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Review
. 2022 Feb 15;14(2):434-449.
doi: 10.4251/wjgo.v14.i2.434.

Multimodal treatment in oligometastatic gastric cancer

Mickael Chevallay  1 , Charles-Henri Wassmer  1 , Pouya Iranmanesh  1 , Minoa K Jung  1 , Stefan P Mönig  2
Affiliations
Review

Multimodal treatment in oligometastatic gastric cancer

Mickael Chevallay et al. World J Gastrointest Oncol. .

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.

Keywords: Chemotherapy; Gastric cancer; Immunotherapy; Multimodal treatment; Oligometastatis; Radiotherapy.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis of overall survival in patients with limited metastatic disease (arm B) who underwent surgery and no surgery. (Adapted from Al-Batran et al[25] with permission from the American Medical Association. Citation: Al-Batran SE, Homann N, Pauligk C. Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial. JAMA Oncol 2017; 3: 1237-1244. Copyright © American Medical Association.
Figure 2
Figure 2
Diagram of the FLOT-5 RENAISSANCE Trial comparing chemotherapy alone vs surgical resection for oligometastatic gastric cancer. FLOT: Fluorouracil, leucovorin, oxaliplatin and docetaxel.
Figure 3
Figure 3
Diagram for the actual therapeutic strategy for patients with oligometastatic gastric cancer. HIPEC: Hyperthermic intraperitoneal chemotherapy.
See this image and copyright information in PMC

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