Combined Modality Therapy of Gastrointestinal Tract Cancer PDF
Preview Combined Modality Therapy of Gastrointestinal Tract Cancer
Recent Results 110 in Cancer Research Founding Editor P. Rentchnick, Geneva Managing Editors Ch. Heifarth, Heidelberg· H. J. Senn, St. Gallen Associate Editors M. Baum, London . V. Diehl, Koln C. von Essen, Villigen . E. Grundmann, Munster W Hitzig, Zurich . M. F. Rajewsky, Essen Recent Results in Cancer Research Volume 100: Therapeutic Strategies in Primary and Metastatic Liver Cancer Edited by Ch. Herfarth, P. Schlag, P. Hohenberger 1986. 163 figures, 104 tables. ISBN 3-540-16011-6 Volume 101: Locoregional High-Frequency Hyperthermia and Temperature Measurement Edited by G. Bruggmoser, W. Hinkelbein, R. Engelhardt, M. Wannenmacher 1986.96 figures, 8 tables. IX, 143. ISBN 3-540-15501-5 Volume 102: Epidemiology of Malignant Melanoma Edited by R. P. Gallagher 1986.15 figures, 70 tables. IX, 169. ISBN 3-540-16020-5 Volume 103: Preoperative (Neoadjuvant) Chemotherapy Edited by J. Ragaz, P. R. Band, J. H. Goldie 1986. 58 figures, 49 tables. IX, 162. ISBN 3-540-16129-5 Volume 104: Hyperthermia and the Therapy of Malignant Tumors Edited by C. Streffer 1987.52 figures, 63 tables. IX, 207. ISBN 3-540-17250-5 Volume 105: Breast Cancer Edited by S. Brunner and B. Langfeldt 1987.59 figures, 43 tables. IX, 132. ISBN 3-540-17301-3 Volume 106: Minimal Neoplasia Edited by E. Grundmann and L. Beck 1988.128 figures, 61 tables. IX, 194. ISBN 3-540-18455-4 Volume 107: Application of Hyperthermia in the Treatment of Cancer Edited by R. D. IsseIs and W. Wilmanns 1988. 118 figures, 56 tables. XII, 277. ISBN 3-540-18486-4 Volume 108: Supportive Care in Cancer Patients Edited by H.-J. Senn and L. Schmid 1988.62 figures, 97 tables. ISBN 3-540-17150-9 Volume 109: Preclinical Hyperthermia Edited by W. Hinkelbein, G. Bruggmoser, R. Engelhardt 1988.182 figures, 40 tables. ISBN 3-540-18487-2 P. Schlag P. Hohenberger U. Metzger (Eds.) Combined Modality Therapy of Gastrointestinal Tract Cancer With 105 Figures and 122 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Professor Dr. Peter Schlag Dr. Peter Hohenberger Chirurgische Klinik, Klinikum der UniversitiH Heidelberg 1m Neuenheimer Feld 110,6900 Heidelberg, FRG PriV. Doz. Dr. Urs Metzger Departement Chirurgie, Universitatsspital Zi.irich RamistraBe 100, 8091 Zi.irich, Switzerland ISBN-13: 978-3-642-83295-6 e-ISBN-13: 978-3-642-83293-2 DOl: 10.1007/978-3-642-83293-2 Library of Congress Cataloging-in-Publication Data Combined modality therapy of gastrointestinal tract cancerl P. Schlag, P. Hohenberger, U. Metzger (eds.) p. cm. - (Recent results in cancer research; 110) Includes index. ISBN 0-587-18610-7 (U.S.): 1. Gastrointestinal system - Cancer - Adjuvant treatment. I. Schlag, P. (Peter), 1948- . II. Hohenberger, P. (Peter), 1953- . III. Metzger, U. (Urs), 1945- . IV. Series. [DNLM: 1. Combined Modality Therapy. 2. Gastrointestinal Neoplasms - therapy. WI RE106P v. 110 1 WI 149 C731] RC261.R35 vol. 110 [RC271.A35] 616.99'4 s - dc 19 [616.99'406] DNLM/DLC 88-4517 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1988 Softcover reprint of the hardcover 15t edition 1988 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in the book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting, printing, and binding: Appl, Wemding 2125/3140-543210 Foreword Modern surgical oncology is characterized by multimodal therapy. In recent years numerous therapeutic approaches of pre-, peri-, intra- and postoperative treatment have been in vestigated with regard to their use in combination with surgi cal intervention. It now is time to analyze and to define the state of our knowledge. For tumors of the gastrointestinal tract there are several encouraging therapeutic approaches, such as preop erative chemotherapy in esophageal and perioperative chemotherapy in colon cancer. For some