[Gastric cancer and adenocarcinoma of the esophagogastric junction: principles of neoadjuvant therapy].

According to the current European and German S3 guidelines, neoadjuvant chemotherapy is now an integral part of the treatment of locally advanced gastric cancer and adenocarcinoma of the esophagogastric junction. Neoadjuvant therapy seeks to achieve downsizing of the primary tumor, lowering of the T and N categories and eradication of micrometastases. As the indications for neoadjuvant treatment are based on pretherapeutic information alone, a sophisticated clinical staging plays a central role.

Metabolic response evaluation by PET during neoadjuvant treatment for adenocarcinoma of the esophagus and esophagogastric junction.

Following several randomized trials, neoadjuvant therapy in adenocarcinoma of esophagus and the esophagogastric junction can be seen as an international standard. However, in a large proportion of patients the objective response achieved is unsatisfactory. These patients do not benefit from neoadjuvant therapy, but do suffer from toxic side effects; sometimes progressive and appropriate surgical therapy is delayed.

[Tumors of the upper gastro-intestinal tract].

The appropriate extent of lymph node dissection in tumors of the upper gastro-intestinal tract continues to be debated. The basic tenet of surgical oncology that cancerous lymph nodes are indicators not governors of survival is under question and derives from the different theories of metastasis. Is the metastatic flow linear (indicators) or does it occur in parallel to tumorigenesis (governor)? If the latter theory is true there would be only a limited indication for lymphadenectomy (LA).

[Early Barrett's carcinoma/high grade intraepithelial neoplasia (HG-IEN): pro endoscopic treatment--pro surgical treatment].

Who may treat early Barrett's carcinoma of the oesophagus? The incidence of adenocarcinoma of the oesophagus developing within Barrett's mucosa has substantially risen in the past few years. Furthermore, treatment of preneoplastic lesions or early carcinoma is controversial. From an endoscopist's point of view high-grade intraepithelial neoplasia (HG-IEN) should be resected endoscopically rather than destroyed endoscopically while early Barrett's carcinoma should undergo endoscopic staging resection.

[Carcinoma of unknown primary site (CUP syndrome)].

Despite the growing array of sophisticated diagnostic tools for establishing a diagnosis of human neoplasia, 2-6% of all cancer patients still present metastatic cancer of which detailed investigations fail to identify the primary anatomic site. The site is found in less than 25% of patients before death and frequently goes undiscovered at post-mortem examination. At the time of first diagnosis with carcinoma of unknown primary site, usually more than 80% of patients present with dissemination.

Sentinel lymph node biopsy in colon cancer: a prospective multicenter trial.

Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results.

Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible.

Delays in diagnosis and therapy of gastric cancer and esophageal adenocarcinoma.

Background And Study Aims: In the past, there were long delays in the diagnosis of patients with cancer of the stomach or esophagus. The objective of this study was to describe current delays in the diagnosis and treatment of gastric and esophageal adenocarcinoma and to compare the findings with those from an historical control population treated at the same institutions 10 years earlier.

Patients And Methods: Patients with biopsy-proven gastric cancer or esophageal adenocarcinoma who were treated at two academic medical centers in Germany between April and October 2003 were consecutively screened for eligibility to take part in the study.

Rectal carcinoma: high-spatial-resolution MR imaging and T2 quantification in rectal cancer specimens.

Purpose: To prospectively compare high-spatial-resolution T1-weighted, T2-weighted, and intermediate-weighted spectral fat-saturated magnetic resonance (MR) imaging for the differentiation of tumor from fibrosis and for delineation of rectal wall layers in rectal cancer specimens.

Materials And Methods: The local ethics committee approved the protocol, and written informed consent was obtained from each patient. Thin-section high-spatial-resolution MR imaging was performed in specimens obtained from 23 patients (16 men, seven women; median age, 64 years; age range, 39-84 years) immediately after resection.

Erythropoietin-alfa during neoadjuvant chemotherapy for locally advanced esophagogastric adenocarcinoma.

Background: In a previous study we showed that many patients with esophagogastric adenocarcinoma experience anemia during neoadjuvant chemotherapy. We now investigated the role of erythropoietin in managing anemia during neoadjuvant chemotherapy.

Methods: Patients with esophagogastric adenocarcinoma who experienced anemia (hemoglobin < 12 g/dL) during neoadjuvant treatment received erythropoietin 10,000 IE subcutaneously three times a week.

Increased risk of ischemic bowel complications during treatment with bevacizumab after pelvic irradiation: report of three cases.

Purpose: To assess the rate of severe bowel complications during treatment with the anti-vascular endothelial growth factor monoclonal antibody bevacizumab.

Methods And Materials: We performed a retrospective evaluation of bevacizumab-associated severe intestinal adverse events from our institutional database.

Results: A total of 33 patients started treatment with bevacizumab at our institution during the first 6 months after its approval in Germany.

[Sentinel lymph node mapping in gastric and esophageal carcinomas].

