Treatment of gastric cancer in the older population

Streszczenie

Gastric cancer (GC) is predominantly a disease of the elderly as approximately 60% of all patients are 70 years of age or older. At present, there are no guidelines dedicated to this group, and current treatment strategies are mainly based on evidence from clinical trials often carried out on younger patients.

The GC in older patients is typically located in the distal third of the stomach and it is well/moderately differentiated, having mainly an intestinal type of tumor by Lauren’s criteria. Lymph nodes and peritoneal metastases have been reported less frequently in comparison to younger patients.

Older patients are a very heterogeneous population in terms of co-morbidity, physical reserve, cognitive function, and social support. Treatment side effects can cause more serious problems than cancer itself, so the comprehensive geriatric assessment (CGA) is as important as the cancer staging. Chronological age alone is not a contraindication for treatment. Surgery is the preferred standard treatment option for resectable GC. However, the prognostic significance of surgery and other treatment options is unknown in the frail group. Fitter patients, according to the CGA, should qualify for the same treatment as younger patients. Frail patients should be discussed during oncogeriatric meetings. Surgery, the benefits of limitation of the surgical resection, and no or non-selective lymphadenectomy should all be analyzed. In experienced hands, minimal invasive surgery is favorable in the short- and long-term. In cases of severe frailty, the best supportive care can often be the best option.