Esophageal cancer is a malignant tumor with a high incidence in China. At pesent, advanced esophageal cancer patients are still frequently encountered. The primary treatment for resectable advanced esophageal cancer is surgery-based multimodality therapy, including preoperative neoadjuvant therapy, such as chemotherapy, chemoradiotherapy or chemotherapy plus immunotherapy, followed by radical esophagectomy with thoraco-abdominal two-field or cervico-thoraco-abdominal three-field lymphadenectomy via minimally invasive approach or thoracotomy. In addition, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, or immunotherapy may also be administered if suggested by postoperative pathological results. Although the treatment outcome of esophageal cancer has improved significantly in China, many clinical issues remain controversial. In this article, we summarize the current hotspots and important issues of esophageal cancer in China, including prevention and early diagnosis, treatment selection for early esophageal cancer, surgical approach selection, lymphadenectomy method, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and nutritional support treatment.
Humans ; Esophageal Neoplasms/surgery* ; Combined Modality Therapy ; Neoadjuvant Therapy/methods* ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Esophagectomy/methods*

Perioperative treatment is critical to improve the outcomes of patients with advanced gastric cancer. There are three therapeutic modes of perioperative treatment for resectable gastric cancer: neoadjuvant chemotherapy+ D1/D2 surgery+ adjuvant chemotherapy, D0/D1 surgery+ adjuvant radiochemotherapy, and D2 surgery+ adjuvant chemotherapy. Over the decades, a large number of clinical studies had been conducted to optimize the perioperative treatment mode of gastric cancer, including the postoperative radiotherapy and chemotherapy, and perioperative chemotherapy, and to explore the feasibility of preoperative radiochemotherapy, targeted therapy, and immunotherapy in advanced gastric cancer. After nearly 20 years of development and exploration, although the perioperative treatment mode for advanced gastric cancer has become standardized, there are still some core issues that need to be solved urgently, including the selection of population for perioperative treatment, the limitation of efficaly evaluation criteria, insufficient emphasis on laparoscopic exploration before neoadjuvant treatment, and lack of exploration in esophagogastric junction cancer. We should fully integrate the current clinical research data into clinical practice, adopt a multidisciplinary diagnosis and treatment mode, and follow the principles of standardized diagnosis and treatment based on a multi-dimensional analysis of patient characteristics, and formulate the most reasonable treatment strategy to ultimately benefit patients.
Antineoplastic Combined Chemotherapy Protocols/administration & dosage* ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Esophagogastric Junction ; Gastrectomy ; Humans ; Lymph Node Excision ; Neoadjuvant Therapy ; Perioperative Care ; Stomach Neoplasms/therapy*

Local advanced gastric cancer (LAGC) accounts for a large proportion of annual newly diagnosed gastric cancer patients in China. There is a general consensus for D2 radical gastrectomy followed by postoperative adjuvant chemotherapy for LAGC patients, and this therapeutic strategy has been confirmed by a series of clinical trials to obviously improve the patients' prognosis; however, the recurrence rate is still high (about 50%-80% in advanced stage), which makes it difficult to further improve the long-term survival. Perioperative therapy, especially whether preoperative neoadjuvant therapy (NAT) can improve the efficacy of patients with LAGC, has been paid more and more attention. NAT is mainly defined as a preoperative chemotherapy or chemoradiotherapy, aiming at increasing curative resection rate by downstaging tumor, eliminating micrometastases, and autologously testing of anti-cancer drug sensitivity etc. However, there are still some controversy whether LAGC patients could gain survival benefit from NAT and also lack of general consensus for this issue. In this paper, the author reviews and analyzes the current situation of perioperative therapies for LAGC patients, especially emphasize the results of neoadjuvant chemotherapy or chemoradiotherapy reported by various high-level clinical studies. The preliminary effect of perioperative chemotherapy combined with molecular targeted or immunotherapy has also aroused great interest and attention. While we continue to carry out NAT and look forward to more new high-level evidence trials on NAT, we must emphasize again that R0 gastrectomy remains the most important therapeutic modality for the patients with LAGC.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Gastrectomy/methods* ; Humans ; Lymph Node Excision ; Neoadjuvant Therapy ; Neoplasm Staging ; Perioperative Care/trends* ; Stomach Neoplasms/therapy*

