インタビュー
「Educational Symposium：胃・食道がんの診断と管理」の座長・Florian Lordick氏に聞く
最近は、胃・食道がんの集学的治療の一環として化学療法と放射線治療を併用する化学放射線療法が注目されている。本セッションでは、こういった集学的治療の話題を中心に、最新の治療や診断の方向性について討議が行われた。座長を務めたドイツ・ハノーバー医科大学のFlorian Lordick氏が、このセッションのポイントについて語ってくれた。（平井佐知）
| 編集部 | 本セッションでは主に胃・食道がんの集学的治療に焦点が当てられました。特にポイントとなった点を簡単に解説してください。 |
| Lordick氏 |  |
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squamous cell cancer：扁平上皮がん
esophagus：食道
chemoradiation：化学放射線療法
adenocarcinoma：腺がん
neoadjuvant chemotherapy：術前化学療法
postgastrectomy：胃切除後
Yeah, we heard the first talk on the role of surgery by Professor Michael Stahl from Germany and he pointed out that at least in western studies and western countries, for squamous cell cancer of the esophagus, there is a trend that these patients are not treated by surgery anymore, but they are treated with chemoradiation, but it seems that still there is a subset of patients, who have a clear benefit from surgery and these are probably those patients, who do not achieve a complete response to chemoradiation. So, he proposed, at least for European and US Centers that patients presenting with esophageal squamous cell cancers could be treated with chemoradiation alone and surgery could be avoided.
This is different when it comes to adenocarcinoma of the esophagus or of the EG junction. There still surgery is the standard procedure. And, then in the second lecture, David Cunningham convincingly showed that a surgery alone is no more the standard for locally advanced disease. There are data from Europe favoring neoadjuvant chemotherapy, there are data from Japan. There is one study, S-1 for 1 year that indicates the prognosis can be improved when postgastrectomy patients receive 1 year of S-1, and the colleagues are from the United States, they favor adjuvant chemoradiation.
But, at the baseline, it has been studied in all the continents and all countries that surgery alone is no more the standard of care for locally advanced gastric cancer.
| 編集部 | 最後の講演では、病期診断や治療法の決定に果たすPETの役割について論じられました。このテーマについてはいかがでしょうか。 |
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FDG-PET：フルオロデオキシグルコースPETの略（がんの画像診断法のひとつ）
prognostication：予後診断，予後判定
validate：検証する
In the last talk, I pointed out the role FDG-PET has for the staging and prognostication of esophageal cancers. I could show that FDG-PET adds something to the diagnostic and staging accuracy in esophageal cancer, but there are availability issues and PET is not paid in all countries. But if you have it available, it certainly adds some information.
But, probably the most interesting point about PET is its possibility to predict response to preoperative treatment. There are very interesting data, especially from Germany that show that at an early time point, you can predict who does respond and benefit from chemotherapy and who will not, but this still has to be validated in prospective trials that are planned in the ERTC Network.
| 編集部 | これからの研究はどのような形で進むとお考えですか？ |
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cetuximab：セツキシマブ（分子標的薬の一種）
anti-EGF receptor antibody：抗EGFR抗体（EGFRは上皮成長因子受容体の略）
tremendous step forward：驚くほどの前進
The basic thing is that the community -- the oncological community really is coming together now. And, when you go back 10 years earlier, the studies performed in Japan and in Europe are very different ones. And, now we are discussing many study concepts together and we are also doing studies together.
And, to give you some examples, the very famous ToGA Study that investigated HER2 positivity in gastric cancer was performed together with the European and the Japanese colleagues. And also, the study in gastric cancer evaluating the value of cetuximab, anti-EGF receptor antibody, is also a global study where Japanese and European centers take part. So, I think these worlds are no more separated and we’re doing studies together now, which is a tremendous step forward.
