Predicting the Response to Chemotherapy in Gastric Adenocarcinoma: Who Benefits from Neoadjuvant Chemotherapy?
Despite a decline in the overall incidence, gastric adenocarcinoma remains the second most common cause of cancer death worldwide and thus a significant global health problem. Even in early-stage locoregional confined disease the 5-year survival rarely ex
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Abstract
Despite a decline in the overall incidence, gastric adenocarcinoma remains the second most common cause of cancer death worldwide and thus a significant global health problem. Even in early-stage locoregional confined disease the 5year survival rarely exceeds 25–35 %. Randomized trials have demonstrated a benefit from neoadjuvant and perioperative chemotherapy. However the optimal approach in individual patients is not clear and remains controversial. A consistent finding is that patients who have a histopathological response to neoadjuvant therapy are more likely to receive a survival benefit. These clinical data provide a strong argument for the urgent development of methods to predict histopathological response to neoadjuvant therapies for gastric adenocarcinomas. Published data demonstrate that clinico-pathological features (tumour histology and location), imaging through metabolic response by FDGPET and tissue/molecular biomarkers may all have a predictive value for neoadjuvant therapies. However it is still uncertain from published data whether or not they will be useful for clinical decision making in individual patients. Existing candidate biomarkers need to be properly qualified and validated and
W. B. Robb C. Mariette Department of Digestive and Oncological Surgery, University Hospital Claude Huriez Regional University Hospital Center, Place de Verdun, 59037 Lille Cedex, France C. Mariette (&) University of Lille 2, Lille, France e-mail: [email protected] C. Mariette Inserm, UMR837, Team 5 ‘‘Mucins epithelial differentiation and carcinogenesis’’, JPARC, Rue Michel Polonovski, 59045 Lille cedex, France
F. Otto and M. P. Lutz (eds.), Early Gastrointestinal Cancers, Recent Results in Cancer Research 196, DOI: 10.1007/978-3-642-31629-6_17, Ó Springer-Verlag Berlin Heidelberg 2012
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novel biomarkers are required and an optimal approach should involve the combination and integration of clinical, imaging, pathological and molecular biomarkers.
Contents 1 Introduction.......................................................................................................................... 244 2 Histological Response Evaluation ...................................................................................... 245 3 Histological Tumour Characteristics as a Predictive Marker of Chemotherapy Response................................................................................................. 245 3.1 Efficacy of Neoadjuvant Treatment in SRC Gastric Cancer.................................... 246 3.2 Chemoresistance SRC Gastric Cancer: Postulated Mechanisms.............................. 247 4 Imaging as a Predictive Biomarker of Chemotherapy Response ...................................... 247 4.1 Response Evaluation: EUS and CT........................................................................... 248 4.2 18-F-Fluoro-2-deoxyglucose Positron EmissionTomography: FDG-PET................ 248 4.3 Is Response Prediction Improved with Other Radiotr
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