Current
best practices and rationalistic perspectives in causation-based
prevention, early detection and multidisciplinary treatment
of breast and gastric cancer
|
|
PERSPECTIVE |
| Tumor
Stage-Based Tailored Therapeutic Strategy: Rational Approach or
New Trend? |
| Abstract |
| Currently,
many patients with gastric cancer are overtreated or undertreated.
Gastrectomy with less (D1) or more (D2) extensive lymph node dissection
usually followed by adjuvant treatment is the standardized treatment
in all stages-cancer, early or late. However, there is little
scientific evidence that aggressive treatment, as compared with
less extensive surgery, provides better clinical outcome especially
in earlier-stages cancer. |
| Since
the principal goal for a curative (R0) resection in early stage-cancers
can be achieved with a less extensive surgery, a trend towards
a tumor stage-based extent of surgery with or without adjuvant
treatment seems to be rational. Such a strategy has already been
started in Japan. |
| Here,
we discuss the risks (local, distant recurrences, death) and benefits
(lower adverse-effects profile), of a tumor stage-oriented therapeutic
strategy, as well as whether decision-making based on tumor stage
is evidence-based or not. |
| Studies
with new biologic markers, as gene expression signature, provide
currently promising data that microarrays, in addition to other
classic predictors, will be used in the future towards improvement
of outcome prediction and treatment in both survival and quality
of life (QOL) by reducing the rate of overtreatment or undertreatment
of the patients with gastric cancer. |
|
