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Purpose Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new, palliative approach for patients with peritoneal surface malignancies (PSMs). Its main goals are to control symptoms and ascites. For this experimental procedure, treatment efficacy and patient safety need to be closely monitored. Methods We performed a prospective registry study for patients with PSMs. Cisplatin (C) (7.5 mg/m2 body surface) and doxorubicin (D) (1.5 mg/m2) were administered laparoscopically via PIPAC. Results Between November 2015 and June 2020, we recorded data from 108 patients and 230 scheduled procedures. Tumor burden, patient fitness, quality of life, operating time and in-hospital stay remained stable over consecutive procedures. We recorded 21 non-access situations and 14 intraoperative complications (11 intestinal injuries, and three aspirations while inducing anesthesia). Three or more previous abdominal surgeries or cytoreductive surgery (CRS) with intraperitoneal hyperthermic chemoperfusion (HIPEC) were risk factors for non-access and intestinal injuries (χ2, p ≤ 0.01). Five Grade IV and three Grade V postoperative complications according to the Clavien–Dindo Classification (CDC) occurred. Median overall survival was 264 days (interquartile range 108–586). Therapies were primarily discontinued because of death (34%), progressive (26%), or regressive (16%) disease. Conclusion PIPAC is effective in stabilizing PSMs and retaining quality of life in selected patients. Earlier abdominal surgeries and CRS with HIPEC should be considered when determining the indication for PIPAC. Randomized controlled studies are needed to evaluate PIPAC’s therapeutic benefits compared to systemic chemotherapy (sCHT) alone. Trial registration NCT03100708 (April 2017).

Sarcopenia represents an established adverse prognostic factor in cancer patients. Consequently, different means to counteract sarcopenia have been proposed to improve cancer treatment. Computed tomography (CT)-based measurements, also labor intensive, are well validated for the analysis of sarcopenia. As inflammation plays a key role in the development of sarcopenia, we here studied the role of the modified Glasgow prognostic score (mGPS), consisting of inflammation parameters plasma C-reactive protein (CRP) and albumin, to predicting sarcopenia and adipose tissue-related body composition (BC) parameters at baseline and their changes during treatment and to analyze its prognostic role in conjunction with BC parameters.CT measurements of BC parameters were carried out at baseline and week 12 in patients with advanced gastric or esophagogastric junction cancer from the phase III EXPAND trial, undergoing first-line platinum-fluoropyrimidine chemotherapy. mGPS was calculated from baseline CRP and albumin plasma levels. Pearson correlation and Cox regression analyses were carried out.mGPS is strongly prognostic for overall survival (OS). Baseline mGPS is significantly correlated with baseline mean muscle attenuation (MA; P0.0001). Baseline mGPS did not predict a decline in muscle or adipose tissue parameters during 12 weeks of treatment and a decline in muscle or adipose tissue parameters was not prognostic for OS. MA lost its prognostic role for OS when mGPS or CRP was entered into the Cox models. Eastern Cooperative Oncology Group performance status together with CRP or mGPS remained the sole baseline prognostic factors for OS.Our findings support a model where tumor-mediated inflammatory response represents a strong prognostic factor, which is causally related to sarcopenia, but with no direct causal path from sarcopenia to survival. Therefore, therapeutic targeting of systemic inflammation should be further explored as a promising strategy to improve both sarcopenia and the efficacy and tolerability of cancer treatment.