special tumors, like anal carcinoma, we have clearly defined combined therapies which even now must be viewed as standard treatment. It is also time to demonstrate the results of several clini cal studies that have been conducted within the last few years that combined surgical efforts with pre- or postinter ventional chemotherapy or radiotherapy. It is necessary to evaluate whether these trials contribute to progress in onco logical therapy. The editors of this volume - surgeons at the university hospitals of Heidelberg and Zurich - must be given the mer it of achieving these goals. It was especially appropriate for the Department of Surgery in Heidelberg, in close coopera tion with the Comprehensive Cancer Center Heidelberg/ Mannheim, to prepare a review of our present knowledge of surgical oncology as it is in the tradition of attempting to combine different therapeutic approaches to cancer therapy. Surgeon Vincenz Czerny was the first to found an institute for cancer research and therapy, in 1906 in Heidelberg. At this time two similar hospitals were already in existence, the VI Foreword Roswell Park Memorial Institute in Buffalo (USA) and the Morosoff Clinic in Moskow. And it was the surgeon K. H. Bauer from Heidelberg who established the German Cancer Research Center in 1962. Thus the Gastrointestinal Tract Cancer Cooperative Group of the EORTC discussed their experiences in a location that represents both a long tradition and an awareness of our responsibility. Ch. Herfarth Professor of Surgery Head, Department of Surgery University of Heidelberg Director, Comprehensive Cancer Center Heidelberg/Mannheim Preface The EORTC (European Organization for Research and Treatment of Cancer) Gastrointestinal Tract Cancer Cooperative Group, founded in 1972, is devoted to clinical research in the combined modality treatment of gastrointestinal tract cancer. To date, the group has conducted 30 multicenter clinical trials, 13 of which have been completed and reported in various cancer journals. Five studies are closed to patient entry but follow-up still continues, and 12 trials are currently open to patient entry. More than 3500 pat ients have been entered so far in these studies with an annual entry rate of 300-350 patients. Why collaborative research in oncology? Collaborative research is needed when a problem is too big to be tackled or solved by a single center. Many problems in oncology are so difficult that the simple rule of "two know more than one" or "two can do more than one" certainly applies. Individual medical centers are domi nated by one or a few outstanding people, which tends to narrow one's vision and precludes the emergence of alternative ideas. Mul ticenter collaboration promotes the comparison of different view points, which is a condition for progress. Apart from the intellectu al aspects there is the obvious advantage of pooling resources and facilities. Even if a single center is sufficiently large to perform its own study, the results which emerge after several years have to be repeated by other centers before they can be generally accepted. In publication policy, there is an obvious bias to select and publish positive results. In cancer treatment, however, negative results may be of similar clinical value and it is obvious that multicenter trials are more suitable for sharing the risk of producing and publishing negative results. Beside the regular semiannual meetings, the EORTC Gastroin testinal Tract Cancer Cooperative Group organizes review sessions every 3 years, where up to date information is given on the differ ent aspects of combined modality treatment in gastrointestinal tract VIIJ Preface cancer. Analysis of the current EORTC trials is supplemented by state-of-the-art lectures from extramural experts. This volume summarizes selected papers, which were presented during the recent EORTC-GI