胃癌に対する化学療法，集学的治療の現状と将来

Present Status and Future Aspect of Chemotherapy and Multi-modality Therapy for Gastric Cancer

要旨　西欧諸国とわが国の研究を対照させながら，胃癌に対する化学療法，集学的治療の現状をreviewした．西欧における進行胃癌に対する化学療法では1979年のFAM療法以来，FAMTX，EAP，ELF，PELF，ECF，DCFなどの治療法が標準治療として検討されてきたが，現時点ではECFまたはDCFが標準治療とみなされている．他方わが国ではS-1，Taxane，CPT-11などの新しい薬剤を中心に高い奏効率と生存期間の延長が報告されたが，これらのregimen相互間の評価は今後の検討に委ねられている．いずれはglobal standardをめざして，西欧とわが国のregimenの比較対照試験が必要である．これらの臨床試験を反映して術前化学療法も高い奏効率が報告されているが，今後延命効果からみた評価が必要である．術後補助化学療法として，Macdonaldらの化学放射線療法の有意の延命効果が報告されたが，これをわが国の標準治療として導入するには種々の問題点がある．

　The present status of chemotherapy and multimodality therapy for gastric cancer was reviewed comparing Japan and Western countries and followed by discussion for their future use. In Western countries, ECF or DCF is supposedly the standard chemotherapy for advanced gastric cancer after randomized controlled studies (RCT) with FAM, FAMTX, EAP, ELF, or PELF regimens in terms of response rate and survival time. In our country, RCTs are not complete until recent promising regimens with S-1, Taxanes, or CPT-11 are carried out for advanced gastric cancer. A global standard, embracing the best regimens used in both Western countries and Japan, should be established for RCTs.

　Neoadjuvant chemotherapy with recent promising regimens seems to provide a good response and high effectiveness, but survival benefit still awaits future RCT. As a postoperative adjuvant therapy, a certain chemoradiotherapy was proved to produce a significant survival benefit in large-scale RCT, and it has become standard therapy after curative gastrectomy in U.S.A. However, incorporation of this theraphy to our country should be made cautiously because of its different background and surgical technology.