Vol 71, No 4 (2021)
Review paper
Published online: 2021-08-18

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Treatment of gastric cancer in the older population

Jakub Kenig1, Piotr Richter1
Nowotwory. Journal of Oncology 2021;71(4):245-250.

Abstract

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.

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References

  1. Rawla P, Barsouk A. Epidemiology of gastric cancer: global trends, risk factors and prevention. Prz Gastroenterol. 2019; 14(1): 26–38.
  2. Gaitonde S, Fischer T, Jones M, et al. Young age, disparities, and survival in gastric adenocarcinoma: Implications for screening strategies. J Clin Oncol. 2017; 35(4_suppl): 17–17.
  3. Joharatnam-Hogan N, Shiu KK, Khan K. Challenges in the treatment of gastric cancer in the older patient. Cancer Treat Rev. 2020; 85: 101980.
  4. Fujiya T, Endoh K, Mikuni J, et al. Clinicopathological Characteristics and Surgical Outcome of Gastric Carcinoma with Regard to Aging. Jpn J Gastroenterol Surg. 1997; 30(7): 1699–1705.
  5. Wu CW, Chen MH, Huang KH, et al. The clinicopathological characteristics and genetic alterations between younger and older gastric cancer patients with curative surgery. Aging. 2020; 12(18): 18137–18150.
  6. Kenig J. Oncogeriatrics (part 1.). Frailty in older adults with cancer. Nowotwory. Journal of Oncology. 2019; 69(2): 55–57.
  7. Loh KP, Soto-Perez-de-Celis E, Hsu T, et al. What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper. J Oncol Pract. 2018; 14(2): 85–94.
  8. Klabunde CN, Ambs A, Keating NL, et al. The role of primary care physicians in cancer care. J Gen Intern Med. 2009; 24(9): 1029–1036.
  9. Grodzicki T, Kenig J. Problemy okołooperacyjne u osób w wieku podeszłym. PZWL Wydawnictwo Lekarskie, Warszawa 2018.
  10. Kenig J, Szabat K. Oncogeriatrics (part 7.). Geriatric assessment for older patients with cancer. Nowotwory. Journal of Oncology. 2020; 70(4): 153–157.
  11. Smyth EC, Verheij M, Allum W, et al. ESMO Guidelines Committee. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016; 27(suppl 5): v38–v49.
  12. Kulig J, Wallner G, Drews M, et al. Polish Consensus on Treatment of Gastric Cancer; update 2017. Pol Przegl Chir. 2017; 89(5): 55–68.
  13. Yang TC, Hou MC, Chen PH, et al. Clinical Outcomes and Complications of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms in the Elderly. Medicine (Baltimore). 2015; 94(44): e1964.
  14. Sinagra E, Luppino I, Messina M, et al. Endoscopic approach to early gastric cancer in older adults. J Geriatr Oncol. 2021; 12(1): 160–162.
  15. Katai H, Sasako M, Sano T, et al. Gastric cancer surgery in the elderly without operative mortality. Surg Oncol. 2004; 13(4): 235–238.
  16. Zhou CJ, Chen FF, Zhuang CL, et al. Feasibility of radical gastrectomy for elderly patients with gastric cancer. Eur J Surg Oncol. 2016; 42(2): 303–311.
  17. Fujisaki M, Shinohara T, Hanyu N, et al. Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc. 2016; 30(4): 1380–1387.
  18. Nie RC, Chen FP, Yuan SQ, et al. Evaluation of objective response, disease control and progression-free survival as surrogate end-points for overall survival in anti-programmed death-1 and anti-programmed death ligand 1 trials. Eur J Cancer. 2019; 106: 1–11.
  19. Mengardo V, Cormack OMc, Weindelmayer J, et al. Multicenter Study of Presentation, Management, and Postoperative and Long-Term Outcomes of Septegenerians and Octogenerians Undergoing Gastrectomy for Gastric Cancer. Ann Surg Oncol. 2018; 25(8): 2374–2382.
  20. Endo S, Shimizu Y, Ikenaga M, et al. Survival benefit of gastrectomy for gastric cancer in patients ≥85 years old: A retrospective propensity score-matched analysis. Surgery. 2017; 161(4): 984–994.
  21. Songun I, Putter H, Kranenbarg EMK, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010; 11(5): 439–449.
