Bas Wijnhoven

 

“The things that interest me most are where multidisciplinary treatments all come together.” Dr Bas Wijnhoven from Erasmus MC， Rotterdam spoke very highly of the IGCC program when interviewed by Daily News. “The good thing about this meeting is that there are oncologists as well as surgeons as well as basic scientists. I think that is the great thing about this

 

meeting - that you can learn a lot from the scientists， you can translate the knowledge into the clinic and try to improve outcomes for patients.” Two fields of study are of particular interest to Dr Wijnhoven. Firstly， the basic science， the molecular biology of gastric cancer. Before there can be effective treatments， there has to be a robust understanding of how cancers develop. “We need to take those results from the laboratory to the bedside”， he said. The other topic of interest to him is the management of patients who undergo palliative care or patients with advanced disease， and the opportunity to offer new treatments including HIPEC procedures or quite extensive surgery for metastases.

 

At this meeting， Dr Wijnhoven presented a report on cancers arising at the gastroesophageal junction and the specific clinical problems they present. These tumors do “not really belong to the esophagus and really don’t belong to the stomach. And some may say they consider them as gastric cancer but the esophageal surgeons will disagree， and they will say they will probably be treated as esophageal cancers.” In his talk， he addressed the classification of these cancers and staging， essential prerequisites to treatment. He discussed perioperative treatment， including neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy， and also surgical aspects of the disease， such as whether an esophagostomy or a gastrectomy should be performed， and the respective outcomes for these approaches. “It is a very interesting topic. Apart from my session， there are other talks addressing this， so I think for all participants， this is a topic we can look at in depth and really have a good discussion about over the next few days.”

 

From Dr Wijnhoven’s home country， the Netherlands， has come the CROSS study. The CROSS Study was published a few years ago and was a multicenter study where approximately 370 patients were randomized to do either surgery or surgery with neoadjuvant chemoradiotherapy. The patients that were included in the study were patients with adenocarcinoma and squamous cancer of the esophagus. But the majority were adenocarcinomas at the distal esophagus， including also adenocarcinomas of the gastroesophageal junction. The results from the CROSS trial show that the toxicity of having neoadjuvant chemoradiotherapy is quite low， and that most patients underwent this treatment without any real significant side effects. Another major outcome was an improved survival in these patients. The survival rate after neoadjuvant chemoradiotherapy plus surgery was approximately 49%， compared to 36% in patients who underwent surgery alone. “The conclusion was that the neoadjuvant chemoradiotherapy really improves survival outcomes.” Dr Wijnhoven’s group published a later report showing that this survival difference was still present after a 5-year follow-up in all patients， as well as a decrease in local regional recurrence as well as distant metastases. “These two reports published in the New England Journal of Medicine and Lancet Oncology really are landmark studies for GE junction and distal esophageal tumors”， he said.

 

Later in the meeting， Dr Wijnhoven will co-moderate a radiotherapy session. “I think this is another very interesting field that we are moving into”， he said. In the past， radiation for gastric cancer was mainly applied in a postoperative setting， specifically in the United States where a trial had been done showing that postoperative radiation was of benefit for patients who underwent gastrectomy. “The trial was criticized in Europe and other countries because the quality of the surgery was inferior compared to European standards. But this prompted a revision of radiation standards and what we are seeing now is that most studies look at preoperative or neoadjuvant radiation and in particular chemoradiation， because that seems to be more potent than radiation alone.” Additional trials are underway in Korea and Australia looking at the potential benefits of chemoradiation. Dr Wijnhoven believes “these trials will really show what the benefit will be and I am sure that this will be coming out in the next few years， and that radiation therapy will be an important part of the treatment of gastric cancer.”