Local palliation for advanced gastric cancer
- Johanna Bendell, MD
Johanna Bendell, MD
- GI Oncology Research
- Sarah Cannon Research Institute
The majority of patients with gastric cancer will require palliative treatment at some point in the course of their disease. Approximately 50 percent of patients already have advanced incurable disease at the time of initial presentation, and even those who undergo potentially curative resection have high rates of distant as well as local recurrence. (See "Surgical management of invasive gastric cancer", section on 'Prognosis'.)
Palliative treatments for advanced gastric cancer can be either local or systemic. While cytotoxic chemotherapy is the most effective treatment modality for patients with metastatic disease, it is frequently inadequate for palliation of local symptoms, such as nausea, pain, obstruction, perforation, or bleeding from a locally advanced or locally recurrent primary tumor, which require multidisciplinary management using endoscopic, surgical, radiotherapeutic, or other approaches. (See "Systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer".)
This topic review will focus on local palliative treatments for patients with locally advanced unresectable or metastatic gastric cancer. Chemotherapy for locally advanced unresectable or metastatic esophageal and gastric cancer is discussed elsewhere, as is endoscopic palliation for dysphagia in patients with locally advanced or recurrent esophageal cancer and primary surgical treatment. (See "Systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer" and "Endoscopic palliation of esophageal cancer" and "Surgical management of invasive gastric cancer" and "Surgical management of resectable esophageal and esophagogastric junction cancers".)
THERAPEUTIC OPTIONS FOR LOCAL PALLIATION
Therapeutic options to control symptoms of local disease progression, such as nausea, pain, bleeding, and obstruction, include palliative surgical resection, surgical bypass (gastrojejunostomy), radiation therapy (RT), and endoscopic techniques. All forms of palliative therapy must take into account the overall prognosis of the patient in order to avoid excessive morbidity and mortality or lengthy hospital stays in those with a limited life span.
Palliative resection — We recommend against palliative gastrectomy in most patients with advanced gastric cancer who are receiving systemic therapy. Palliative gastrectomy should be reserved for extreme, highly symptomatic cases where less invasive methods cannot be used.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Zhang JZ, Lu HS, Huang CM, et al. Outcome of palliative total gastrectomy for stage IV proximal gastric cancer. Am J Surg 2011; 202:91.
- Chang YR, Han DS, Kong SH, et al. The value of palliative gastrectomy in gastric cancer with distant metastasis. Ann Surg Oncol 2012; 19:1231.
- Mariette C, Bruyère E, Messager M, et al. Palliative resection for advanced gastric and junctional adenocarcinoma: which patients will benefit from surgery? Ann Surg Oncol 2013; 20:1240.
- Shridhar R, Almhanna K, Hoffe SE, et al. Increased survival associated with surgery and radiation therapy in metastatic gastric cancer: a Surveillance, Epidemiology, and End Results database analysis. Cancer 2013; 119:1636.
- Jeong O, Park YK, Choi WY, Ryu SY. Prognostic significance of non-curative gastrectomy for incurable gastric carcinoma. Ann Surg Oncol 2014; 21:2587.
- Al-Batran SE, Homann N, Pauligk C, et al. 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.
- Kahlke V, Bestmann B, Schmid A, et al. Palliation of metastatic gastric cancer: impact of preoperative symptoms and the type of operation on survival and quality of life. World J Surg 2004; 28:369.
- Ouchi K, Sugawara T, Ono H, et al. Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol 1998; 69:41.
- Kikuchi S, Arai Y, Kobayashi N, et al. Is extended lymphadenectomy valuable in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis? Hepatogastroenterology 2000; 47:563.
- Kokkola A, Louhimo J, Puolakkainen P. Does non-curative gastrectomy improve survival in patients with metastatic gastric cancer? J Surg Oncol 2012; 106:193.
- Schmidt B, Look-Hong N, Maduekwe UN, et al. Noncurative gastrectomy for gastric adenocarcinoma should only be performed in highly selected patients. Ann Surg Oncol 2013; 20:3512.
- Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol 2016; 17:309.
- Takeno A, Takiguchi S, Fujita J, et al. Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: multi-institutional retrospective analysis. Ann Surg Oncol 2013; 20:3527.
- Guzman EA, Dagis A, Bening L, Pigazzi A. Laparoscopic gastrojejunostomy in patients with obstruction of the gastric outlet secondary to advanced malignancies. Am Surg 2009; 75:129.
- Jeurnink SM, van Eijck CH, Steyerberg EW, et al. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 2007; 7:18.
- Tey J, Back MF, Shakespeare TP, et al. The role of palliative radiation therapy in symptomatic locally advanced gastric cancer. Int J Radiat Oncol Biol Phys 2007; 67:385.
- Harvey JA, Bessell JR, Beller E, et al. Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia. Dis Esophagus 2004; 17:260.
- Burmeister BH, Denham JW, O'Brien M, et al. Combined modality therapy for esophageal carcinoma: preliminary results from a large Australasian multicenter study. Int J Radiat Oncol Biol Phys 1995; 32:997.
- Hashimoto K, Mayahara H, Takashima A, et al. Palliative radiation therapy for hemorrhage of unresectable gastric cancer: a single institute experience. J Cancer Res Clin Oncol 2009; 135:1117.
- Asakura H, Hashimoto T, Harada H, et al. Palliative radiotherapy for bleeding from advanced gastric cancer: is a schedule of 30 Gy in 10 fractions adequate? J Cancer Res Clin Oncol 2011; 137:125.
- Tey J, Choo BA, Leong CN, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era. Medicine (Baltimore) 2014; 93:e118.
- Yuan ST, Wang FL, Liu N, et al. Concurrent involved-field radiotherapy and XELOX versus XELOX chemotherapy alone in gastric cancer patients with postoperative locoregional recurrence. Am J Clin Oncol 2015; 38:130.
- Norberto L, Ranzato R, Marino S, et al. Endoscopic palliation of esophageal and cardial cancer: neodymium-yttrium aluminum garnet laser therapy. Dis Esophagus 1999; 12:294.
- Freitas D, Gouveia H, Sofia C, et al. Endoscopic Nd-YAG laser therapy as palliative treatment for esophageal and cardial cancer. Hepatogastroenterology 1995; 42:633.
- Wu KL, Tsao WL, Shyu RY. Low-power laser therapy for gastrointestinal neoplasia. J Gastroenterol 2000; 35:518.
- Barr H, Krasner N. Interstitial laser photocoagulation for treating bleeding gastric cancer. BMJ 1989; 299:659.
- Mathus-Vliegen EM, Tytgat GN. Laser photocoagulation in the palliative treatment of upper digestive tract tumors. Cancer 1986; 57:396.