Background Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim...Background Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced .qastric cancer.展开更多
Gastric cancer is one of the leading causes of death for cancer worldwide,although geographical variations in incidence exist.Over the last decades,its incidence and mortality have gradually decreased in Western count...Gastric cancer is one of the leading causes of death for cancer worldwide,although geographical variations in incidence exist.Over the last decades,its incidence and mortality have gradually decreased in Western countries,while these have increased,or remained stable,in the other world regions.Gastric cancer is often diagnosed at an advanced stage,with the only notable exception of Japan,where nationwide screening programs are enforced,due to local high incidence.Curativeintent surgery(i.e.,gastrectomy,total or partial,and lymphadenectomy)remains the cornerstone of treatment of gastric cancer.Much has been debated about the extent of lymph node dissection and,although it is a valuable contribution to staging and cure,operative treatment only represents one aspect of overall effective management,as the risk of both locoregional and distant recurrences are high,and bear a poor prognosis.As a matter of fact,surgery,as a single modality treatment,has probably achieved its maximum efficacy for local control and survival,while other accompanying nonsurgical treatment modalities have to be taken into account,although their role is still the subject of considerable debate.The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative,intraoperative,and postoperative strategies.展开更多
Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the...Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.展开更多
Fifteen percent to twenty-five percent of patients affected by colorectal cancer presents with liver metastases at diagnosis. In resectable cases, surgery is the only potentially curative treatment and achieves surviv...Fifteen percent to twenty-five percent of patients affected by colorectal cancer presents with liver metastases at diagnosis. In resectable cases, surgery is the only potentially curative treatment and achieves survival rates up to 50% at 5 years. Management is complex, as colorectal resection, liver resection, chemotherapy, and, in locally advanced mid/low rectal tumors, radiotherapy have to be integrated. Modern medical practice usually relies on evidence-based protocols. Levels of evidence for synchronous metastases are poor:published studies include few recent prospective series and several retrospective analyses collecting a limited number of patients across long periods of time. Data are difficult to be generalized and are mainly representative of single centre's experience, biased by local recruitment, indications and surgical technique. In this context, surgeons have to renounce to "evidence-based medicine" and to adopt a sort of "experience-based medicine". Anyway, some suggestions are possible. Simultaneous colorectal and liver resection can be safely performed whenever minor hepatectomies are planned, while a case-by-case evaluation is mandatory in case of more complex procedures. Neoadjuvant chemotherapy is preferentially scheduled for patients with advanced metastatic tumors to assess disease biology and to control lesions. It can be safely performed with primarytumor in situ , even planning simultaneous resection at its end. Locally advanced mid/low rectal tumor represents a further indication to neoadjuvant therapies, even if treatment's schedule is not yet standardized. In summary, several issues have to be solved, but every single HPB centre should define its proper strategy to optimize patient's selection, disease control and safety and completeness of surgery.展开更多
背景与目的:术前化疗和术前放化疗都是胃癌治疗指南推荐的针对局部进展期胃癌患者的治疗方法。然而,由于缺乏对比性的研究证据,两者的优劣性不详。本研究将对比术前放化疗与术前化疗在临床疗效及毒性反应之间的差异。方法:2007年6月—2...背景与目的:术前化疗和术前放化疗都是胃癌治疗指南推荐的针对局部进展期胃癌患者的治疗方法。然而,由于缺乏对比性的研究证据,两者的优劣性不详。本研究将对比术前放化疗与术前化疗在临床疗效及毒性反应之间的差异。方法:2007年6月—2012年10月期间,30例局部进展期胃癌患者入组一项术前化疗的Ⅱ期临床试验,采用EOF(表柔比星+奥沙利铂+氟尿嘧啶)方案进行3～4个周期的术前化疗,对于能手术的患者予以手术,术后给于2～3个周期的EOF方案化疗。2012年4月—2014年8月,40例局部晚期胃癌患者入组一项术前放化疗的Ⅱ期临床试验,患者接受1个周期的SOX[替吉奥(S-1)+奥沙利铂]方案化疗,继续行同步放化疗,再进行1个周期的SOX方案化疗,对于能手术的患者予以手术,术后给于4个周期的SOX方案化疗。比较两项临床试验患者的临床病理特点、术前治疗的效果、R0手术切除率、预后及不良反应。结果:术前化疗临床试验定义为化疗组,有30例胃癌患者入组,且完成了所有的术前化疗,都可评估。术前放化疗临床试验定义为放化疗组,有40例胃癌患者入组,其中36例(90%)患者可评估。两组间的基线参数,如性别、年龄、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分、临床T分期、临床N分期及肿瘤部位,差异无统计学意义。化疗组的临床有效率(CR+PR)为30%(9/30),放化疗组的临床有效率(CR+PR)为41.7%,两者间的差异无统计学意义(P>0.05)。化疗组与放化疗组间的R0手术切除率差异无统计学意义(46.7% vs 66.7%)。放化疗组的病理有效率高于化疗组,且差异有统计学意义(50.0% vs 23.3%)。术前放化疗组的毒性反应较化疗组明显。放化疗组的3年总生存率为41%,高于化疗组的20%(P=0.009)。结论:放化疗组的病理有效率及3年总生存率高于化疗组。急性毒性反应也较化疗组明显,但无严重的毒性反应展开更多
文摘Background Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced .qastric cancer.