Introduction: Off-label use of medicines is generally discouraged. However, several off-patent, low-cost cancer medicines remain off-label for indications in which they are commonly used in daily practice, supported by high-level evidence based on results of phase III clinical trials. This discrepancy may generate prescription and reimbursement obstacles as well as impaired access to established therapies.Methods: A list of cancer medicines that remain off-label in specific indications despite the presence of high-level evidence was generated and subjected to European Society for Medical Oncology (ESMO) expert peer review to assess for accountability of reasonableness. These medicines were then surveyed on approval procedures and workflow impact. The most illustrative examples of these medicines were reviewed by experts from the European Medicines Agency to ascertain the apparent robustness of the supporting phase III trial evidence from a regulatory perspective.Results: A total of 47 ESMO experts reviewed 17 cancer medicines commonly used off-label in six disease groups. Overall, high levels of agreement were recorded on the off-label status and the high quality of data supporting the efficacy in the off-label indications, often achieving high ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scores. When prescribing these medicines, 51% of the reviewers had to implement a time-consuming process associated with additional workload, in the presence of litigation risks and patient anxiety. Finally, the informal regulatory expert review identified only 2 out of 18 (11%) studies with significant limitations that would be difficult to overcome in the context of a potential marketing authorisation application without additional studies.Conclusions: We highlight the common use of off-patent essential cancer medicines in indications that remain off-label despite solid supporting data as well as generate evidence on the adverse impact on patient access and clinic workflows. In the current regulatory framework, incentives to promote the extension of indications of off-patent cancer medicines are needed for all stakeholders.

Hintergrund: Molekular zielgerichtete Therapien und zellbasierte Immuntherapie ergänzen zunehmend die klassische zytotoxische Chemotherapie. Ziel:Der aktuelle Wissensstand und die größten Herausforderungen der molekularen und zellbasierten Krebstherapie werden dargestellt. Material und Methode: Die PubMed-gelisteten Publikationen und Tagungsberichte zu molekularer und zellbasierte Krebstherapie in den letzten 25 Jahren und den zu erwartenden Entwicklungsperspektiven wurden ausgewertet. Ergebnisse: Die Indikationen für molekulare und zellbasierte Therapien nehmen stetig zu. Gerade bei den soliden Tumoren stellen Heterogenität und Evolution bisher eine Limitation für molekular zielgerichtete Therapie dar. Die Identifikation tumorassoziierter Antigene und die Überwindung des immunsuppressiven Tumormikromilieus sind wesentliche Herausforderungen für die Entwicklung zellbasierter Therapien. Erfolgversprechende neue Strategien sind genmodifizierte T‑Zellen, NK-Zellen, mesenchymale Stromazellen, dendritische Zellen, Technologien des In-vivo-Targeting und individualisierte RNA-Vakzine. Die genauere molekulare Charakterisierung von Tumoren auf genomischer, transkriptomischer, epigenetischer und proteomischer Ebene ist eine Voraussetzung für die Entwicklung wirksamer personalisierter Therapien. Künstliche Intelligenz wird benötigt, um die Interpretation der großen Datenmengen, die Diagnosestellung und die ärztliche Entscheidungsfindung zu unterstützen. Schlussfolgerung: Die biologische Komplexität von Krebserkrankungen erfordert ein multimodales Konzept und eine umfassende genotypische und phänotypische Charakterisierung, auch unter Zuhilfenahme künstlicher Intelligenz, um unwirksame Behandlungen zu vermeiden, mögliche Resistenzentwicklungen gegen molekulare und zellbasierte Therapien zu umgehen und eine Elimination oder langfristige Erkrankungskontrolle zu erreichen.

We established an international consortium to review and discuss relevant clinical evidence in order to develop expert consensus statements related to cancer management during the severe acute respiratory syndrome coronavirus 2-related disease (COVID-19) pandemic. The steering committee prepared 10 working packages addressing significant clinical questions from diagnosis to surgery. During a virtual consensus meeting of 62 global experts and one patient advocate, led by the European Society for Medical Oncology, statements were discussed, amended and voted upon. When consensus could not be reached, the panel revised statements until a consensus was reached. Overall, the expert panel agreed on 28 consensus statements that can be used to overcome many of the clinical and technical areas of uncertainty ranging from diagnosis to therapeutic planning and treatment during the COVID-19 pandemic.

