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Postoperative Chemotherapy for Gastric Cancer(一)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:32

  作者:Michael Hejnaa, Stefan Wöhrerb, Manuela Schmidingera, Markus Raderera,b

  【关键词】 ,Gastric,cancer,•,Adjuvant,treatment,•,Chemotherapy,•,Review

  LEARNING OBJECTIVES

  After completing this course, the reader will be able to:

  Identify the current standard of care and new chemotherapy options for patients with resected gastric cancer.

  Discuss recently reported results of phase II and phase III randomized trials of chemotherapy for the postoperative treatment of gastric cancer.

  Discuss the clinical implications of recent clinical trial findings and future treatment strategies.

  ABSTRACT

  

  Introduction. Adjuvant chemotherapy for gastric cancer after potentially curative surgery has been under clinical investigation for more than four decades. However, potentially curative resection can be performed in only 30%50% of patients. Theobjective of this article is to review briefly the clinical trials available in the current literature using adjuvant cytotoxic chemotherapy in patients with gastric cancer after potentially curative surgical resection.

  Methods. Computerized (MEDLINE) and manual searches were performed to identify papers published on this topic between 1965 and 2005. Only articles with an English abstract were reviewed for inclusion; information abstracted included histologic proof of diagnosis, number of patients, dose and modality of treatment, survival duration, and side effects.

  Results. Forty-three reports were identified. Single-agent chemotherapy was eva luated in four clinical trials, and postoperative combination chemotherapy was eva luated in 33 trials. Furthermore, we identified five meta-analyses. Five-year survival rates ranged from 12%91.2%, and the median survival durations were 1360+ months. Adjuvant chemotherapy, whencompared with surgery alone, seems to result in longer survival.

  Conclusion. The high rate of recurrence, even in patients undergoing state-of-the art curative resection, suggests that effective adjuvant chemotherapy might indeed be an attractive concept to improve the overall outcome of patients with gastric cancer. However, because there is no standard regimen for postoperative treatment at the moment, patients with R0-resected (no residual tumors) gastric cancer should be offered the opportunity to participate in prospective clinical trials.

  BACKGROUND

  

  Surgical resection remains the mainstay of curative treatment for patients with gastric cancer. However, curative surgery can be performed in only a relatively small subgroup of patients. Several recent large surgical series indicate that only 30%50% of patients with gastric cancer undergoing exploration can be operated with curative intent. Even for those patients who undergo radical resection, the rate of recurrence is very high.

  It has been suggested that the presentation (and even the biology) of gastric c

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