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. 1994 Mar 26;308(6932):834–838. doi: 10.1136/bmj.308.6932.834

Management of carcinomas of the upper gastrointestinal tract.

P Ellis 1, D Cunningham 1
PMCID: PMC2540003  PMID: 8167493

Abstract

Patients with oesophageal, gastric, and pancreatic carcinomas present a common and difficult problem for the clinician. Surgery is the best option for curative treatment but overall survival figures remain low. Recent improvements in our understanding of the biology of these tumours and improvements in their clinical staging, along with the development of combined modality approaches to local-regional disease, have led to renewed optimism that survival figures may be improved. This is particularly so for oesophageal and gastric carcinomas. In addition, there have been advances in the palliative management of all three tumours. This article examines some of these developments and looks at future prospects.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ali N. J., Capewell S., Ward M. J. Bone turnover during high dose inhaled corticosteroid treatment. Thorax. 1991 Mar;46(3):160–164. doi: 10.1136/thx.46.3.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Amin Z., Donald J. J., Masters A., Kant R., Steger A. C., Bown S. G., Lees W. R. Hepatic metastases: interstitial laser photocoagulation with real-time US monitoring and dynamic CT evaluation of treatment. Radiology. 1993 May;187(2):339–347. doi: 10.1148/radiology.187.2.8475270. [DOI] [PubMed] [Google Scholar]
  3. Cullinan S. A., Moertel C. G., Fleming T. R., Rubin J. R., Krook J. E., Everson L. K., Windschitl H. E., Twito D. I., Marschke R. F., Foley J. F. A comparison of three chemotherapeutic regimens in the treatment of advanced pancreatic and gastric carcinoma. Fluorouracil vs fluorouracil and doxorubicin vs fluorouracil, doxorubicin, and mitomycin. JAMA. 1985 Apr 12;253(14):2061–2067. [PubMed] [Google Scholar]
  4. Forastiere A. A., Orringer M. B., Perez-Tamayo C., Urba S. G., Husted S., Takasugi B. J., Zahurak M. Concurrent chemotherapy and radiation therapy followed by transhiatal esophagectomy for local-regional cancer of the esophagus. J Clin Oncol. 1990 Jan;8(1):119–127. doi: 10.1200/JCO.1990.8.1.119. [DOI] [PubMed] [Google Scholar]
  5. Gilsanz V., Gibbens D. T., Roe T. F., Carlson M., Senac M. O., Boechat M. I., Huang H. K., Schulz E. E., Libanati C. R., Cann C. C. Vertebral bone density in children: effect of puberty. Radiology. 1988 Mar;166(3):847–850. doi: 10.1148/radiology.166.3.3340782. [DOI] [PubMed] [Google Scholar]
  6. Girling D. J., Clark P. I. Randomized trials in the treatment of cancer of the esophagus. J Clin Oncol. 1992 Jul;10(7):1031–1033. doi: 10.1200/JCO.1992.10.7.1031. [DOI] [PubMed] [Google Scholar]
  7. Grace P. A., Pitt H. A., Longmire W. P. Pylorus preserving pancreatoduodenectomy: an overview. Br J Surg. 1990 Sep;77(9):968–974. doi: 10.1002/bjs.1800770906. [DOI] [PubMed] [Google Scholar]
  8. Grau J. J., Estapé J., Alcobendas F., Pera C., Daniels M., Terés J. Positive results of adjuvant mitomycin-C in resected gastric cancer: a randomised trial on 134 patients. Eur J Cancer. 1993;29A(3):340–342. doi: 10.1016/0959-8049(93)90381-o. [DOI] [PubMed] [Google Scholar]
  9. Hagiwara A., Takahashi T., Kojima O., Sawai K., Yamaguchi T., Yamane T., Taniguchi H., Kitamura K., Noguchi A., Seiki K. Prophylaxis with carbon-adsorbed mitomycin against peritoneal recurrence of gastric cancer. Lancet. 1992 Mar 14;339(8794):629–631. doi: 10.1016/0140-6736(92)90792-2. [DOI] [PubMed] [Google Scholar]
  10. Hallissey M. T., Allum W. H., Jewkes A. J., Ellis D. J., Fielding J. W. Early detection of gastric cancer. BMJ. 1990 Sep 15;301(6751):513–515. doi: 10.1136/bmj.301.6751.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Herskovic A., Martz K., al-Sarraf M., Leichman L., Brindle J., Vaitkevicius V., Cooper J., Byhardt R., Davis L., Emami B. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992 Jun 11;326(24):1593–1598. doi: 10.1056/NEJM199206113262403. [DOI] [PubMed] [Google Scholar]
  12. Kalser M. H., Ellenberg S. S. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985 Aug;120(8):899–903. doi: 10.1001/archsurg.1985.01390320023003. [DOI] [PubMed] [Google Scholar]
  13. Kelly P. J., Eisman J. A., Sambrook P. N. Interaction of genetic and environmental influences on peak bone density. Osteoporos Int. 1990 Oct;1(1):56–60. doi: 10.1007/BF01880417. [DOI] [PubMed] [Google Scholar]
  14. Kelsen D., Atiq O. T., Saltz L., Niedzwiecki D., Ginn D., Chapman D., Heelan R., Lightdale C., Vinciguerra V., Brennan M. FAMTX versus etoposide, doxorubicin, and cisplatin: a random assignment trial in gastric cancer. J Clin Oncol. 1992 Apr;10(4):541–548. doi: 10.1200/JCO.1992.10.4.541. [DOI] [PubMed] [Google Scholar]