文摘Gastric cancer is one of the leading causes of death for cancer worldwide,although geographical variations in incidence exist.Over the last decades,its incidence and mortality have gradually decreased in Western countries,while these have increased,or remained stable,in the other world regions.Gastric cancer is often diagnosed at an advanced stage,with the only notable exception of Japan,where nationwide screening programs are enforced,due to local high incidence.Curativeintent surgery(i.e.,gastrectomy,total or partial,and lymphadenectomy)remains the cornerstone of treatment of gastric cancer.Much has been debated about the extent of lymph node dissection and,although it is a valuable contribution to staging and cure,operative treatment only represents one aspect of overall effective management,as the risk of both locoregional and distant recurrences are high,and bear a poor prognosis.As a matter of fact,surgery,as a single modality treatment,has probably achieved its maximum efficacy for local control and survival,while other accompanying nonsurgical treatment modalities have to be taken into account,although their role is still the subject of considerable debate.The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative,intraoperative,and postoperative strategies.
文摘Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.
文摘Fifteen percent to twenty-five percent of patients affected by colorectal cancer presents with liver metastases at diagnosis. In resectable cases, surgery is the only potentially curative treatment and achieves survival rates up to 50% at 5 years. Management is complex, as colorectal resection, liver resection, chemotherapy, and, in locally advanced mid/low rectal tumors, radiotherapy have to be integrated. Modern medical practice usually relies on evidence-based protocols. Levels of evidence for synchronous metastases are poor:published studies include few recent prospective series and several retrospective analyses collecting a limited number of patients across long periods of time. Data are difficult to be generalized and are mainly representative of single centre's experience, biased by local recruitment, indications and surgical technique. In this context, surgeons have to renounce to "evidence-based medicine" and to adopt a sort of "experience-based medicine". Anyway, some suggestions are possible. Simultaneous colorectal and liver resection can be safely performed whenever minor hepatectomies are planned, while a case-by-case evaluation is mandatory in case of more complex procedures. Neoadjuvant chemotherapy is preferentially scheduled for patients with advanced metastatic tumors to assess disease biology and to control lesions. It can be safely performed with primarytumor in situ , even planning simultaneous resection at its end. Locally advanced mid/low rectal tumor represents a further indication to neoadjuvant therapies, even if treatment's schedule is not yet standardized. In summary, several issues have to be solved, but every single HPB centre should define its proper strategy to optimize patient's selection, disease control and safety and completeness of surgery.
文摘背景与目的:术前化疗和术前放化疗都是胃癌治疗指南推荐的针对局部进展期胃癌患者的治疗方法。然而,由于缺乏对比性的研究证据,两者的优劣性不详。本研究将对比术前放化疗与术前化疗在临床疗效及毒性反应之间的差异。方法:2007年6月—2012年10月期间,30例局部进展期胃癌患者入组一项术前化疗的Ⅱ期临床试验,采用EOF(表柔比星+奥沙利铂+氟尿嘧啶)方案进行3～4个周期的术前化疗,对于能手术的患者予以手术,术后给于2～3个周期的EOF方案化疗。2012年4月—2014年8月,40例局部晚期胃癌患者入组一项术前放化疗的Ⅱ期临床试验,患者接受1个周期的SOX[替吉奥(S-1)+奥沙利铂]方案化疗,继续行同步放化疗,再进行1个周期的SOX方案化疗,对于能手术的患者予以手术,术后给于4个周期的SOX方案化疗。比较两项临床试验患者的临床病理特点、术前治疗的效果、R0手术切除率、预后及不良反应。结果:术前化疗临床试验定义为化疗组,有30例胃癌患者入组,且完成了所有的术前化疗,都可评估。术前放化疗临床试验定义为放化疗组,有40例胃癌患者入组,其中36例(90%)患者可评估。两组间的基线参数,如性别、年龄、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分、临床T分期、临床N分期及肿瘤部位,差异无统计学意义。化疗组的临床有效率(CR+PR)为30%(9/30),放化疗组的临床有效率(CR+PR)为41.7%,两者间的差异无统计学意义(P>0.05)。化疗组与放化疗组间的R0手术切除率差异无统计学意义(46.7% vs 66.7%)。放化疗组的病理有效率高于化疗组,且差异有统计学意义(50.0% vs 23.3%)。术前放化疗组的毒性反应较化疗组明显。放化疗组的3年总生存率为41%,高于化疗组的20%(P=0.009)。结论:放化疗组的病理有效率及3年总生存率高于化疗组。急性毒性反应也较化疗组明显,但无严重的毒性反应
