancer. 2008; 44(13):1807-19. DOI: 10.1016/j.ejca.2008.06.005. View

Siewert J, Bartels H, Stein H . [Abdomino-right-thoracic esophagectomy with intrathoracic anastomosis in Barrett's cancer]. Chirurg. 2005; 76(6):588-94. DOI: 10.1007/s00104-005-1028-8. View

Theisen J, Danenberg K, Ott K, Becker K, Danenberg P, Stein H . Predictors of response and survival for neoadjuvant treated patients with esophageal adenocarcinoma. Dis Esophagus. 2008; 21(7):601-6. DOI: 10.1111/j.1442-2050.2008.00820.x. View

Siewert J, Lordick F, Ott K, Stein H, Weber W, Becker K . Induction chemotherapy in Barrett cancer: influence on surgical risk and outcome. Ann Surg. 2007; 246(4):624-8. DOI: 10.1097/SLA.0b013e318155a7d1. View

Stein H, Sendler A, Fink U, Siewert J . Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am. 2000; 80(2):659-82; discussions 683-6. DOI: 10.1016/s0039-6109(05)70205-x. View

10.

Cunningham D, Allum W, Stenning S, Thompson J, van de Velde C, Nicolson M . Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006; 355(1):11-20. DOI: 10.1056/NEJMoa055531. View

11.

. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002; 359(9319):1727-33. DOI: 10.1016/S0140-6736(02)08651-8. View

12.

Fiorica F, Di Bona D, Schepis F, Licata A, Shahied L, Venturi A . Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut. 2004; 53(7):925-30. PMC: 1774092. DOI: 10.1136/gut.2003.025080. View

13.

Greil R, Stein H . Is it time to consider neoadjuvant treatment as the standard of care in oesophageal cancer?. Lancet Oncol. 2007; 8(3):189-90. DOI: 10.1016/S1470-2045(07)70053-0. View

14.

Siewert J, Stein H, von Rahden B . Multimodal treatment of gastrointestinal tract tumors: consequences for surgery. World J Surg. 2005; 29(8):940-8. DOI: 10.1007/s00268-005-0010-4. View

15.

Ott K, Weber W, Lordick F, Becker K, Busch R, Herrmann K . Metabolic imaging predicts response, survival, and recurrence in adenocarcinomas of the esophagogastric junction. J Clin Oncol. 2006; 24(29):4692-8. DOI: 10.1200/JCO.2006.06.7801. View

16.

Stahl M, Walz M, Stuschke M, Lehmann N, Meyer H, Riera-Knorrenschild J . Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol. 2009; 27(6):851-6. DOI: 10.1200/JCO.2008.17.0506. View

17.

Gebski V, Burmeister B, Smithers B, Foo K, Zalcberg J, Simes J . Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol. 2007; 8(3):226-34. DOI: 10.1016/S1470-2045(07)70039-6. View

18.

Stein H, von Rahden B, Feith M . Surgery for early stage esophageal adenocarcinoma. J Surg Oncol. 2005; 92(3):210-7. DOI: 10.1002/jso.20362. View

19.

Weber W, Ott K, Becker K, Dittler H, Helmberger H, Avril N . Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol. 2001; 19(12):3058-65. DOI: 10.1200/JCO.2001.19.12.3058. View