Dieser Ubersichtsartikel stellt neue Ansatze fur eine medikamentose Therapie des Magenkarzinoms dar. Eine neu entwickelte molekulare Klassifikation des Magenkarzinoms basiert auf der Histologie, genetischen, epigenetischen und proteomischen Charakteristika. Sie stellt eine Weichenstellung fur die Entwicklung neuer Medikamente und Kombinationen sowie fur die Stratifikation von Patienten im Rahmen klinischer Studien dar und wird voraussichtlich die klinische Praxis bald erreichen. Die Anti-human-epidermal-growth-factor-receptor-2(Anti-HER2)-gerichtete Therapie ist eine validierte Strategie zur Behandlung metastasierter Magenkarzinome und wird nun auch in der perioperativen Situation untersucht. Ziel ist, die Responseraten und letztlich das Uberleben der Patienten zu verbessern. Allerdings sind die Resistenzmechanismen einer HER2-gerichteten Therapie bislang schlecht verstanden und die Patientenselektion bleibt eine Herausforderung. Antiangiogenese ist ein neues Konzept in der Behandlung fortgeschrittener Magenkarzinome. Ramucirumab, ein anti-vascular-endothelial-growth-factor-receptor-2(VEGFR2)-Antikorper, verlangert das Uberleben in der 2. Therapielinie sowohl als Monotherapie als auch in Kombination mit Paclitaxel. Biomarker zur Identifikation von Patienten, die von einer antiangiogenen Therapie besonders profitieren, fehlen bislang allerdings. Immuncheckpointblockade und Stammzellinhibition sind 2 sich entwickelnde Prinzipien zur medikamentosen Behandlung von Magenkarzinomen. Grose internationale Studien zur Bewertung dieser Therapieansatze werden derzeit durchgefuhrt. Zusammenfassend gibt es vielversprechende neue biologisch basierte Behandlungsansatze. Die fur das Magenkarzinom charakteristische Tumorheterogenitat ist allerdings eine besondere Herausforderung fur die Entwicklung zielgerichteter Medikamente und einer personalisierten Therapie.

Klassische Studienkonzepte in der Onkologie werden der Forderung einer raschen Translation von Grundlagenkenntnissen in die Klinik nicht mehr gerecht. Sie werden deshalb zunehmend zugunsten biologisch spezifischer, teils aber auch flexibler und schneller durchfuhrbarer Studien verlassen. Die vier wichtigsten Modelle dieser neuen Studiengeneration sind das Enrichment-Design, das adaptive Studiendesign, die Basket- und die Umbrella-Studie. Beim Enrichment-Design werden nicht alle Patienten einer Tumorentitat, sondern eine meist molekular definierte Subpopulation eingeschlossen. Auf diese Weise werden Patienten selektioniert, die auf eine entsprechende zielgerichtete Therapie gut ansprechen sollten. Ein adaptives Studiendesign bedeutet, dass wahrend der Durchfuhrung der Studie Daten erhoben werden, auf deren Basis die laufende Studie modifiziert wird. Diese Modifikationen werden prospektiv geplant und betreffen meist das Offnen oder Schliesen von Patientenkohorten, die Fallzahl, die Dosis der Prufsubstanz oder die Randomisierung. Die meisten modernen klinischen Studien enthalten adaptive Elemente. Bei einer Basket-Studie werden Patienten mit unterschiedlichen Tumorentitaten in einem gemeinsamen Protokoll therapiert; hier handelt es sich haufig um zielgerichtete Therapien gegen eine definierte genetische Alteration oder um fruhe Phase-I/II-Studien. Bei Umbrella-Studien werden Tumoren einer Entitat auf unterschiedliche Alterationen untersucht, fur die dann verschiedene Prufarme zur Verfugung stehen. Herausforderungen bei all diesen Konzepten sind die statistische Auswertung und die praktische Durchfuhrung. Die neuen Studiendesigns zielen auf eine effektive und rasche Priorisierung neuer Wirkmechanismen und somit eine raschere Entwicklung wirksamer Substanzen bis hin zur klinischen Anwendung.

