Adjuvant and neoadjuvant therapy of tumors of the gastrointestinal tract.

Abstract

Tumors of the gastrointestinal tract (GIT) - is an extremely heterogeneous group of tumors and characterized by a variety of morphological, genetic characteristics and different approaches to treatment. Most of the tumors can be removed surgically, but as the results of follow-up show, even in case of radical surgical treatment at least half of patients die because of distant metastases. It means that at the time of radical surgery a large number of patients have undetectable micrometastases and therefore the disease is systemic. Adjuvant therapy is a drug therapy after radical surgery, aimed to eradicate distant micrometastases in order to increase overall and disease-free survival. There is no doubt that strong attention of oncologists to the adjuvant treatment of gastrointestinal tumors is dictated by a will to achieve increase in progression-free survival after radical surgery. This period of life of a cancer patient can be equated to a period of temporary recovery when the patient for a considerable length of time does not need any special treatment, leads an active lifestyle and may even go back to work. From the point of view of the public healthcare adjuvant chemotherapy (CT) is the most important. For today research and the searching of optimal regimes of adjuvant chemotherapy of gastrointestinal tumors continue. The basic principle of adjuvant therapy regimen selection - is proved high efficiency in the treatment of metastatic disease. At the same time neoadjuvant regimens are studied. The aim of neoadjuvant chemotherapy is to reduce tumor size, to provide partial destruction of tumor cells (ideally - to achieve complete morphological regression), that allows to performs the operation of smaller volume than the operation that would be performed without neoadjuvant chemotherapy. Currently, principles based on randomized clinical trials with a high level of evidence are established for the selection a regimen of adjuvant and neoadjuvant chemotherapy of gastrointestinal tumors.