Esophageal squamous cell carcinoma (ESCC) is one of the commonest malignancies in China. Surgery is the main treatment for ESCC. However, the long-term survival is very poor by surgery alone. Perioperative multimodality treatment, including locally and systemically administrated, preoperatively and postoperatively, has been and will be the standard treatment in terms of improving long-term survival. Base on decades of practice and clinical trials, it is believed that preoperative treatment is better than postoperative treatment, and that chemotherapy plus radiotherapy preoperatively is better than either chemotherapy or radiotherapy alone. Therefore, preoperative radiochemotherapy followed by surgery is the standard treatment and future direction for locally advanced ESCC.
Chemotherapy, Adjuvant ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Humans ; Neoadjuvant Therapy ; Perioperative Care ; Radiotherapy, Adjuvant

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). MATERIALS AND METHODS: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. RESULTS: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). CONCLUSION: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.
Chemotherapy, Adjuvant ; Combined Modality Therapy ; Drug Therapy ; Follow-Up Studies ; Humans ; Male ; Mesothelioma ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Pneumonectomy ; Radiation Pneumonitis ; Radiotherapy ; Radiotherapy, Adjuvant ; Radiotherapy, Intensity-Modulated ; Recurrence

Recently, treatment strategy optimization for neoadjuvant therapy of rectal cancer includes two aspects: (1) Increasing treatment intensity may improve pathological complete response rate, including increasing radiation dose or concurrent chemotherapy intensity, or shifting adjuvant chemotherapy; (2) Short-course radiotherapy or neoadjuvant chemotherapy which can promise treatment efficacy will decrease toxicity and lead to better tolerance. Long-course chemoradiotherapy is the recent treatment standard for locally advanced rectal cancer. NCCN guidelines do not recommend combined chemotherapy in the radiotherapy period. However, it is important for individualized treatment of rectal cancer if appropriate patients who may benefit from the combined concurrent chemotherapy can be selected. Short-course radiotherapy is defined as 5 Gy × 5. It is recommended for T3 or N+ rectal cancer in NCCN guidelines, but not for T4 patients. In ESMO guidelines, stratified patients of intermediate risk by MRI can be treated with either short-course or long-course radiotherapy, but short-course radiotherapy is not recommended for T4 or positive mesorectum fascia (MRF+) patients with high risk. Neoadjuvant chemotherapy incorporated in the neoadjuvant part has been a therapeutic choice in NCCN guidelines. However, It is still unclear whether chemotherapy upfront as a component of neoadjuvant treatment or even completion of chemotherapy before surgery can improve treatment outcome or not. There are phase II( studies focused on this issue and final results are pending.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms ; radiotherapy ; Treatment Outcome

Pancreatic cancer remains a major troublesome clinical problem, with conventional cancer treatments having little impact on disease course. The extent of disease is often classified as localized, locally advanced, and metastatic. Radical operation is the most effective method, but only 15%-20% of patients have resectable disease, and around 20% of them survive to 5 years. For locally advanced, unresectable, and metastatic diseases, palliative treatment is more appropriate, but the median survival in these patients is less than 6 months and the 5-year survival rates are even lower than 4%. Neoadjuvant therapy has been gradually accepted in breast cancer and gastroenterological cancer, and its value in pancreatic cancer has attracted increasing interests. This paper reviews recent advances of neoadjuvant therapy in pancreatic cancer.
Adenocarcinoma ; therapy ; Chemotherapy, Adjuvant ; adverse effects ; methods ; Combined Modality Therapy ; Humans ; Neoadjuvant Therapy ; adverse effects ; methods ; Pancreatic Neoplasms ; therapy ; Radiotherapy, Adjuvant ; adverse effects ; methods

Chemotherapy, Adjuvant ; Combined Modality Therapy ; Humans ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; drug therapy ; radiotherapy

In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy.
Adenocarcinoma ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Humans ; Lymph Node Excision ; Radiotherapy, Adjuvant ; Recurrence ; Stomach Neoplasms ; Tetrazolium Salts

In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy.
Adenocarcinoma ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Humans ; Lymph Node Excision ; Radiotherapy, Adjuvant ; Recurrence ; Stomach Neoplasms ; Tetrazolium Salts