Oncologie

, Volume 15, Issue 3–4, pp 149–154

Traitement préopératoire des adénocarcinomes oesogastriques

Mise au point / Update
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Résumé

Les adénocarcinomes oesogastriques (AOG) représentent une des premières causes de décès par cancer dans le monde. Alors que l’incidence de l’adénocarcinome (ADK) gastrique diminue, celle de l’ADK de la jonction oesogastrique augmente dans les pays occidentaux. Le traitement chirurgical étant le seul traitement curatif et le taux de survie à cinq ans dépendant du stade pTNM, la prise en charge thérapeutique est un véritable challenge pour les oncologues. Plusieurs modalités de traitement dont la chimiothérapie systémique ont été évaluées afin de diminuer les récidives et d’augmenter la survie globale. Les FNCLCC-FFCD et la UKMAGIC ont clairement démontré que la chimiothérapie préopératoire avait un bénéfice sur la survie globale des patients opérables pour leur AOG; ce traitement est un standard et il est couramment réalisé en Europe. De nouvelles stratégies comme la chimiothérapie d’induction suivie d’une radiochimiothérapie, l’addition de thérapies ciblées à la chimiothérapie périopératoire ou l’utilisation de nouveaux schémas de chimiothérapies sont en cours d’évaluation afin d’augmenter le bénéfice des traitements standard actuels.

Mots clés

Adénocarcinome gastrique Adénocarcinome de la jonction oesogastrique Traitement préopératoire Traitement néoadjuvant 

Preoperative treatment of esogastric adenocarcinomas

Abstract

Gastric and esophageal adenocarcinomas (GEA) are among the leading causes of cancer-related death worldwide. Despite a decline in the incidence of gastric adenocarcinomas, incidence of oesophagogastric junction adenocarcinoma is rising rapidly in occidental countries. Surgical resection being the only curative treatment and the 5-year survival rate depending on pTNM stage, treatment approach remains challenging for oncologists. Several treatment modalities including systemic chemotherapy have been evaluated to prevent recurrences and improve overall survival. The UK-MAGIC and FNCLCCFFCD trials showed survival benefit with preoperative chemotherapy in operable gastric and lower oesophageal cancers, and those results had impact on clinical practice in Europe. Novel strategies such as the induction chemotherapy followed by preop-CRT, targeted therapies added to perioperative chemotherapy or the use of new cytotoxic regimens are being assessed to improve current standards and facilitate the delivery of more tailored therapeutic interventions.

Keywords

Gastric adenocarcinoma Gastroesophageal junction carcinoma Preoperative treatment Neoadjuvant treatment 

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Références

  1. 1.
    Ajani JA, Mansfield PF, Janjan N, et al. (2004) Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially respectable gastric carcinoma. J Clin Oncol 23: 2774–2780CrossRefGoogle Scholar
  2. 2.
    Ajani JA, Mayer RJ, Ota DM, et al. (1993) Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Natl Cancer Inst 85: 1839–1844CrossRefPubMedGoogle Scholar
  3. 3.
    Ajani JA, Winter K, Okawara GS, et al. (2006) Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904): quality of combined modality therapy and pathologic response. J Clin Oncol 24: 3953–3958CrossRefPubMedGoogle Scholar
  4. 4.
    Allum WH, Stenning P, Bancewicz J, et al. (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27: 5062–5067CrossRefPubMedGoogle Scholar
  5. 5.
    Belot A, Grosolaude P, Bossard N, et al. (2008) Cancer incidence and mortality in France over the period 1980–2005. Rev Epidemiol Sante Publique 56: 159–175CrossRefPubMedGoogle Scholar
  6. 6.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF (1991) Rising incidence of adenocarcinoma of the oesophagus and gastric cardia. JAMA 265: 1287–1289CrossRefPubMedGoogle Scholar
  7. 7.
    Burmeister BH, Smithers BM, Gebski V, et al. (2005) Surgery alone versus chemoradiotherapy followed by surgery for resecable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 6: 659–668CrossRefPubMedGoogle Scholar
  8. 8.
    Burmeister BH, Thomas JM, Burmeister EA, et al. (2011) Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. Eur J Cancer 47: 354–360CrossRefPubMedGoogle Scholar
  9. 9.
    Crookes P, Leichman CG, Leichman L, et al. (1997) Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report. Cancer 79: 1767–1775CrossRefPubMedGoogle Scholar
  10. 10.
    Cunningham D, Allum WH, Stenning SP, et al. (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355: 11–20CrossRefPubMedGoogle Scholar
  11. 11.
    GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, et al. (2010) Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 303: 1753–1754CrossRefGoogle Scholar
  12. 12.
    Gebski V, Burmeister B, Smithers BM, et al. (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma. Lancet Oncol 8: 226–234CrossRefPubMedGoogle Scholar
  13. 13.
    Hartgrink HH, Van de Velde CJ, Putter H, et al. (2004) Neoadjuvant chemotherapy for operable gastric cancer: long-term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 30: 643–649CrossRefPubMedGoogle Scholar
  14. 14.
    Hundhal SA, Menck HR, Mansour EG, Winchester DP (1997) The National Cancer Data Base report on gastric carcinoma. Cancer 80: 2333–2341CrossRefGoogle Scholar
  15. 15.
    Kelsen D, Karpeh M, Schwartz G, et al. (1996) Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plusintravenous fluorouracil. J Clin Oncol 14: 1818–1828PubMedGoogle Scholar
  16. 16.
    Li W, Qin J, Sun YH, Liu TS (2010) Neoadjuvant chemotherapy for advanced gastric cancer: a meta-analysis. World J Gastroenterol 16: 5621–5628CrossRefPubMedGoogle Scholar
  17. 17.
    Lutz MP, Zalcberg JR, Ducreux M, et al. (2012) Highlights of the EORTC St Gallen International Expert Consensus on the primary therapy of gastric, gastroesophageal and oesophageal cancer-differential treatment strategies for subtypes of early gastroesophageal cancer. Eur J Cancer 48: 2941–2953CrossRefPubMedGoogle Scholar
  18. 18.
    Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359: 1727–1733CrossRefGoogle Scholar
  19. 19.
    Messager M, Lefevre JH, Pichot-Delahaye V, et al. (2011) The impact of perioperative chemotherapy on survival in patients with gastric signet ring cell adenocarcinoma: a multicenter comparative study. Ann Surg 254: 684–693CrossRefPubMedGoogle Scholar
  20. 20.
    Okines A, Langley R, Thompson L, et al. (2011) Safety results from a randomized trial of perioperative epirubicin, cisplatin plus capecitabine (ECX) with or without bevacizumab (B) in patients (pts) with gastric or type II/III oesophagogastric junction (OGJ) adenocarcinoma. Proc Am Soc Clin Oncol 29: abstract 4092Google Scholar
  21. 21.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55: 74–108CrossRefPubMedGoogle Scholar
  22. 22.
    Schuhmacher C, Gretschel S, Lordick F, et al. (2010) Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 28: 5210–5218CrossRefPubMedGoogle Scholar
  23. 23.
    Siewert JR, Bottcher K, Roder JD, et al. (1993) Pronostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg 80: 1015–1018CrossRefPubMedGoogle Scholar
  24. 24.
    Songun I, Keizer HJ, Hermans J, et al. (1999) Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTX trial. The Dutch Gastric Cancer Group (DGCG). Eur J Cancer 35: 558–562CrossRefPubMedGoogle Scholar
  25. 25.
    Stahl M, Walz MK, Stuschke M, et al. (2009) Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27: 836–837CrossRefGoogle Scholar
  26. 26.
    Tepper J, Krasna MJ, Niedzwiecki D, et al. (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 1086–1092Google Scholar
  27. 27.
    The Japanese Research Society for Gastric Cancer (1995) Treatment results of gastric cancer patients: an analysis of nationwide database. In: Watanabe S, Tominaga S, Kakizoe T (eds) In cancer treatment and survival, Gann Monograph on Cancer Research 43. Japan Scientific Society Press, Tokyo, pp. 47–56Google Scholar
  28. 28.
    Urba SG, Orringer MB, Turrisi A, et al. (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19: 305–313PubMedGoogle Scholar
  29. 29.
    Van Hagen P, Hulshof M, van Lanschot JJ, et al. (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366: 2074–2084CrossRefPubMedGoogle Scholar
  30. 30.
    Wagner AD, Grothe W, Behl S, et al. (2005) Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2: CD004064PubMedGoogle Scholar
  31. 31.
    Walsh TN, Noonan N, Hollywood D, et al. (1996) A comparaison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335: 462–467CrossRefPubMedGoogle Scholar
  32. 32.
    Webb A, Cunningham D, Scarffe JH, et al. (1997) Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate, in advanced esophagogastric cancer. J Clin Oncol 15: 261–267PubMedGoogle Scholar
  33. 33.
    Ychou M, Boige V, Pignon JP, et al. (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29: 1715–1721CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.ICMMontpellier cedex 05France

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