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Neoadjuvant therapy for gastrointestinal cancers

¹Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.

Oncology (Williston Park, N.Y.)

|September 1, 1993

Summary

Neoadjuvant chemotherapy offers improved local control and micrometastasis destruction for upper GI and rectal cancers. Endoscopic ultrasonography aids in identifying high-risk patients for these promising investigational approaches.

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Area of Science:

Oncology
Gastroenterology

Background:

Neoadjuvant chemotherapy is being explored for upper GI tract malignancies and rectal cancer.
The goal is to enhance local control and eliminate micrometastasis.
Endoscopic ultrasonography is emerging as a tool to identify suitable high-risk patients.

Purpose of the Study:

To review the role and emerging applications of neoadjuvant chemotherapy in upper GI and rectal cancers.
To highlight the potential of endoscopic ultrasonography in patient selection for neoadjuvant therapies.

Main Methods:

Review of current clinical trial data and established treatment paradigms for esophageal, gastric, and rectal cancers.
Discussion of the evolving role of neoadjuvant chemotherapy and its combination with radiation therapy.

Main Results:

Concurrent chemoradiation has largely replaced radiation alone for esophageal cancer.
Phase III trials for preoperative chemotherapy in esophageal cancer are ongoing.
Phase II trials for neoadjuvant chemotherapy in gastric cancer are underway.
Preoperative treatment for rectal cancer may offer reduced toxicity and improved curative resection rates compared to postoperative adjuvant therapy.

Conclusions:

Neoadjuvant chemotherapy is a key strategy for managing upper GI and rectal cancers.
Endoscopic ultrasonography may refine patient selection for neoadjuvant treatment protocols.
Preoperative neoadjuvant approaches show promise for improved outcomes and reduced toxicity in rectal cancer management.

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