Gastric Cancer Management

e16079 Background: The most commonly used treatment options for gastric cancer include complete resection with adequate margins with either perioperative chemotherapy (PCT) or adjuvant chemoradiotherapy (CRT). While both treatment strategies have shown superiority over surgical resection alone, it is not clear which treatment strategy is more optimal. Methods: Our decision tree model was built to analyze the survival and costs associated with the two major management methods: perioperative chemotherapy and adjuvant chemoradiation therapy. Costs were obtained from Medicare reimbursement rates using a third-party payer perspective. Our model’s effectiveness was represented using quality-adjusted life years (QALYs). Our analysis tested the robustness of our conclusions by utilizing one-way, two-way, and probabilistic sensitivity analyses. Results: PCT was the preferred treatment strategy for diagnosed gastric cancer over CRT, with a cost of $54,326.10 and 4.08 QALYs. CRT was the costliest economic strategy with a cost of $77,987.52 and 4.28 QALYs and an ICER of 115,907.48. We set a threshold of $100,000 per QALYs gained which CRT surpassed making PCT the preferred treatment modality. Over 100,000 simulations, 51.4% of simulations favored PCT. CRT became favored when CRT non-curative procedure rates rose 3% higher than PCT non-curative procedure rates and when PCT complication rates rose 15% higher than CRT complication rates. Conclusions: In our simulated patients with diagnosed gastric cancer, the most cost-effective treatment strategy was PCT. We see cost-effectiveness alternating to favor CRT with changes in non-curative procedure rates and adjuvant therapy complication rates.[Table: see text]

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Gastric cancer management in elderly patients: a population-based study of treatment patterns and outcomes in gastric cancer patients ≥ 75 years from Alberta, Canada

The American Journal of Surgery ◽

10.1016/j.amjsurg.2020.03.006 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jennifer Schendel ◽

Evan Jost ◽

Matt Mah ◽

Lloyd Mack ◽

Michael McCall ◽

...

Keyword(s):

Gastric Cancer ◽

Elderly Patients ◽

Cancer Patients ◽

Population Based ◽

Treatment Patterns ◽

Population Based Study ◽

Cancer Management ◽

Gastric Cancer Patients

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Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management

Surgical Endoscopy ◽

10.1007/s00464-006-0031-6 ◽

2006 ◽

Vol 20 (11) ◽

pp. 1738-1743 ◽

Cited By ~ 60

Author(s):

W. Ziqiang ◽

Q. Feng ◽

C. Zhimin ◽

W. Miao ◽

Q. Lian ◽

...

Keyword(s):

Gastric Cancer ◽

Distal Gastrectomy ◽

Extended Lymphadenectomy ◽

Cancer Management

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Staging Laparoscopy Is Still a Valuable Tool for Optimal Gastric Cancer Management

10.21203/rs.3.rs-253611/v1 ◽

2021 ◽

Author(s):

Erica Sakamoto ◽

Marcus Fernando Kodama Pertille Ramos ◽

Marina Alessandra Pereira ◽

Andre Roncon Dias ◽

Ulysses Ribeiro Junior ◽

...

Keyword(s):

