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Gastroenterology Research and Practice
Volume 2017 (2017), Article ID 5651903, 6 pages
https://doi.org/10.1155/2017/5651903
Review Article

Perioperative Therapy of Oesophagogastric Adenocarcinoma: Mainstay and Future Directions

Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität, Leipziger Str. 44, 39120 Magdeburg, Germany

Correspondence should be addressed to Marino Venerito; ed.ugvo.dem@otirenev.m

Received 4 May 2017; Revised 7 June 2017; Accepted 27 June 2017; Published 13 July 2017

Academic Editor: Haruhiko Sugimura

Copyright © 2017 Katrin Bose et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Perioperative chemotherapy improves overall survival in patients with oesophagogastric adenocarcinoma (OAC) and locoregional disease. The mainstay of perioperative chemotherapy in these patients is a platinum/fluoropyrimidine combination. The phase III FLOT4 trial has shown that the FLOT triplet regimen (oxaliplatin, infusional 5-FU, and docetaxel) improves the outcome of patients with OAC and locoregional disease as compared to the ECF triplet (epirubicin, cisplatin, and infusional 5-FU). Targeted therapies have currently no role in the perioperative setting for the treatment of patients with OAC. For patients with oligometastatic disease, upfront gastrectomy followed by chemotherapy did not show any survival benefit compared with chemotherapy alone and thus should be discouraged. Whether surgery should be offered to patients with metastatic OAC achieving a systemic control after upfront chemotherapy is under scrutiny in the phase III FLOT5/Renaissance trial. After neoadjuvant treatment, lymph node status but not pathologic tumor response is an independent factor in the prediction of overall survival. Growing evidence suggests that perioperative chemotherapy may be associated with an increased mortality risk in patients with microsatellite instable (MSI)/mismatch repair-deficient (MMRD) adenocarcinoma, thus validating poor responsiveness to chemotherapy in MSI patients with locoregional disease.