Group Conference in Heidelberg. The editor's wish is to give a topical survey on pre-, peri- and post operative chemotherapy and radiotherapy, both in the adjuvant sit uation and for the treatment of advanced disease. In addition, new preclinical and experimental data relevant to the clinical situation are included. Hopefully, this volume will further stimulate preclinical and clinical research in the treatment of the most common solid malig nancy, the gastrointestinal tract tumor. Through combined efforts, surgeons, radiotherapists, and medical oncologists will achieve progress step-by-step. Heidelberg/Zurich, February 1988 P.Schlag P. Hohenberger U.Metzger Contents Combined Therapy in Esophageal Cancer ...... . 1 M. Gignoux, A. Roussel, B. Paillot, M. Gillet, P. Schlag, O. Dalesio, M. Buyse, and N. Duez The Value of Preoperative Radiotherapy in Esophageal Cancer: Results of a Study by the EORTC 1 P. Schlag, R. Herrmann, U. Raeth, B. Lehner, V. Schwarz, and C. Herfarth Preoperative (Neoadjuvant) Chemotherapy in Squamous Cell Cancer of the Esophagus . . . . . . . . . . .. 14 A. Roussel, J. H. Jacob, P. Haegele, G. M. Jung, B. Paillot, J. P. Heintz, M. Gignoux, S. Nasca, A. Namer, H. Bleiberg, M. Buyse, O. Dalesio, and N. Duez Controlled Clinical Trial for the Treatment of Patients with Inoperable Esophageal Carcinoma: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group .. 21 A.Roth Combination of Chemotherapy and Irradiation: A New Approach in the Treatment of Locally Advanced Esophageal Cancer . . . . . . . . . . . . . . . . . . . . . . .. 30 Combined Therapy in Gastric Cancer . . . . . . . . . . . . . .. 36 M. Lise, D. Nitti, M. Buyse, G. Cartei, A. Fornasiero, J. Guimaraes dos Santos, and N. Duez Phase-III Clinical Trial of Adjuvant FAM2 (5-FU, Adriamycin and Mitomycin C) vs Control in Resectable Gastric Cancer: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group . . . . . . . . . . . . . . . . . . . . . . .. 36 X Contents R. Jakesz, C. Dittrich, J. Funovics, F. Hofbauer, H. Rainer, G. Reiner, M. Schemper, R. Schiessel, and M. Starlinger The Effect of Adjuvant Chemotherapy in Gastric Carcinoma Is Dependent on Tumor Histology: 5-Year Results of a Prospective Randomized Trial . . . . . . . . . . . . . . .. 44 E. Gez, A. Sulkes, T. Peretz, and Z. Weshler Combined 5-Fluorouracil and Radiation Therapy Following Resection of Locally Advanced Gastric Carcinoma: A 5-Year Follow-Up. . . . . . . . . . . . . . . . . . . . . . .. 52 J. W L. Fielding The Value of a Multidisciplinary Approach in the Management of Gastric Cancer . . . . . . . . . .. 57 The Approach to Hepatobiliary-Pancreatic Cancer. ..... 65 R. Pichlmayr, B. Ringe, W O. Bechstein, W Lauchart, and P Neuhaus Approach to Primary Liver Cancer. . . . . . . . . .. .... 65 S.Bengmark Biliary Duct Cancer: Therapeutic Nihilism or Prospect .. 74 F. P Gall and F. Kockerling The Problem of Radical Surgery in Pancreatic Cancer and Its Implications for a Combined-Treatment Approach . .. . 79 J.A. Wils Treatment of Pancreatic Carcinoma: Therapeutic Nihilism? . 87 Combined Therapy in Colorectal Cancer . . . . . . . . . . .. 95 V.Metzger Adjuvant Portal Infusion Chemotherapy in Colorectal Cancer 95 J. PArnaud, M. Buyse, M.Adloff, B. Nordlinger, J. C. Pector, and N.Duez Interim Analysis of a Double-Blind Phase-III Clinical Trial of Adjuvant Levamisole Versus Control in Resectable Dukes-C Colon Cancer: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group . . . . 101 R.D.James The Northwest of England Rectal Cancer Trial .. 104 W Niebel, V. Schulz, M. Ried, J. Erhard, F. Beersiek, G. Blocher, H. Nier, H. Halama, E. Scherer, G. Zeller, and F. W Eigler Five-Year Results of a Prospective and Randomized Study: Experience with Combined Radiotherapy and Surgery of Primary Rectal Carcinoma . . . . . . . . . . . . . . 111
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