Combined Modality Therapy of Gastrointestinal Tract Cancer

Modern surgical oncology is characterized by multimodal therapy. In recent years numerous therapeutic approaches of pre-, peri-, intra-and postoperative treatment have been in­ vestigated with regard to their use in combination with surgi­ cal intervention. It now is time to analyze and to define the state of our knowledge. For tumors of the gastrointestinal tract there are several encouraging therapeutic approaches, such as preop­ erative chemotherapy in esophageal and perioperative chemotherapy in colon cancer. For some special tumors, like anal carcinoma, we have clearly defined combined therapies which even now must be viewed as standard treatment. It is also time to demonstrate the results of several clini­ cal studies that have been conducted within the last few years that combined surgical efforts with pre- or postinter­ ventional chemotherapy or radiotherapy. It is necessary to evaluate whether these trials contribute to progress in onco­ logical therapy. The editors of this volume - surgeons at the university hospitals of Heidelberg and Zurich - must be given the mer­ it of achieving these goals. It was especially appropriate for the Department of Surgery in Heidelberg, in close coopera­ tion with the Comprehensive Cancer Center Heidelberg/ Mannheim, to prepare a review of our present knowledge of surgical oncology as it is in the tradition of attempting to combine different therapeutic approaches to cancer therapy.

Combined Therapy in Esophageal Cancer.- The Value of Preoperative Radiotherapy in Esophageal Cancer: Results of a Study by the EORTC.- Preoperative (Neoadjuvant) Chemotherapy in Squamous Cell Cancer of the Esophagus.- Controlled Clinical Trial for the Treatment of Patients with Inoperable Esophageal Carcinoma: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group.- Combination of Chemotherapy and Irradiation: A New Approach in the Treatment of Locally Advanced Esophageal Cancer.- Combined Therapy in Gastric Cancer.- Phase-III Clinical Trial of Adjuvant FAM2 (5-FU, Adriamycin and Mitomycin C) vs Control in Resectable Gastric Cancer: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group.- The Effect of Adjuvant Chemotherapy in Gastric Carcinoma Is Dependent on Tumor Histology: 5-Year Results of a Prospective Randomized Trial.- Combined 5-Fluorouracil and Radiation Therapy Following Resection of Locally Advanced Gastric Carcinoma: A 5-Year Follow-Up.- The Value of a Multidisciplinary Approach in the Management of Gastric Cancer.- The Approach to Hepatobiliary-Pancreatic Cancer.- Approach to Primary Liver Cancer.- Biliary Duct Cancer: Therapeutic Nihilism or Prospect.- The Problem of Radical Surgery in Pancreatic Cancer and Its Implications for a Combined-Treatment Approach.- Treatment of Pancreatic Carcinoma: Therapeutic Nihilism?.- Combined Therapy in Colorectal Cancer.- Adjuvant Portal Infusion Chemotherapy in Colorectal Cancer.- Interim Analysis of a Double-Blind Phase-III Clinical Trial of Adjuvant Levamisole Versus Control in Resectable Dukes-C Colon Cancer: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group.- The Northwest of England Rectal Cancer Trial.- Five-Year Results of a Prospective and Randomized Study: Experience with Combined Radiotherapy and Surgery of Primary Rectal Carcinoma.- The True Role of External-Beam Irradiation in the Initial Treatment of Cancer of the Rectum.- Combined-Treatment Approaches in the Management of Rectal Cancer.- Preoperative Radiotherapy and Radical Surgery as Combined Treatment in Rectal Cancer.- Combined Therapy in Anal Carcinoma.- Preoperative Radio-Chemotherapy in Anal Carcinoma.- Combined Modality Treatment of Anal Carcinoma.- Current Therapeutic Concepts in Management of Carcinoma of the Anal Canal.- Treatment of Liver Metastases of Colorectal Cancer.- Approach of the Treatment of Colorectal Liver Metastases.- Patterns of Failure Following Surgical Resection of Colorectal Cancer Liver Metastases: Rationale for a Multimodal Approach.- Regional Chemotherapy of the Liver for Colorectal Malignancies.- Interim Results of Intra-Arterial 4?-Epi-Doxorubicin for Liver Metastases.- The Use of an Implantable Vascular Occluder in the Treatment of Nonresectable Hepatic Malignancies.- Hepatic Arterial Ligation with and Without Portal Infusion in Metastatic Colorectal Cancer.- Basic Investigations on Interaction of 5-Fluorouracil and Tumor Ischemia in the Treatment of Liver Malignancies.- Current Chemotherapeutic Trials in GI-Tract Cancer.- Systemic Chemotherapy with Cisplatin, 5-Fluorouracil and Allopurinol in the Management of Advanced Epidermoid Esophageal Cancer.- Phase-II-Study with EAP (Etoposide, Adriamycin, Cis-Platinum) in Patients with Primary Inoperable Gastric Cancer and Advanced Disease.- Background for and Progress of an Ongoing EORTC Phase-II Study in Metastatic Gastric Cancer.- 5-Fluorouracil Versus a Combination of BCNU, Adriamycin, 5-FU and Mitomycin C in Advanced Gastric Cancer: A Prospective Randomized Study of the Italian Clinical Research Oncology Group.- 5-Methyltetrahydrofolic Acid (MFH4): An Effective Folate for the Treatment of Advanced Colorectal Cancer with 5-FU.- New Therapeutic Approaches to GI-Tract Cancer.- Intraoperative Radiotherapy in Carcinoma of the Stomach and Pancreas.- Is There a Role for Hyperthermia in Gastrointestinal Tract Cancer?.- Intraperitoneal Chemotherapy and Immunotherapy.- Predictive Assays for the Therapy of Rectal Carcinoma.- Therapy of Carcinoid Tumors with [131I]Meta-Iodo-Benzyl-Guanidine.- New Drug Development in Gastrointestinal-Tract Cancer.