What are the ESMO/ESSO/ESTRO treatment guidelines for gastric cancer?

Updated: Feb 23, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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he European Society for Medical Oncology recommendations for treatment are as follows [75] :

  • Multidisciplinary treatment planning is mandatory; the management team should include surgeons, medical and radiation oncologists, gastroenterologists, radiologists, and pathologists plus other specialists if available.
  • For stage IB–III gastric cancer, radical gastrectomy is indicated and perioperative therapy is recommended. Medically fit patients should undergo D2 resections in high-volume surgical centers.

  • T1a gastric cancers may be amenable to endoscopic resection if they are well-differentiated, ≤2 cm, confined to the mucosa, and not ulcerated.

  • With T1 tumors that do not meet the criteria for endoscopic therapy, lymph node dissection during open surgery can be limited to perigastric nodes and include local N2 nodes; sentinel lymph node mapping may further modify these approaches.

  • The preferred treatment for operable gastric cancers beyond stage T1N0 is surgery with both preoperative and postoperative chemotherapy

  • For patients with stage IB disease or higher who do not receive preoperative chemotherapy, the treatment options include either chemoradiotherapy or chemotherapy in the adjuvant setting
  • Radical gastrectomy is indicated for resectable stage IB–III disease, although subtotal gastrectomy may be performed if a macroscopic proximal margin of 5 cm can be achieved between the tumor and the es.ophagogastric junction (8 cm for diffuse-type cancers).
  • In Asian countries, dissection leads to superior outcomes compared with D1 resection. In Western countries, medically fit patients should undergo D2 dissection in specialized, high-volume centers.
  • Pre- and postoperative chemotherapy with a platinum and fluoropyrimidine combination is recommended for patients with stage IB or higher resectable gastric cancer; capecitabine-containing regimens can also be suggested.
  • For inoperable or metastatic gastric cancer, treatment is with palliative chemotherapy, or best supportive care if the patient is unfit for treatment
  • In HER-2 negative disease, combination regimens based upon a platinum–fluoropyrimidine doublet are generally used; triplet regimens are controversial, but the addition of an anthracycline (eg, epirubicin) has demonstrated benefit
  • In HER-2 positive disease, recommended chemotherapy is with trastuzumab plus cisplatin and either 5-fluorouracil or capecitabine
  • Second-line chemotherapy options include irinotecan and docetaxel or paclitaxel

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