Gastric cancer: ESMO–ESSO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Waddell, Tom; Verheij, Marcel; Allum, William; Cunningham, David; Cervantes, Andrés; Arnold, Dirk

doi:10.1093/annonc/mdt344

Cited by 256 publications

(128 citation statements)

References 41 publications

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“…This would mean that endoscopic treatment of patient with early gastric cancer will result in suboptimal treatment in those with lymph node metastases. This is tacitly acknowledged by the recommendations of The National Comprehensive Cancer Network (NCCN) [40] and the European Society of Medical Oncology (ESMO) [41] which advise adjuvant chemotherapy for patients with T1 (early gastric cancer) and node-positive disease.…”

Section: Early Gastric Cancer: the Definitions And Issuesmentioning

confidence: 99%

“…The JGCA indications for EMR, which have also been adopted by the ESMO [41], require the following criteria to be fulfilled. The JGCA has more recently provided certain ''expanded'' indications for ESMD only [22] for investigational purposes.…”

Section: Therapeutic Endoscopy In Early Gastric Cancer: Evolving Indimentioning

confidence: 99%

“…The NCCN and ESMO do not provide any guidelines for this [40,41]. The JGCA criteria are failing to achieve an en bloc endoscopic resection, maximum tumour diameter of[2 cm, undifferentiated tumour,[pT1a, positive margins (horizontal and/or vertical) and lymphovascular infiltration.…”

Section: Therapeutic Endoscopy In Early Gastric Cancer: Evolving Indimentioning

confidence: 99%

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Redefining early gastric cancer

Barreto

Windsor

2015

Surg Endosc

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Background The problem is that current definitions of early gastric cancer allow the inclusion of regional lymph node metastases. The increasing use of endoscopic submucosal dissection to treat early gastric cancer is a concern because regional lymph nodes are not addressed. The aim of the study was thus to critically evaluate current evidence with regard to tumour-specific factors associated with lymph node metastases in ''early gastric cancer'' to develop a more precise definition and improve clinical management. Methods A systematic and comprehensive search of major reference databases (MEDLINE, EMBASE, PubMed and the Cochrane Library) was undertaken using a combination of text words All available publications that described tumour-related factors associated with lymph node metastases in early gastric cancer were included. ResultsThe initial search yielded 1494 studies, of which 42 studies were included in the final analysis. Over time, the definition of early gastric cancer has broadened and the indications for endoscopic treatment have widened. The mean frequency of lymph node metastases increased on the basis of depth of infiltration (mucosa 6 % vs. submucosa 28 %), presence of lymphovascular invasion (absence 9 % vs. presence 53 %), tumour differentiation (differentiated 13 % vs. undifferentiated 34 %) and macroscopic type (elevated 13 % vs. flat 26 %) and tumour diameter (B2 cm 8 % vs.[2 cm 25 %). Conclusion There is a need to re-examine the diagnosis and staging of early gastric cancer to ensure that patients with one or more identifiable risk factor for lymph node metastases are not denied appropriate chemotherapy and surgical resection.Gastric cancer is the fourth most common cancer in the world [1]. With an overall 5-year survival rate of \20 % [2], gastric cancer accounts for 10 % of cancer-related deaths worldwide [3,4]. The main reason for the dismal outcome associated with gastric cancer stems from the fact that while curative surgery holds the only hope for cure [5], patients often present at a late stage of the disease [2, 6] when performance of this curative surgery is not feasible or warranted. Buried in these dismal statistics lies a subset of patients with so-called early gastric cancer who have reported 5-year survival rates approaching 99 % [7-9]. Early gastric cancer is more commonly reported in Japan [10,11] owing to widespread screening programmes and a greater awareness of gastric cancer owing to the high incidence of disease. However, the incidence appears to be rising in other parts of the world, as well [7,12,13].

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Section: Early Gastric Cancer: the Definitions And Issuesmentioning

confidence: 99%

Section: Therapeutic Endoscopy In Early Gastric Cancer: Evolving Indimentioning

confidence: 99%

See 1 more Smart Citation

Redefining early gastric cancer

Barreto

Windsor

2015

Surg Endosc

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“…D2 lymphadenectomy is the recommended procedure in the current U.S. [10] and European guidelines, to be carried out in specialized, high-volume centers [11]. The role of adjuvant chemoradiotherapy in appropriately resected gastric cancer remains unclear.…”

Section: Us Adjuvant Chemoradiationmentioning

confidence: 99%

“…While in the U.S. an adjuvant chemoradiation approach is now the recommended standard of care for stage IB to resectable stage IV M0 GC [10], European guidelines recommend perioperative chemotherapy for all resectable stage II and stage III cancers [11] and Japanese guidelines recommend adjuvant chemotherapy with S1 for 1 year for resected GC in stages IIA, IIB, IIIA, IIIB, or IIIC [12]. Survival outcomes differ across geographical regions, with overall 5-year survival rates being 10%-15% in North America and 45%-50% in East Asia.…”

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confidence: 99%