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Multimodal treatment in oligometastatic gastric cancer.

ABSTRACT: Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration. This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes. Oncosurgical approach of metastatic disease could prolong survival in selected patients. The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management. We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.

SUBMITTER: Chevallay M

PROVIDER: S-EPMC8919006 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Multimodal treatment in oligometastatic gastric cancer.

Chevallay Mickael M Wassmer Charles-Henri CH Iranmanesh Pouya P Jung Minoa K MK Mönig Stefan P SP

World journal of gastrointestinal oncology 20220201 2

Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maint ...[more]

PMID: 35317315

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Project description:BACKGROUND:Metastatic pancreatic cancer has a median overall survival of less than 12?months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. CASE PRESENTATION:We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000?mg/mq 1,8,15q 28), followed by external radiotherapy (54?Gy in 25 fractions) associated with gemcitabine 50?mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85?mg/mq, irinotecan 180?mg/mq, leucovorin 400?mg/mq and fluorouracil 400?mg/mq given as a bolus followed by 2400?mg/mq as a 46?h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6?cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4?cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12?months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12?months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6?years from the diagnosis. CONCLUSIONS:Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.

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Multimodal treatment in oligometastatic gastric cancer.

Publications

Multimodal treatment in oligometastatic gastric cancer.

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