The internist oncologist’s view of gastric cancer treatment

Abstract

After resection, a large number of patients with gastric carcinoma (GC) and carcinoma of gastroesophageal junction (GEJ) have recurrences. Recurrences are local or with distant metastases, or a combination of both. Adjuvant chemotherapy can improve overall survival in some types of solid tumours primarily by minimising the residues of micro-metastases. While the importance of adjuvant chemotherapy in GC and GEJ is not entirely clear, adjuvant radiochemotherapy significantly prolongs the disease-free period and overall survival. Perioperative treatment with ECF chemotherapy significantly improves disease-free and overall survival. ECF chemotherapy or its other regimens, namely EOF, ECX or EOX, are the standard treatment for patients with advanced gastric carcinoma (GC) or GEJ. Treatment with taxans in combination with 5-FU and cisplatin (TCF) is also effective. New combinations of cytostatics and the introduction of new cytostatics have improved the median survival of patients with gastric carcinoma and GEJ. Target drugs have also been introduced for the treatment of metastatic GC and GEJ. Determination of biomarkers and introduction of target treatment in combination with chemotherapy has opened a new era of patientadapted treatment, also for patients with advanced gastric carcinoma and GEJ. After resection, a large number of patients with gastric carcinoma (GC) and carcinoma of gastroesophageal junction (GEJ) have recurrences. Recurrences are local or with distant metastases, or a combination of both. In Europe and the USA, locoregional recurrences are more common and most frequently occur in the abdominal region, regional lymph nodes or at the anastomosis. The most common systemic extensions are liver metastases and metastases to peritoneum. GEJ carcinoma can often metastasise also to the lungs.

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Povzetek

Veliko število bolnikov s karcinomom želodca (KŽ) in gastroezofegealnega prehoda (GEP) ima ponovitev bolezni po resekciji. Ponovitve so lokalne ali z oddaljenimi zasevki ali pa kombinacija obojega. Adjuvantna kemoterapija lahko podaljša celokupno preživetje pri nekaterih vrstah solidnih tumorjev predvsem z zmanjšanjem ostanka mikrozasevkov. Vloga adjuvantne kemoterapije pri KŽ in GEP ni tako jasna, adjuvantna radiokemoterapija pa značilno podaljša čas brez bolezni in celokupno preživetje. Perioperativno zdravljenje s kemoterapijo ECF značilno podaljša preživetje brez bolezni in celokupno.
Standardno zdravljenje za bolnike z napredovalim karcinomom želodca in GEP je kemoterapija ECF ali njene izpeljanke EOF, ECX oziroma EOX. Učinkovito je tudi zdravljenje s taksani v kombinaciji s 5-FU in cisplatinom (TCF). Z novimi kombinacijami citostatikov in z uvajanjem novih citostatikov se srednja preživetja bolnikov s karcinomom želodca in GEP podaljšujejo. V zdravljenje metastatskega KŽ in GEP pa prihajajo tudi tarčna zdravila. Določanje biomarkerjev in uvajanje tarčnega zdravljenja v kombinaciji s kemoterapijo pa odpira novo ero bolniku prilagojenega zdravljenja, tudi pri bolnikih z napredovalim karcinomom želodca in GEP.
Veliko število bolnikov s karcinomom želodca (KŽ) in gastroezofegealnega prehoda (GEP) ima ponovitev bolezni po resekciji. Ponovitve so lokalne ali z oddaljenimi zasevki ali pa kombinacija obojega. V Evropi in ZDA so bolj pogoste lokoregionalne ponovitve, med katerimi se največkrat pojavijo na mestu želodca, regionalnih bezgavk in anostomozi. Med sistemskimi razširitvami bolezni so najpogostejši jetrni zasevki in zasevki po potrebušnici. Karcinom GEP pa lahko pogosto zaseva tudi v pljuča.