title: The role of neoadjuvant and adjuvant treatment for adenocarcinoma of the upper gastrointestinal tract.
abstract: Both locally advanced adenocarcinoma of the stomach and gastro-esophageal junction are associated with poor prognosis due to the lack of effective treatment. Recently multimodal treatment consisting of neoadjuvant chemotherapy in combination with radiotherapy is reported to improve survival when compared to surgery alone. Neoadjuvant therapy in these locally advanced tumors allows for early tumor responses and the extent of tumor regression that can be achieved is considered a significant prognostic factor. This, in turn, increases the resectability of these tumors. Also due to the high frequency of lymph node metastasis, patients with locally advanced adenocarcinoma should undergo a D2 lymphadenectomy. Postoperative chemo?radiation and perioperative chemotherapy have been studied in gastric adenocarcinomas and showed a survival benefit. However, the surgical techniques used in these trials are no longer considered to be standard by today's surgical practice. In addition, there are no standard recommendations for adjuvant chemotherapy or chemoradiation after R0 resection and adequate lymph node dissection.
authors.affiliation: Klinik für Strahlentherapie und Radiologische Onkologie, Heinrich-Heine-Universität Düsseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Matuschek
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.forename: M
authors.initials: M
authors.lastname: Peiper
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: W
authors.initials: W
authors.lastname: Budach
authors.forename: A
authors.initials: A
authors.lastname: Erhardt
authors.forename: A
authors.initials: A
authors.lastname: Scherer
authors.forename: P A
authors.initials: PA
authors.lastname: Gerber
authors.forename: B A
authors.initials: BA
authors.lastname: Buhren
authors.forename: N
authors.initials: N
authors.lastname: Gattermann
authors.forename: S E
authors.initials: SE
authors.lastname: Baldus
authors.forename: E
authors.initials: E
authors.lastname: Rusnak
authors.forename: V
authors.initials: V
authors.lastname: Shukla
authors.forename: K
authors.initials: K
authors.lastname: Orth
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D004943:Esophagogastric Junction; D005770:Gastrointestinal Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome