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MULTIDISCIPLINARY APPROACH TO ESOPHAGEAL AND GASTRIC CANCER - 06/09/11

Doi : 10.1016/S0039-6109(05)70205-X 
Hubert J. Stein, MD *, Andreas Sendler, MD *, Ulrich Fink, MD *, J.R. Siewert, MD *

Résumé

In contrast to the incidence of gastric cancer, which is decreasing worldwide, the incidence of esophageal cancer is increasing at an alarming rate in the Western world, primarily because of an increase in the rate of adenocarcinoma of the distal esophagus.13 In addition, the location of gastric tumors is shifting from the distal portion of the stomach to the proximal stomach and the gastric cardia.13 The treatment of patients with adenocarcinoma in the vicinity of the esophagogastric junction (AEGs) will therefore become a major challenge in the coming years.

Despite marked advances in surgical therapy for esophageal, esophagogastric, and gastric cancers, the overall prognosis of patients with these diseases has not improved markedly during the past few decades because, in the Western world, these tumors continue to be diagnosed at an advanced stage in most affected patients. Systemic and local recurrences are common even after complete tumor resection and extensive lymphadenectomy. Multidisciplinary approaches with adjuvant (i.e., postoperative) and neoadjuvant (i.e., preoperative) chemotherapy, radiotherapy, or combined radiochemotherapy therefore receive increasing attention with regard to the management of these patients. Despite a large number of phase II and III studies, the role of such multimodal protocols is still unclear. The study design of most, if not all, multimodal treatment trials shows marked shortcomings. For example, patients usually are not stratified according to tumor type (i.e., adenocarcinoma or squamous cell esophageal cancer [SCEC] of the esophagus), tumor location (i.e., proximal or distal esophageal cancer, AEG, or cancer of the proximal or distal stomach), extent of tumor (i.e., locoregional or locally advanced), type of resection, extent of lymphadenectomy, and the experience of the surgeon or institution performing the resection. Each of these factors may independently influence prognosis to a greater extent than the potential benefit of multidisciplinary approaches.

In the future, improvements in the overall survival of patients with esophageal, esophagogastric junction, or gastric cancer most likely will be achieved only by tailored therapeutic strategies that are based on the individual tumor location and tumor stage and on consideration of established prognostic factors. A clear classification of the underlying tumor entity, a profound knowledge of the prognostic factors applicable, and a thorough preoperative staging are therefore essential for the selection of the optimal therapeutic modality in a given situation.

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 Address reprint requests to Hubert J. Stein, MD, Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar of the, Technische Universität München, Ismaningerstr 22, D-81675 München, Germany, e-mail: stein@nt1.chir.med.tu-muenchen.de


© 2000  W. B. Saunders Company. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 2

P. 659-682 - avril 2000 Retour au numéro
Article précédent Article précédent
  • SECONDARY PULMONARY MALIGNANCY
  • James P. Greelish, Joseph S. Friedberg
| Article suivant Article suivant
  • COMMENTARY ON `MULTIDISCIPLINARY APPROACH TO ESOPHAGEAL AND GASTRIC CANCER' BY STEIN ET AL
  • Blake Cady

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