Background Following neoadjuvant chemotherapy for operable gastroesophageal cancer, lymph node metastasis is the only validated prognostic variable; however, within lymph node groups there is still heterogeneity with risk of relapse. We hypothesized that gene profiles from neoadjuvant chemotherapy treated resection specimens from gastroesophageal cancer patients can be used to define prognostic risk groups to identify patients at risk for relapse. Patients and methods The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial (n = 202 with high quality RNA) samples treated with perioperative chemotherapy were profiled for a custom gastric cancer gene panel using the NanoString platform. Genes associated with overall survival (OS) were identified using penalized and standard Cox regression, followed by generation of risk scores and development of a NanoString biomarker assay to stratify patients into risk groups associated with OS. An independent dataset served as a validation cohort. Results Regression and clustering analysis of MAGIC patients defined a seven-Gene Signature and two risk groups with different OS [hazard ratio (HR) 5.1; P

Prehabilitation prior to complex visceral oncological surgery is playing an increasingly important role.The aim of this review article is to present special situations of preconditioning in visceral oncological patient cohorts. The following conditions were defined as special situations with subsequently increased risk profile: cardiopulmonary comorbidities, geriatric patients, neoadjuvant therapy and simultaneous fatigue.A selective literature review based on a search in the electronic databases MEDLINE, PubMed, Cochrane Library and the International Standard Randomization Controlled Trial Number (ISRCTN) was performed.The identification of high-risk patients is an essential part of the preoperative evaluation conducted by the anesthesiologist prior to surgery. The cardiovascular and the pulmonary risk profile are determined by means of prediction indices evaluating patient-specific and surgery-related risk factors. The increased use of new oral anticoagulants and dual platelet aggregation inhibition requires individualized treatment strategies. Numerous studies have shown clinically relevant effects of exercise therapy interventions throughout all phases of oncological treatment. In addition to positive effects on therapy-associated side effects, sport can also counteract the effects of sedentary behavior in cancer patients and improve the health-related quality of life. The effectiveness of sport and exercise therapies as well as psychological interventions in oncological patients with fatigue (CRF) is broad, with important components being motivation and compliance.In high-risk patients an interdisciplinary approach to planning and conduction of prehabilitation is essential for the early detection and optimization of perioperative risk factors and potential complications. The aim is faster recovery, reduced morbidity and mortality and the possibility to improve long-term survival and quality of life.

Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment.The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery.Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided.This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate.In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new tool in the treatment of patients with peritoneal carcinomatosis. The aerosol containing chemotherapeutic drugs is administered laparoscopically into the abdominal cavity to achieve a local treatment effect. This can be carried out in combination with systemic chemotherapy.Within the framework of a register study, we prospectively documented and evaluated the data of our first 111 PIPAC procedures. The analysis focused on perioperative patient safety and safety at the workplace. Perioperative clinical patient data were analyzed and the platinum concentration in the operating room was checked by wipe samples.A total of 62 patients were scheduled for PIPAC and 121 operations were carried out. In 9 procedures a secure access to the abdomen could not be found and 54 patients received 111 PIPAC treatments. One patient died as a result of intestinal perforation, six bowel lesions were treated immediately and healed without further complications. A further patient developed a postoperative renal failure. Otherwise, there was no major complications and no cases of toxicity.The PIPAC procedure can be used as a supplement to systemic drug treatment for peritoneal carcinomatosis. An exact selection of suitable patients is important. The PIPAC is a low-risk procedure when performed under strict inclusion criteria and under standardized conditions, for the patients and also the surgical staff.

