Aziz Zaanan1, Olivier Bouché2, Leonor Benhaim3, Bruno Buecher4, Nicolas Chapelle5, Olivier Dubreuil6, Nadim Fares7, Victoire Granger8, Christine Lefort9, Johan Gagniere10, Julie Meilleroux11, Anne-Sophie Baumann12, Veronique Vendrely13, Michel Ducreux14, Pierre Michel15. 1. Department of Gastroenterology and Digestive Oncology, European Georges Pompidou Hospital, APHP, Paris, France. Electronic address: aziz.zaanan@aphp.fr. 2. Department of Gastroenterology and Digestive Oncology, CHU Reims, Reims, France. 3. Department of Surgical Oncology, Gustave Roussy Cancer Center, UNICANCER, Villejuif, France. 4. Departments of Genetics and Medical Oncology, Curie Institute, UNICANCER, Paris, France. 5. Department of Hepato-Gastroenterology and Digestive Oncology, Institute for Diseases of the Digestive System, CHU Nantes, France. 6. Department of Gastroenterology and Digestive Oncology, Pitié-Salpêtrière Hospital, APHP, Paris, France. 7. Department of Digestive Oncology, CHU Toulouse, Toulouse, France. 8. Department of Hepato-Gastroenterology and Digestive Oncology, CHU Grenoble, Grenoble, France. 9. Department of Gastroenterology and Endoscopy, Private Hospital Jean Mermoz, Lyon, France. 10. Department of Digestive and Hepatobiliary Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France. 11. Department of Pathology, IUCT-Oncopole, Toulouse, France. 12. Department of Radiotherapy, Lorraine Institute of Oncology, UNICANCER, Vandœuvre-lès-Nancy, France. 13. Department of Radiotherapy, CHU Bordeaux, Pessac, France. 14. Department of Medical Oncology, Gustave Roussy Cancer Center, UNICANCER, Villejuif, France. 15. Department of Hepato-gastroenterology and Digestive Oncology, CHU Rouen, Rouen, France.
Abstract
INTRODUCTION: This document is a summary of the French Intergroup guidelines regarding the management of gastric cancer published in October 2016, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org), updated in October 2017. METHODS: This collaborative work was realized under the auspices of several French medical societies involved in management of gastric cancer. Recommendations are graded in three categories (A-C), according to the amount of evidence found in the literature until July 2017. RESULTS: There are several known risk factors for gastric cancer, including Helicobacter pylori and genetic predispositions, both requiring a specific screening for patients and their relatives. The diagnosis and staging evaluation are essentially based on gastroscopy plus biopsies and computed tomography scan. The endoscopic ultrasonography can be used for superficial tumors in case of discussion for endoscopic resection (T1N0). For local disease (N+ and/or T > T1), the strategic therapy is based on surgery associated with perioperative chemotherapy. In the absence of preoperative treatment (for any raison), the postoperative chemoradiotherapy (or chemotherapy) should be discussed for patients with stage II or III tumor. For metastatic disease, the treatment is based on "palliative" chemotherapy consisting in a doublet or triplet regimens depending of age, performance status and HER2 tumor status. For patients with limited metastatic disease, surgical resection could be discussed in multidisciplinary meeting in case of stable disease after chemotherapy. CONCLUSION: These guidelines in gastric cancer are done to help decision for daily clinical practice. These recommendations are permanently being reviewed. Each individual case must be discussed within a multidisciplinary team.
INTRODUCTION: This document is a summary of the French Intergroup guidelines regarding the management of gastric cancer published in October 2016, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org), updated in October 2017. METHODS: This collaborative work was realized under the auspices of several French medical societies involved in management of gastric cancer. Recommendations are graded in three categories (A-C), according to the amount of evidence found in the literature until July 2017. RESULTS: There are several known risk factors for gastric cancer, including Helicobacter pylori and genetic predispositions, both requiring a specific screening for patients and their relatives. The diagnosis and staging evaluation are essentially based on gastroscopy plus biopsies and computed tomography scan. The endoscopic ultrasonography can be used for superficial tumors in case of discussion for endoscopic resection (T1N0). For local disease (N+ and/or T > T1), the strategic therapy is based on surgery associated with perioperative chemotherapy. In the absence of preoperative treatment (for any raison), the postoperative chemoradiotherapy (or chemotherapy) should be discussed for patients with stage II or III tumor. For metastatic disease, the treatment is based on "palliative" chemotherapy consisting in a doublet or triplet regimens depending of age, performance status and HER2 tumor status. For patients with limited metastatic disease, surgical resection could be discussed in multidisciplinary meeting in case of stable disease after chemotherapy. CONCLUSION: These guidelines in gastric cancer are done to help decision for daily clinical practice. These recommendations are permanently being reviewed. Each individual case must be discussed within a multidisciplinary team.
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