[Neoadjuvant therapy in the upper gastro-intestinal tract. Modern strategies for Barrett's cancer]

Chirurg. 2009 Nov;80(11):1019-22. doi: 10.1007/s00104-009-1734-8.
[Article in German]

Abstract

While primary surgical resection with systematic lymphadenectomy remains the treatment of choice for locoregional Barrett's cancer, neoadjuvant chemotherapy is an increasingly accepted treatment modality for patients with locally advanced tumors and patients with extensive lymphatic spread. In contrast to neoadjuvant radiochemotherapy preoperative chemotherapy alone does not seem to increase peri-operative complications and mortality. Responders to pre-operative treatment clearly have a survival advantage as compared to those who do not respond. The use of positron emission tomography to measure changes in glucose metabolism of the primary tumor can predict response early after initiation of neoadjuvant chemotherapy and thus help to select patients who will or will not benefit from this approach. The best treatment strategy for non-responders to neoadjuvant therapy remains to be defined.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / pathology
  • Adenocarcinoma / radiotherapy
  • Adenocarcinoma / surgery*
  • Barrett Esophagus / drug therapy
  • Barrett Esophagus / pathology
  • Barrett Esophagus / radiotherapy
  • Barrett Esophagus / surgery*
  • Blood Glucose / metabolism
  • Combined Modality Therapy
  • Disease-Free Survival
  • Esophageal Neoplasms / drug therapy
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / radiotherapy
  • Esophageal Neoplasms / surgery*
  • Esophagectomy*
  • Fluorodeoxyglucose F18
  • Humans
  • Lymph Node Excision*
  • Lymphatic Metastasis / pathology
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Positron-Emission Tomography
  • Precancerous Conditions / drug therapy
  • Precancerous Conditions / pathology
  • Precancerous Conditions / radiotherapy
  • Precancerous Conditions / surgery*
  • Prognosis

Substances

  • Blood Glucose
  • Fluorodeoxyglucose F18