Tumorpatienten sind haufig von Gewichtsverlust betroffen. Die Folgen sind eine schlechte Lebensqualitat und Leistungsfahigkeit, vermehrte Nebenwirkungen und Komplikationen wahrend der Tumortherapie und eine kurzere Uberlebenszeit. Die fruhzeitige Diagnose und der Ausgleich einer Mangelernahrung sind deshalb relevante Bestandteile der onkologischen Behandlung. Zur onkologischen Anamnese und Befunderhebung gehoren die Erfassung des Gewichtsverlustes und die Ermittlung des Body-Mass-Index. Die klinische Untersuchung bietet wesentliche Befunde. Die Bioimpedanzanalyse kann zusatzliche objektive Daten liefern. Die Behandlung der Mangelernahrung soll fruhzeitig erfolgen. Es hat sich ein stufenweises Vorgehen bewahrt, das von der Ernahrungsberatung uber die Verordnung von Trink- und Zusatznahrung bis zur parenteralen Ernahrung reicht.

Das Auftreten peritonealer Metastasierung (PM) solider Tumoren stellt eine interdisziplinare Herausforderung dar und erfordert individuell angepasste Konzepte der Therapie. Sie ist in aller Regel mit einer Verschlechterung der Prognose sowie – von wenigen Ausnahmen abgesehen – dem Verlust kurativer Therapieoptionen vergesellschaftet. Grundsatzlich ist eine systemische Chemotherapie auch bei peritonealer Metastasierung wirksam. Allerdings scheint das Ansprechen signifikant schlechter als beispielsweise bei hepatischer Metastasierung zu sein. Dies erklart man sich unter anderem mit einer schlechteren Durchblutung des Peritoneums und damit einhergehend auch der peritonealen Metastasen. Praklinische Untersuchungen unterstreichen die Bedeutung der Angioneogenese fur die Entstehung und die Dissemination der PM. Vor diesem Hintergrund werden im Stadium IV beim kolorektalen Karzinom, aber auch beim Magen- und Ovarialkarzinom, regelhaft antiangiogenetische Substanzen eingesetzt. Eine der spezifischen Situation – peritoneale Metastasierung – angepasste Systemtherapie existiert derzeit allerdings nicht.

Magenkarzinome einschlieslich der Adenokarzinome des osophagogastralen Ubergangs sind die vierthaufigste Krebserkrankung weltweit und die zweithaufigste Ursache tumorbedingter Todesfalle. Aufgrund fehlender Fruhsymptome wird die Erkrankung bei vielen Patienten erst in einem fortgeschrittenen Stadium diagnostiziert. Zum Staging sollten eine hochauflosende Computertomographie von Thorax, Abdomen und Becken sowie eine dokumentierte Videoendoskopie und Endosonographie angewendet werden. Beim Mukosakarzinom kann eine endoskopische Resektion die chirurgische Variante ersetzen. In den lokal fortgeschrittenen Stadien ist eine perioperative Chemotherapie als Standard etabliert. In der metastasierten Situation sind die Behandlungsziele palliativ. Eine Chemotherapie kann zur Verlangerung des Uberlebens und zur verbesserten Symptomkontrolle und Lebensqualitat beitragen. Kombinationen auf der Basis eines Platinsalzes und Fluoropyrimidins sind etabliert. Etwa 16 % der Magenkarzinome weisen eine Uberexpression des Wachstumsfaktorrezeptors HER2 auf. Der monoklonale Antikorper Trastuzumab fuhrt bei HER2-uberexprimierenden Magenkarzinomen in Kombination mit einer Chemotherapie zu einer Verlangerung des Uberlebens.

