TY - JOUR
T1 - The 4th St. Gallen EORTC Gastrointestinal Cancer Conference
T2 - Controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma
AU - Lutz, Manfred P.
AU - Zalcberg, John R.
AU - Ducreux, Michel
AU - Adenis, Antoine
AU - Allum, William
AU - Aust, Daniela
AU - Carneiro, Fatima
AU - Grabsch, Heike
AU - Laurent-Puig, Pierre
AU - Lordick, Florian
AU - Moehler, Markus
AU - Monig, Stefan
AU - Obermannova, Radka
AU - Piessen, Guillaume
AU - Riddell, Angela
AU - Roecken, Christoph
AU - Roviello, Franco
AU - Schneider, Paul Magnus
AU - Seewald, Stefan
AU - Smyth, Elizabeth
AU - van Cutsem, Eric
AU - Verheij, Marcel
AU - Wagner, Anna Dorothea
AU - Otto, Florian
N1 - Funding Information:
Manfred Lutz received grants or research support from Celgene and Shire and honoraria or consultation fees from Eli Lilly and Falk Foundation. John Zalcberg received grants or research supports from Specialized Therapeutics and Shire and honoraria or consultation fees from Pfizer, Amgen and MSD. Arnaud Roth received honoraria or consultation fees from Roche, Bayer, BMS, Celgene, Amgen and Merck. William Allum received honoraria or consultation fees from Eli Lilly, Nestle and Taiho and is a member of speakers' bureau for Lilly, Nestle and Taiho. Michel Ducreux received grants or research supports from Roche, Chugai and Pfizer and honoraria or consultation fees from Roche, Celgene, Merck Serono, Amgen, Novartis, Sanofi, Pfizer, Lilly and Servier, and his spouse is the head of BU, Sandoz. Pierre Laurent-Puig received honoraria or consultation fees from Amgen, Boehringer Ingelheim, AstraZeneca, BMS, Merck, Roche and Lilly. Florian Lordick received grants or research support from BMS and Fresenius Biotech and honoraria or consultation fees from Amgen, Astellas, Biontech, BMS Boston Biomedical, Ganymed, Lilly, MSD, Nordic, Roche and Taiho. Markus Möhler received grants or research support from Merck, Amgen, BMS, Taiho, Roche, AIO, MSD and honoraria or consultation fees from Falk, Nordic, Amgen, MCI, AstraZeneca, Lilly, MSD, Merck, Pfizer and BMS. Radka Obermannová received grants or research supports from Merck and honoraria or consultation fees from BMS and is a member of speakers' bureau for Eli Lilly, Servier, Roche and BMS. Guillaume Piessen received honoraria or consultation fees from Amgen. Christoph Röcken is a member of advisory boards for BMS, MSD and Roche. Stefan Seewald received grants or research supports from WATS and honoraria or consultation fees from Cook Medical, Olympus and Boston. Elizabeth Smyth received honoraria or consultation fees from Five Prime Therapeutics and BMS. Eric Van Cutsem received grants or research supports from Amgen, Bayer, Boehringer, Celgene, Ipsen, Lilly, MSD, Merck, Novartis, Roche and Servier and honoraria or consultation fees from Bayer, Celgene, Lilly, Novartis and Servier. Marcel Verheij received grants or research supportRoche. Dorothea Wagner received research funding from Roche and is a consultant or involved in advisory activities for Lilly, Celgene, Merck, Bristol-Myers Squibb, Pfizer, Servier and Shire. The other authors declare that they have no conflict of interest to disclose.
Funding Information:
This meeting was made possible through the generous financial support of St. Gallen Oncology Conferences. The authors wish to thank Hans-Jörg Senn and Agnes Glaus for their expertise as well as Judith Eberhardt and Fabienne Hevi for the excellent operational management of the conference.
Publisher Copyright:
© 2019
PY - 2019/5
Y1 - 2019/5
N2 - Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multi-modal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting. (C) 2019 Published by Elsevier Ltd.
AB - Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multi-modal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting. (C) 2019 Published by Elsevier Ltd.
KW - Gastric cancer
KW - Adenocarcinoma of
KW - the gastro-oesophageal junction
KW - Multimodal treatment
KW - Expert consensus
KW - CLINICAL-PRACTICE GUIDELINES
KW - GASTROESOPHAGEAL ADENOCARCINOMA
KW - PERIOPERATIVE CHEMOTHERAPY
KW - DECISION-MAKING
KW - DIAGNOSIS
KW - SURGERY
KW - CHEMORADIOTHERAPY
KW - PATHOLOGY
KW - SURVIVAL
U2 - 10.1016/j.ejca.2019.01.106
DO - 10.1016/j.ejca.2019.01.106
M3 - (Systematic) Review article
C2 - 30878666
SN - 0959-8049
VL - 112
SP - 1
EP - 8
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -