Adjuvant and neoadjuvant therapy for gastric cancer.

作者：David Paul Kelsen · 发表于：PubMed · 年份：1996 · 被引用次数：92 · 研究领域：Gastric Cancer Management and Outcomes、Gastrointestinal Tumor Research and Treatment、Metastasis and carcinoma case studies

In the United States and in Europe, curative resections are possible in only 50% to 60% of newly diagnosed gastric cancer patients chosen to undergo surgery. For patients with higher stage tumors (T3-N(any)M0, T34N(any)M0, stages II, IIIa or IIIb), even after resection of all gross disease with negative margins, the recurrence risk is high. In the absence of earlier diagnosis, there is a clear need to develop new innovative treatment strategies that will increase the potentially curative resection rate and decrease the risk of recurrence after operation. The major treatment strategy pursued during the last 20 to 30 years has been postoperative systemic therapy with or without associated regional radiation. In general, using the systemic treatment regimens available in the past, no major decrease in recurrence rate has been shown. The use of routine postoperative systemic chemotherapy remains unproven. Several new approaches are currently undergoing intense study, in addition to chemoradiation. One involves the use of preoperative (neoadjuvant) systemic chemotherapy. The goal of these treatment plans is to allow an early attack on systemic micrometastatic disease, and by downstaging the primary tumor to increase the percentage of patients able to undergo curative resection. Phase 11 studies performed to date indicate acceptable toxicity to multidrug regimens including cisplatin-fluorouracil, variants of the 5-fluorouracil, doxorubicin, high-dose methotrexate (FAMTX) regimen, o...