In der metastasierten Situation sind die Behandlungsziele palliativ. Eine korrekt indizierte Chemotherapie ist einer alleinigen besten supportiven Therapie (BSC, Best Supportive Care) hinsichtlich Uberlebenszeit und Lebensqualitat uberlegen. Dieser Beitrag diskutiert die neuen Therapiestrategien und die bisher vorliegenden Ergebnisse beim fortgeschrittenen Magenkarzinom. Behandlungsempfehlungen unter Berucksichtigung aktueller Literatur (Pubmed, Medline und manuelle Recherche). Etabliert sind Kombinationen aus einem Platinsalz und einem Fluoropyrimidin. Oxaliplatin kann Cisplatin und Capecitabin oder S1 konnen infusionales 5-Fluorouracil (5-FU) ersetzen. Bei alteren Patienten hat Oxaliplatin gegenuber Cisplatin Vorteile. Triple-Chemotherapien mit zusatzlicher Gabe von Docetaxel oder – mit eingeschrankter Evidenz – von Epirubicin erhohen die Wirksamkeit, allerdings auch die Nebenwirkungsrate einer Platin-Fluoropyrimidin-Therapie. Eine Zweitlinientherapie gilt als wirksam. Bei Patienten mit einer Uberexpression des Wachstumsfaktorrezeptors HER2 fuhrt eine Therapie mit dem HER2-Antikorper Herceptin in Kombination mit Cisplatin und 5-FU oder Capecitabin zu einer Verlangerung des Uberlebens. Fur das fortgeschrittene Magenkarzinom haben sich die therapeutischen Moglichkeiten in den letzten Jahren verbessert. Derzeit stehen viele wirksame Behandlungsregime zu Verfugung.

This review article delineates novel approaches for the pharmaceutical treatment of gastric cancer. A newly developed molecular classification of gastric cancer based on histology, genetic, epigenetic and proteomic characteristics has evolved. It provides a road map for development of new drugs and combinations as well as for patient stratification in clinical research and it is expected to be introduced into clinical practice in the near future. Anti-HER2 targeted treatment is a validated strategy for treatment of metastatic gastric cancer and is now also being studied in the perioperative setting to increase response rates and ultimately survival in patients undergoing curative surgery; however, the resistance mechanisms of HER2-targeted treatment are poorly understood and optimal patient selection remains challenging. Targeting angiogenesis is a novel concept in the management of advanced gastric cancer. Ramucirumab is an antibody against vascular endothelial growth factor receptor 2 (VEGFR2) and prolongs survival in second-line treatment as a monotherapy and also in combination with paclitaxel; however, biomarkers for selection of patients who particularly benefit from antiangiogenic treatment are still lacking. Immune checkpoint blockade and inhibition of cancer stem cell targets are two emerging principles for the medicinal treatment of gastric cancer. Large-scale international studies for evaluation of these treatment approaches are ongoing. In summary, promising biology-based treatment strategies are evolving; however, tumor heterogeneity, which is an inherent feature of gastric cancer is a particular challenge for the development of targeted medications and a personalized treatment.

Circulating tumor cells as a biomarker for response to therapy in multiple myeloma patients treated within the GMMG-MM5 trial

Valid HER2 testing is essential for the optimal care of patients with HER2-positive gastric cancer and the correct use of first-line treatment. Although all cases of breast cancer are routinely tested for the HER2 status, HER2 testing in gastric cancer has still not become part of the routine and is usually only done upon request by the therapist. An interdisciplinary group of German experts has taken on the challenges of HER2 testing in gastric cancer as an opportunity to address essential aspects and questions on the practical use of HER2 testing in this indication from the perspective of pathologists and therapists. The recommendations made in this article reflect the consensus of all participants and correspond to their opinions and long-term experience.

During radiotherapy 80% to 90% of all patients will develop some degree of inflammation symptoms, such as erythema, dry or wet desquamation, skin folds, or mucositis depending on radiation-and patient-related factors and the extent of irradiated skin or mucosal areas. Up to now radiation induced local reactions represent still an important toxicity factor. Cutaneous and mucosal side effects may reduce the patient's compliance and can be limiting factors to follow radiotherapy protocols. Therefore, there is a high need for effective prophylactic and therapeutic treatments. Basically, guidelines recommend the avoidance of mechanical, chemical and thermal irritants, especially the exposure to high temperatures. To delay onset of radiodermatitis various preventive topicals may be applied like aqueous cream formula with or without antioxidative agents. In general, the treatment of radiodermatitis primarily should maintain moisture and skin permeability and consists of hydrophilic creams, antioxidative and anti-inflammatory topicals. Hydrocolloid dressings may reduce and improve wound healing in grade 2 and 3 reactions. Supportive therapy of radiation-induced mucositis includes the maintenance of oral care protocols and adequate nutrition during the course of treatment. A sufficient oral health status is one of the most important factors for prevention of severe oral complications. The MASCC guidelines recommend furthermore the use of non-medicated rinses with saline or sodium bicarbonate 4 to 6 times daily. Further approaches suggest the use of local anaesthetics and systemic analgesics for severe mucositis. Besides local preventive agents and supportive care protocols, modern radiation treatment techniques remain the most promising intervention in reducing the degree of skin reactions.