  15. Kim N. K., Park Y. S., Heo D. S., Suh C., Kim S. Y., Park K. C., Kang Y. K., Shin D. B., Kim H. T., Kim H. J. A phase III randomized study of 5-fluorouracil and cisplatin versus 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil alone in the treatment of advanced gastric cancer. Cancer. 1993 Jun 15;71(12):3813–3818. doi: 10.1002/1097-0142(19930615)71:12<3813::aid-cncr2820711205>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  16. Klaassen D. J., MacIntyre J. M., Catton G. E., Engstrom P. F., Moertel C. G. Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. J Clin Oncol. 1985 Mar;3(3):373–378. doi: 10.1200/JCO.1985.3.3.373. [DOI] [PubMed] [Google Scholar]
  17. Mallinson C. N., Rake M. O., Cocking J. B., Fox C. A., Cwynarski M. T., Diffey B. L., Jackson G. A., Hanley J., Wass V. J. Chemotherapy in pancreatic cancer: results of a controlled, prospective, randomised, multicentre trial. Br Med J. 1980 Dec 13;281(6255):1589–1591. doi: 10.1136/bmj.281.6255.1589. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Maunoury V., Brunetaud J. M., Cochelard D., Boniface B., Cortot A., Paris J. C. Endoscopic palliation for inoperable malignant dysphagia: long term follow up. Gut. 1992 Dec;33(12):1602–1607. doi: 10.1136/gut.33.12.1602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Moertel C. G., Frytak S., Hahn R. G., O'Connell M. J., Reitemeier R. J., Rubin J., Schutt A. J., Weiland L. H., Childs D. S., Holbrook M. A. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer. 1981 Oct 15;48(8):1705–1710. doi: 10.1002/1097-0142(19811015)48:8<1705::aid-cncr2820480803>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  20. Murad A. M., Santiago F. F., Petroianu A., Rocha P. R., Rodrigues M. A., Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer. 1993 Jul 1;72(1):37–41. doi: 10.1002/1097-0142(19930701)72:1<37::aid-cncr2820720109>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  21. Parsonnet J., Friedman G. D., Vandersteen D. P., Chang Y., Vogelman J. H., Orentreich N., Sibley R. K. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991 Oct 17;325(16):1127–1131. doi: 10.1056/NEJM199110173251603. [DOI] [PubMed] [Google Scholar]
  22. Perez E. A., Gandara D. R. Advances in the control of chemotherapy-induced emesis. Ann Oncol. 1992 Aug;3 (Suppl 3):47–50. doi: 10.1093/annonc/3.suppl_3.s47. [DOI] [PubMed] [Google Scholar]
  23. Priftis K., Everard M. L., Milner A. D. Unexpected side-effects of inhaled steroids: a case report. Eur J Pediatr. 1991 Apr;150(6):448–449. doi: 10.1007/BF02093730. [DOI] [PubMed] [Google Scholar]
  24. Saltz L., Kelsen D. Combined-modality therapy in the treatment of local-regional esophageal cancer. Ann Oncol. 1992 Dec;3(10):793–799. doi: 10.1093/oxfordjournals.annonc.a058098. [DOI] [PubMed] [Google Scholar]
  25. Scott N., Cross D., Plumb M. I., Dixon M. F., Quirke P. An investigation of different methods of cell cycle analysis by flow cytometry in rectal cancer. Br J Cancer. 1992 Jan;65(1):8–10. doi: 10.1038/bjc.1992.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Tio T. L., Cohen P., Coene P. P., Udding J., den Hartog Jager F. C., Tytgat G. N. Endosonography and computed tomography of esophageal carcinoma. Preoperative classification compared to the new (1987) TNM system. Gastroenterology. 1989 Jun;96(6):1478–1486. doi: 10.1016/0016-5085(89)90515-5. [DOI] [PubMed] [Google Scholar]
  27. Trede M., Schwall G., Saeger H. D. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990 Apr;211(4):447–458. doi: 10.1097/00000658-199004000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wilke H., Preusser P., Fink U., Gunzer U., Meyer H. J., Meyer J., Siewert J. R., Achterrath W., Lenaz L., Knipp H. Preoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol. 1989 Sep;7(9):1318–1326. doi: 10.1200/JCO.1989.7.9.1318. [DOI] [PubMed] [Google Scholar]
  29. Wils J. A., Klein H. O., Wagener D. J., Bleiberg H., Reis H., Korsten F., Conroy T., Fickers M., Leyvraz S., Buyse M. Sequential high-dose methotrexate and fluorouracil combined with doxorubicin--a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol. 1991 May;9(5):827–831. doi: 10.1200/JCO.1991.9.5.827. [DOI] [PubMed] [Google Scholar]
  30. Wolthers O. D., Pedersen S. Growth of asthmatic children during treatment with budesonide: a double blind trial. BMJ. 1991 Jul 20;303(6795):163–165. doi: 10.1136/bmj.303.6795.163. [DOI] [PMC free article] [PubMed] [Google Scholar]

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