Gastric Cancer ◽

Ct Scan ◽

Imaging Techniques ◽

Clinicopathological Characteristics ◽

Staging Laparoscopy ◽

Preoperative Imaging ◽

Cancer Center ◽

Cancer Management ◽

Stage Ivb ◽

Sensitivity Specificity

Abstract Purpose: Complete surgical resection is the main determining factor in the survival of advanced gastric cancer (AGC) patients, but resection should be avoided in metastatic disease. Peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect peritoneal metastasis (PM). Thus, the aim of this study was to evaluate the role of Staging Laparoscopy (SL) in the staging of AGC patients in a Western tertiary cancer center. Methods: We reviewed 130 patients with gastric adenocarcinoma submitted to SL from 2009 to 2020 from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of PM. We also evaluated the accuracy and strength of agreement between computed tomography (CT) and SL in detecting PM, and the change in treatment strategy after SL. Results: Among the 130 patients, PM was identified in 66 patients (50.76%) - P1 group. The sensitivity, specificity and accuracy of CT in detecting PM were 51,5%, 87,5% and 69.2%, respectively. According to the Kappa coefficient, concordance between SL and CT was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected PM on CT scan (p=0.007) were statistically correlated with the P1 group. In 40 patients (30.8%), staging and treatment plans changed after SL (32 patients avoided unnecessary laparotomy and 8 patients who were previously considered stage IVb by CT scan were referred for surgical treatment). Conclusions: Even with current advances in imaging techniques, SL demonstrated an important role in the diagnosis of PM and remains valuable for determining the correct therapeutic strategy.

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Nanoparticles in Gastric Cancer Management

Current Pharmaceutical Design ◽

10.2174/1381612826666201120155120 ◽

2020 ◽

Vol 26 ◽

Author(s):

Alexandra V. Avgustinovich ◽

Olga V. Bakina ◽

Sergey G. Afanas’ev ◽

Olga V. Cheremisina ◽

Liudmila V. Spirina ◽

...

Keyword(s):

Gastric Cancer ◽

Anticancer Drugs ◽

Tumor Therapy ◽

Tumor Biology ◽

Cancer Drug ◽

Autophagic Flux ◽

Heterogeneous Distribution ◽

Mesenchymal Transition ◽

Cancer Management ◽

Wide Range

: Gastric cancer is the second most common cause of cancer-related deaths in the world. The surgical management of the tumor is the best therapeutic option for gastric cancer patients. A combination of a heterogeneous distribution of genetic and environmental factors appears to be required to explain patients' poor prognosis. A search for targeted and molecular-based approaches is affected by the optimal gastric cancer drug management. The modern multidisciplinary approach in treating the pathology using worldwide prolongs the overall patient survival and decreases the rate of recurrence. An understanding of the mechanisms that underlie therapies will provide new insights into gastric cancer treatment. The improvement in medicine will probably be associated with a study of tumor biology, followed by a personalized and molecular-based approach development in anticancer drugs administration. The modern perspective in gastric cancer detection and treatment is the application of nanoparticles. Nanoparticles affecting the intensity of biological processes in cancer cells can be used to treat cancers to increase the effectiveness of anti-tumor therapy. Their cytotoxicity involves a wide range of pathological events. Their targets are the extracellular matrix degradation, epithelial-mesenchymal transition, tumor angiogenesis, tumor microenvironment modulation. It is accompanied by lipid peroxidation, apoptosis, and autophagic flux. Preliminary studies on the efficacy of nanoparticle use in cultured gastric cancers open new opportunities for anti-tumor treatment to overcome the toxicity of therapeutic agents and decrease the rate of resistance to anticancer drugs and therapies.

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Patient-level costs of treating metastatic gastric cancer by treatment strategy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.167 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 167-167

Author(s):

Yunni Jeong ◽

Alyson L. Mahar ◽

Brandon Zagorski ◽

Natalie Coburn

Keyword(s):