Even in the era of improved surgical resection techniques adjuvant or neoadjuvant radio/-chemotherapy contributes to a better local control. Short-course preoperative radiotherapy or long-term preoperative radiochemotherapy are two different options with proven efficacy. The first approach may be reasonable for patients in whom a complete surgical removal is possible upfront. Preoperative combined radiochemotherapy is certainly more appropriate for patients who need significant downsizing of the tumour to achieve a resection with clear surgical margins. Acute toxicity is more pronounced during combined preoperative treatment, but long-term side-effects may be more prevalent when using short-course radiation. So far the increase in local control following neoadjuvant treatment could not be translated in a substantial survival benefit. Improvements in surgical and radiation techniques as well as a more effective systemic treatment may offer further advantages. However the results of ongoing trials employing newer cytotoxic agents together with neoadjuvant radiation have to be awaited before their use can be advocated routinely. RC is a malignant disease that warrants close multidisciplinary cooperation and each discipline should treat the patients with the highest standard of quality to achieve optimal results.

Gastric cancer is the fourth most common malignant tumour and the second-most common cause of cancer-related death worldwide. Multidisciplinary care and stage-specific treatment lead to improvements of this very aggressive disease. Accurate staging should include high-resolution computed tomography. Localised disease should also be staged with endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In cancer infiltrating the submucosal layer or beyond, surgical resection including resection of the D2 lymph nodes is regarded as standard of care. In the stages II and III, perioperative chemotherapy has been studied with positive results. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine is the current standard. 22% of gastric cancers exhibit overexpression of the growth factor receptor Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and fluoropyrimidines in the treatment of Her2-positive gastric cancer. The current role of other biologically targeted therapies like anti-EGFR directed treatment still needs to be established.

A multidisciplinary approach integrating surgery, radiotherapy and systemic treatment has gained importance in the treatment of gastrointestinal (GI) cancer. Significant progress in curing localized cancer and prolonging lives in metastatic cancer has been reached. However, side effects, predominantly GI toxicity, are frequent and often dose-limiting. Patients encounter mucosal injuries resulting in oesophagitis, gastritis, nausea and vomiting, colitis causing diarrhoea or constipation. In rarer cases drugs cause hepatotoxicity or pancreatitis. Nausea, vomiting and diarrhoea are the main digestive toxicities in GI cancer patient undergoing chemo- and/or-radiotherapy. Quick relief from these side effects is important to improve the quality of life and also to prevent hospitalization. Professional prophylactic and on demand care to prevent or treat these toxicities are warranted. Supportive care should be tailored to the individual patient and to the underlying pathophysiology. This review focuses on the acute side effects in gastrointestinal cancer treatment and emphasizes therapeutic approaches which could ameliorate severity and incidence of toxicities.

From a global perspective, gastric cancer including cancer of the esophago-gastric junction is the fourth most common malignant tumor and the second-most common cause of cancer-related death. Due to the lack of screening programs in Western countries, most gastric cancers are diagnosed in advanced stages. A sophisticated staging should include high-resolution computed tomography of the thorax, abdomen and pelvis and video-documented endoscopy and endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In the stages II and III perioperative chemotherapy has been established as a standard of care and should be applied. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can help to maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine regarded as standard. About 20 % of gastric cancers exhibit overexpression of the growth factor receptor family member Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and 5-fluorouracil or capecitabine.