  22. Katai H, Sasako M, Sano T, et al. The outcome of surgical treatment for gastric carcinoma in the elderly. Jpn J Clin Oncol. 1998; 28(2): 112–115.
  23. Shuto K, Yamazaki M, Mori M, et al. [Partial Gastrectomy for Elderly Patients with Early-Stage Gastric Cancer]. Gan To Kagaku Ryoho. 2018; 45(13): 1824–1826.
  24. Shinozuka T, Kanda M, Ito S, et al. D2 lymph node dissection confers little benefit on the overall survival of older patients with resectable gastric cancer: a propensity score-matching analysis of a multi-institutional dataset. Surg Today. 2020; 50(11): 1434–1442.
  25. Suzuki S, Kanaji S, Matsuda Y, et al. Long-term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients. Ann Gastroenterol Surg. 2018; 2(1): 72–78.
  26. Wang S, Xu L, Wang Q, et al. Postoperative complications and prognosis after radical gastrectomy for gastric cancer: a systematic review and meta-analysis of observational studies. World J Surg Oncol. 2019; 17(1): 52.
  27. Kanda M, Ito S, Mochizuki Y, et al. Multi-institutional analysis of the prognostic significance of postoperative complications after curative resection for gastric cancer. Cancer Med. 2019; 8(11): 5194–5201.
  28. Takeda J, Tanaka T, Koufuji K, et al. Gastric cancer surgery in patients aged at least 80 years old. Hepatogastroenterology. 1994; 41(6): 516–520.
  29. Tanaka R, Lee SW, Imai Y, et al. Advantages of Laparoscopic Surgery for Gastric Cancer in Elderly Patients Aged Over 80 Years: A Propensity Score Matching Analysis. World J Surg. 2021 [Epub ahead of print].
  30. Mikami R, Tanaka E, Murakami T, et al. The safety and feasibility of laparoscopic gastrectomy for gastric cancer in very elderly patients: short-and long-term outcomes. Surg Today. 2021; 51(2): 219–225.
  31. Rausei S, Galli F, Milone M, et al. Laparoscopic distal gastrectomy in old-old patients: the first Western experience. Updates Surg. 2021 [Epub ahead of print].
  32. Tanaka T, Suda K, Inaba K, et al. Impact of Frailty on Postoperative Outcomes for Laparoscopic Gastrectomy in Patients Older than 80 Years. Ann Surg Oncol. 2019; 26(12): 4016–4026.
  33. Drozd R. Kto powinien wybierać metodę leczenia operacyjnego – pacjent czy lekarz? Chirurgia po Dyplomie. 2017; 2(12): 34–36.
  34. Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019; 393(10184): 1948–1957.
  35. Lorenzen S, Pauligk C, Homann N, et al. Feasibility of perioperative chemotherapy with infusional 5-FU, leucovorin, and oxaliplatin with (FLOT) or without (FLO) docetaxel in elderly patients with locally advanced esophagogastric cancer. Br J Cancer. 2013; 108(3): 519–526.
  36. van Hagen P, Hulshof MC, van Lanschot JJB, et al. CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012; 366(22): 2074–2084.
  37. Slagter AE, Tudela B, van Amelsfoort RM, et al. Older versus younger adults with gastric cancer receiving perioperative treatment: Results from the CRITICS trial. Eur J Cancer. 2020; 130: 146–154.
  38. Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016; 27(5): 38–49.
  39. Schendel J, Jost E, Mah M, et al. Gastric cancer management in elderly patients: a population-based study of treatment patterns and outcomes in gastric cancer patients ≥ 75 years from Alberta, Canada. Am J Surg. 2021; 221(4): 839–843.
  40. 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(3): 309–318.
  41. Ueno D, Matsumoto H, Kubota H, et al. Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol. 2017; 15(1): 59.
  42. Nie RC, Chen FP, Yuan SQ, et al. Evaluation of objective response, disease control and progression-free survival as surrogate end-points for overall survival in anti-programmed death-1 and anti-programmed death ligand 1 trials. Eur J Cancer. 2019; 106: 1–11.
  43. Howlader N, Ries LAG, Mariotto AB, et al. Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst. 2010; 102(20): 1584–1598.