| Přispěvatelé: |
van Laarhoven, Hanneke W. M., van Oijen, Martijn G. H., CCA - Imaging and biomarkers, APH - Quality of Care, APH - Methodology, CCA - Treatment and quality of life, AGEM - Re-generation and cancer of the digestive system, Graduate School, van Laarhoven, H.W.M., van Oijen, M.G.H., Faculteit der Geneeskunde |
| Popis: |
Locally unresectable or metastasized upper gastrointestinal cancer, in example esophageal, gastric and pancreatic cancer, is a multifactorial disease with a poor prognosis. The current approach to upper gastrointestinal cancer has evolved in the past decade, but is still suboptimal. Chemotherapy and other forms of systemic therapy can prolong survival but are associated with toxicity. In this PhD-thesis, we made extensive use of multiple types of data that can be derived from clinical studies conducted in the past 20 years using systematic review and (network) meta-analysis, in order to facilitate the optimal clinical approach. In the first part, we aimed to established the optimal first-line chemotherapy regimen for advanced esophagogastric cancer, as a globally accepted regimen is still lacking. In the second part, we aimed to answer important clinical questions concerning second- or later-line treatment of advanced esophagogastric cancer. In the third part, we constructed a new graphical method to present toxicity of palliative systemic therapy to patients with advanced esophagogastric cancer in clinical practice. Moreover, we assessed the current state of reporting on quality-of-life outcomes in randomized-controlled-trials and we assessed the influence from palliative systemic therapy on the quality-of-life of patients with advanced esophagogastric cancer. In the fourth and final part, we identified baseline characteristics with prognostic and predictive value for treatment efficacy in patients with advanced esophagogastric cancer. Furthermore, we established an international guideline using both literature evidence and expert opinion to state which baseline and prognostic characteristics should be included in future clinical trials on advanced pancreatic cancer. |
