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Response to Preoperative Therapy in Upper Gastrointestinal Cancers

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In cancer, a response to therapy implies a reduction in the volume or activity of localized and/or metastatic tumors. In localized upper gastrointestinal cancer, there is no accepted definition of clinical response; however, tumor shrinkage is frequently observed when preoperative therapy is administered. As patients with upper gastrointestinal cancers often undergo multimodal therapy, it is therefore imperative that new definitions for assessing the response to preoperative therapy be established.

Methods

We reviewed the development of response criteria from a historical perspective, with particular emphasis on the criteria used to assess upper gastrointestinal cancers.

Results

Observing the response to preoperative therapy appears to make it possible to distinguish between favorable and unfavorable clinical biology in the cancer. Patients who experience a response to preoperative treatment appear to fare better in terms of overall survival than those whose cancers do not respond. We reviewed the published results regarding the response to preoperative therapy and the implications of this for patients.

Conclusions

This review of the literature suggests that a variety of tools are available for defining the response to preoperative therapy and that these need to be exploited. Developing reliable methods of assessing the response will improve the individualization of therapy for patients with gastroesophageal cancer. There is a strong need for surrogate markers for efficacy in order to assess responses that are capable of predicting patient outcome.

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Acknowledgments

The authors are very grateful for the critical advice on this paper provided by Prof. Murray Brennan of the Memorial Sloan-Kettering Cancer Center, New York City, NY, USA. This manuscript is dedicated to U. Fink, emeritus professor of oncology, who had a major impact on response assessment in oncology during the last 20 years and J. R. Siewert, emeritus professor of surgery, who had a major impact on response assessment as well as on esophageal surgery generally within the last 25 years.

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Authors and Affiliations

  1. Department of Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany

    Björn L. D. M. Brücher MD, PhD, FACS, Alfred Königsrainer MD & Derek Zieker MD

  2. Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Stephen G. Swisher MD, FACS

  3. Department of Oncology, Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany

    Jörg Hartmann MD

  4. Department of Surgery, University of Salzburg, Salzburg, Austria

    Hubert Stein MD

  5. Department of Surgery, Keio University Medical School, Tokyo, Japan

    Yuko Kitagawa MD, FACS

  6. Department of Surgery, Queen Mary Hospital/University of Hong Kong, Hong Kong, China

    Simon Law MD, FACS, FRCS

  7. Department of Gastrointestinal Oncology and Digestive Disease, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Jaffer A. Ajani MD

Authors
  1. Björn L. D. M. Brücher MD, PhD, FACS
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  2. Stephen G. Swisher MD, FACS
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  3. Alfred Königsrainer MD
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  5. Jörg Hartmann MD
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  6. Hubert Stein MD
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  7. Yuko Kitagawa MD, FACS
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  8. Simon Law MD, FACS, FRCS
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  9. Jaffer A. Ajani MD
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Correspondence to Björn L. D. M. Brücher MD, PhD, FACS.

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Brücher, B.L.D.M., Swisher, S.G., Königsrainer, A. et al. Response to Preoperative Therapy in Upper Gastrointestinal Cancers. Ann Surg Oncol 16, 878–886 (2009). https://doi.org/10.1245/s10434-009-0315-x

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