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The 4th St. Gallen EORTC Gastrointestinal Cancer Conference: Controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma
MP. Lutz, JR. Zalcberg, M. Ducreux, A. Adenis, W. Allum, D. Aust, F. Carneiro, HI. Grabsch, P. Laurent-Puig, F. Lordick, M. Möhler, S. Mönig, R. Obermannova, G. Piessen, A. Riddell, C. Röcken, F. Roviello, PM. Schneider, S. Seewald, E. Smyth, E....
Language English Country Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't, Review
- MeSH
- Adenocarcinoma therapy MeSH
- Esophagogastric Junction drug effects MeSH
- Combined Modality Therapy methods MeSH
- Humans MeSH
- Esophageal Neoplasms therapy MeSH
- Stomach Neoplasms therapy MeSH
- Neoadjuvant Therapy methods MeSH
- Antineoplastic Combined Chemotherapy Protocols therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multimodal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting.
Cambridge University Hospitals NHS Foundation Trust Cambridge United Kingdom
CaritasKlinikum St Theresia Saarbrücken Germany
Centre for Visceral Thoracic and Specialized Tumor Surgery Klinik Hirslanden Zurich Switzerland
Département d'Oncologie Médicale Institut du Cancer de Montpellier Montpellier France
Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute Brno Czech Republic
Department of Diagnostic Radiology The Royal Marsden London United Kingdom
Department of Medicine Surgery and Neurosciences University of Siena Siena Italy
Department of Oncology Lausanne University Hospital Lausanne Switzerland
Department of Pathology Christian Albrechts University Kiel Germany
Department of Pathology Faculdade de Medicina Universidade do Porto Porto Portugal
Department of Radiation Oncology Netherlands Cancer Institute Amsterdam The Netherlands
Gastroenterology Centre Klinik Hirslanden Zurich Switzerland
Hôpitaux Universitaires de Genève Service de Chirurgie Viscéral Geneva Switzerland
Institut für Pathologie Universitätsklinikum Carl Gustav Carus Dresden Germany
Institut Gustave Roussy Villejuif France
Medizinische Klinik und Poliklinik Universitätsmedizin Mainz Mainz Germany
Royal Marsden NHS Foundation Trust London United Kingdom
Tumor und Brustzentrum ZeTuP St Gallen Switzerland
Université René Descartes UFR Biomédicale des Saints Pères Paris France
References provided by Crossref.org
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