Gastric Cancer ◽

Supportive Care ◽

Cancer Patients ◽

Treatment Strategy ◽

Metastatic Gastric Cancer ◽

Practice Variation ◽

Adverse Outcomes ◽

Cancer Management ◽

Patient Level ◽

Gastric Cancer Patients

167 Background: Half of gastric cancer patients in North America present with metastatic disease. The appropriate management of these patients is complex and few guidelines exist to definitively guide treatment; as a result, practice variation exists. This variation may lead to care inefficiencies with adverse outcomes. We therefore aimed to conduct a patient-level exploration of metastatic gastric cancer management costs, by treatment strategy, and identify predictors of cost. Methods: We performed a patient-level cost analysis of metastatic gastric cancer patients diagnosed between 2005 and 2008 using a 26-month time horizon and the healthcare system’s perspective. Clinical data was derived from a provincial chart review. Costs associated with supportive care, radiation only, chemotherapy only, chemoradiation, gastrectomy, and gastrectomy with chemotherapy +/- radiotherapy were derived using administrative data from a universal healthcare system. Costs were inflated to 2017 United States dollars (USD) Linear regression was used to identify factors predictive of cost. Results: The absolute mean costs of metastatic gastric cancer management increased with increasing level of intervention and ranged from $34,002 to $72,778 (USD); supportive care was associated with the lowest costs and gastrectomy with chemotherapy +/- radiotherapy was associated with the highest costs. Age over 70 and lower Charlson Comorbidity Index were predictors of lower costs while supportive care, radiotherapy, chemoradiation, and gastrectomy were associated with higher costs. Conclusions: Practice variation has known clinical implications, but economic impact also needs to be considered. Variation in the management of metastatic gastric cancer may reflect dissimilar resource availability between health regions as well as differential access to palliative care. Evidence-based guidelines directing appropriate care for metastatic gastric cancer patients to reduce inefficiencies in care and governmental intervention to implement equitable resource allocation to bridge gaps in care are necessary.

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Radiotherapy in localized gastric cancer management: To be or not to be?

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16511 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16511-e16511

Author(s):

Amany Hussein ◽

Khaled Al Saleh ◽

Mustafa El-Sherify ◽

Nashwa Nazmy ◽

Jitendra Shete

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Locally Advanced ◽

Cancer Control ◽

Clinicopathological Features ◽

P Value ◽

High Grade ◽

Control Center ◽

Positive Margins ◽

Cancer Management

e16511 Background: Gastric adenocarcinoma still have dismal outcome in spite of the progress made in systemic treatment in last 2 decades. In localized disease, treatment outcome still suboptimal, with up to 88% suffer from recurrence/metastasis. Hence, improvement in radical initial treatment is mandatory. Recent trials showed survival benefit of adding radiotherapy (preoperative or adjuvant) with favorable toxicity profile when using current advances radiation techniques. Methods: We retrospectively analyzed impact of radiotherapy in management of localized gastric cancer in Kuwait. 87 adult patients with newly diagnosed gastric cancers were treated and followed up at Kuwait Cancer Control Center (KCCC) between 2009-2015, 12 were excluded due to inoperability. 13 patients were excluded as they had early disease and underwent only surgery. Finally, 62 patients were submitted in study 48 patient received radiotherapy (RT group) as part of treatment (44 postoperative, 3 postoperative after induction Chemotherapy, 1 preoperative). 14 patients did not receive radiotherapy (NRT group); five received perioperative chemotherapy, nine received postoperative chemotherapy). Survival analysis was done using Kaplan-Meier, and comparison was done according to clinicopathological features. Results: The median age at diagnosis was 55 (range 25-70). Men represented 65.5%. Asian were 17 patients and Caucasian were 70 patients. 68.9% were nonsmoker while 31% were smoker. Median follow up was 45 months (1-89). 2 year Overall survival in the NRT group was 50% while in RT group was 79.1%. 3 year OAS was 42.8% and 64.5% in NRT group and RT group respectively. Median overall survival for NRT group was 82 months. While for the RT group median survival was not reached at time of analysis with p value (0.025). 2 year DFS in NRT group was 50% while in RT group was 66.6%. 3 year DFS was 42.8% and 54.1% in NRT group and RT group respectively. Median DFS not reached in both groups p value (0.04). On correlation of prognostic clinicopathological features with benefits of adding radiotherapy it was noticed that high grade, positive margins statistically benefit more from local radiotherapy and had better local control. Distal tumours behave badly whether received radiotherapy or not. Interestingly benefit of adding radiotherapy was not significantly affected by nodal status. Conclusions: Radiotherapy should be part of management in postoperative locally advanced gastric cancer especially with high grade tumours and positive margins. However still ongoing trials to clear the role of radiotherapy in preoperative setting.

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