During the last 5 years, the concept of sentinel lymph nodes has been investigated in a variety of solid tumors. Despite the multidirectional and complex lymphatic drainage of the stomach, early gastric cancer has been shown to be a suitable model for sentinel lymph node mapping. In contrast, sentinel lymph node mapping of esophageal cancer is compromised by the anatomic location of the esophagus and its lymphatic drainage in the closed space of the mediastinum.

Sentinel node detection in Barrett's and cardia cancer.

Because of surveillance strategies in patients with known Barrett's esophagus, more patients with high-grade dysplasia or early cancer in the distal esophagus and at the esophagogastric junction are identified. The need for and extent of lymphadenectomy in such patients are controversial. The technique of sentinel lymph node dissection (SLND) to diagnose early lymphatic spread is applied increasingly in tumors of the gastrointestinal tract.

Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II study.

Background: Patients with locally advanced gastric cancer (cT3, cT4, N+, M0) have a dismal prognosis, despite complete resection. The objective of this study was to evaluate the toxicity and efficacy of neoadjuvant chemotherapy using the PLF (cisplatin/leucovorin [folinic acid]/5-fluorouracil [FU]) regimen in these patients. Primary endpoints of the study were the toxicity and the response to chemotherapy.

[Interdisciplinary psychoeducational intervention by oncologists proved helpful for cancer patients].

Objectives: We prospectively evaluated the effects of a six-session psychoeducational intervention held by medical doctors or psychologists in a German acute cancer center setting.

Methods: A cluster randomization was used to assign n=108 oncologic patients (55 female, 53 male; mean age=58.5) to the intervention or the control group.

Individualizing therapy in gastric cancer.

Although its incidence in developed countries has declined, gastric cancer remains one of the most common human malignancies. In western countries a shift from distal to proximal tumors has been noted during the past 15 years. Today, surgery is no longer the only treatment modality of gastric cancer, with the help of modern and sophisticated staging procedures it becomes increasingly possible to individually tailor therapy.

Current status of neoadjuvant therapy for adenocarcinoma of the distal esophagus.

Prospective studies dealing with preoperative therapy in adenocarcinoma of the esophagus alone are rare. The interpretation of the preferential phase II trials and a few phase III trials is complicated, as most studies include adenocarcinoma of the esophagus (i.e.

Ionizing radiation modulates cell surface integrin expression and adhesion of COLO-320 cells to collagen and fibronectin in vitro.

Purpose: Adhesion of tumor cells to endothelial cells and to the extracellular matrix is a key step in the initial phase of metastasis. Since radiotherapy of tumors can induce alterations of the cell surface, we investigated the effect of ionizing radiation on the expression of integrins in the colorectal tumor cell line COLO-320 and the modulation of adhesion capacity of irradiated cells to collagen and fibronectin.

Material And Methods: The cell surface expression of a broad range of integrins on COLO-320 cells was determined by flow cytometry during 144 hours after X-irradiation.

Site-dependent resection techniques for gastric cancer.

In addition to tumor stage and growth pattern, the tumor site is a major factor in determining the extent of resection and lymphadenectomy necessary in patients with gastric carcinoma. Total gastrectomy with D2-lymphadenectomy is the procedure of choice for tumors of the gastric corpus. Extended total gastrectomy with trans-hiatal resection of the distal esophagus is required for tumors of the proximal region; in these patients lymphadenectomy may also include splenic hilum and left retroperitoneal nodes.

[Structured patient education in oncology. A prospective study for implementing and effectiveness of interdisciplinary psycho-educational group intervention at a German university clinic].

Aim: To identify the target group for a structured educational group intervention in an acute cancer care setting, and to prove its effectiveness.

Patients And Methods: Cancer patients were given an opportunity to join an educational group intervention lasting 3 weeks (consisting of six times 1 hour). The intervention consisted of two major components: health education and coping skills.

[Extent of resection in surgery of stomach carcinoma].

The extraluminal extent of resection in cases of advanced gastric cancer is controversial. If, however, following meticulous staging--including the detection of free abdominal tumor cells--complete resection seems possible, then multivisceral resection is justified. If complete resection is achieved, the prognosis of these patients can be improved.

[Response evaluation--pathway for accurate indications development].

Only patients, which respond to neoadjuvant therapy and in which a subsequent complete resection (R0) is possible, demonstrate a significant survival advantage compared to non-responders. Therefore, a sensitive response evaluation is of high clinical interest. Response evaluation by endoscopy, biopsy, endoluminal ultrasound or by CT scan showed unfavourable and overall nor reliable results.

Esophageal cancer: patient evaluation and pre-treatment staging.

Improvements in the overall survival of patients with esophageal cancer can in the future only be achieved by tailored therapeutic strategies which are based on the individual histologic tumor type, tumor location, tumor stage at the time of presentation, consideration of established prognostic factors and the physiologic status of the patient. The major aim of every diagnostic strategy is to assess whether a complete macroscopic and microscopic tumor resection (i.e.

Proliferation kinetics and prognosis in gastric cancer after resection.

The influence of proliferation and proliferation kinetics on prognosis in gastric cancer after complete resection are controversial. In a prospective study we investigated the tumour specimens of 111 patients after resection of gastric cancer, who received 200 mg intravenous (i.v.