Gastric cancer

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Palex80

RAD ON
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Hello!

What's the current standard of treatment in locally advanced gastric cancer in your institution (cT3 or cN+).

Some clinics like to do neoadjuvant chemo, followed by resection. Other prefer neoadjuvant radiochemo, then resection. Furthermore there is the option of operating first and then delivering adjuvant treatment.

Since the different non-surgical therapy modalities have not been tested against each other in a randomized trial as far as sequence and intensity is concerned, I would like to hear what you regularly do in your clinic.

Please try to think only of gastic cancer and not distal esophagus adenoca or AEGs. Just gastric cancer.
:)

Where I work, we do neoadjuvant chemo, followed by resection and the further chemo. Radiation therapy is also offered postoperatively for pN+ or R1-resections.

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At our place (and from what I know, in most places around the US), we generally follow the intergroup 0116 study, which showed an OS benefit to adjuvant chemoradiation after gastrectomy, compared with gastrectomy alone.

Original study: http://www.ncbi.nlm.nih.gov/pubmed/11547741?dopt=Abstract
Updated at ASCO: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=27&abstractID=538

This study included GE junction patients also, so when it comes to the GE junction, some people will treat this way as well (as opposed to doing neoadjuvant therapy).
 
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