Abstract
In recent decades, improved socioeconomic conditions, medical progress, and preventive medicine have lengthened life expectancy in our society and consequently increased the elderly population. Despite an overall drop in the incidence of gastric cancer in the Western world, increased life expectancy has resulted in a growing proportion of elderly patients with gastric cancer. Today, more than 30% of patients with gastric cancer are older than 70 years. Although some characteristics of this disease are similar in younger and older patients, management of gastric cancer in the elderly exhibits some significant differences and presents unique challenges compared to management in younger patients. In this chapter, we will explore some of the unique epidemiological and pathological features of this disease in the elderly. Furthermore, we will try to elucidate the ideal surgical treatment strategies and the role of multimodality management in this challenging group of patients.
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References
US Cancer Statistics Working Group (2009) United States Cancer Statistics: 1999–2005 Incidence and Mortality Web-based Report. US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, Atlanta. Available at: http://www.cdc.gov/uscs
Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96
Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (2007) SEER Cancer Statistics Review, 1975–2005. National Cancer Institute, Bethesda, MD
Brown LM, Devesa SS (2002) Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin N Am 11(2):235–256
Wilkinson NW, Howe J, Gay G, Patel-Parekh L, Scott-Conner C, Donohue J (2008) Differences in the pattern of presentation and treatment of proximal and distal gastric cancer: results of the 2001 gastric patient care evaluation. Ann Surg Oncol 15(6):1644–1650
Inoshita N, Yanagisawa A, Arai T, Kitagawa T, Hirokawa K, Kato Y (1998) Pathological characteristics of gastric carcinomas in the very old. Jpn J Cancer Res 89(10):1087–1092
Kitamura K, Yamaguchi T, Taniguchi H et al (1996) ClinicoÂpathological characteristics of gastric cancer in the elderly. Br J Cancer 73(6):798–802
Arai T, Esaki Y, Inoshita N et al (2004) Pathologic characteristics of gastric cancer in the elderly: a retrospective study of 994 surgical patients. Gastric Cancer 7(3):154–159
Lambert R, Hainaut P (2007) The multidisciplinary management of gastrointestinal cancer. Epidemiology of oesophagogastric cancer. Best Pract Res Clin Gastroenterol 21(6):921–945
Wang C, Yuan Y, Hunt RH (2007) The association between Helicobacter pylori infection and early gastric cancer: a meta-Âanalysis. Am J Gastroenterol 102(8):1789–1798
Gretschel S, Estevez-Schwarz L, Hunerbein M, Schneider U, Schlag PM (2006) Gastric cancer surgery in elderly patients. World J Surg 30(8):1468–1474
Grossmann EM, Longo WE, Virgo KS et al (2002) Morbidity and mortality of gastrectomy for cancer in Department of Veterans Affairs Medical Centers. Surgery 131(5):484–490
Zhang XF, Huang CM, Lu HS et al (2004) Surgical treatment and prognosis of gastric cancer in 2,613 patients. World J Gastroenterol 10(23):3405–3408
Hanazaki K, Wakabayashi M, Sodeyama H et al (1998) Surgery for gastric cancer in patients older than 80 years of age. Hepatogastroenterology 45(19):268–275
Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P’Eng FK (2000) Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 24(4):465–472
Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92(9):1099–1102
Korenaga D, Baba H, Kakeji Y et al (1991) Comparison of R1 and R2 gastrectomy for gastric cancer in patients over 80 years of age. J Surg Oncol 48(2):136–141
Roviello F, Marrelli D, De Stefano A, Messano A, Pinto E, Carli A (1998) Complications after surgery for gastric cancer in patients aged 80 years and over. Jpn J Clin Oncol 28(2):116–122
Tsujitani S, Katano K, Oka A, Ikeguchi M, Maeta M, Kaibara N (1996) Limited operation for gastric cancer in the elderly. Br J Surg 83(6):836–839
Lamb P, Sivashanmugam T, White M, Irving M, Wayman J, Raimes S (2008) Gastric cancer surgery – a balance of risk and radicality. Ann R Coll Surg Engl 90(3):235–242
Crane SJ, Locke GR III, Harmsen WS, Zinsmeister AR, Romero Y, Talley NJ (2008) Survival trends in patients with gastric and esophageal adenocarcinomas: a population-based study. Mayo Clin Proc 83(10):1087–1094
Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24(14):2137–2150
D’Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS (2004) Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 240(5):808–816
Macdonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345(10):725–730
Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355(1):11–20
Imanaga H, Nakazato H (1977) Results of surgery for gastric cancer and effect of adjuvant mitomycin C on cancer recurrence. World J Surg 2(1):213–221
Grau JJ, Estape J, Alcobendas F, Pera C, Daniels M, Teres J (1993) Positive results of adjuvant mitomycin-C in resected gastric Âcancer: a randomised trial on 134 patients. Eur J Cancer 29A(3):340–342
The Gastrointestinal Tumor Study Group (1982) Controlled trial of adjuvant chemotherapy following curative resection for gastric Âcancer. The Gastrointestinal Tumor Study Group. Cancer 49(6):1116–1122
Neri B, de Leonardis V, Romano S et al (1996) Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study. Br J Cancer 73(4):549–552
Macdonald JS, Fleming TR, Peterson RF et al (1995) Adjuvant chemotherapy with 5-FU, adriamycin, and mitomycin-C (FAM) versus surgery alone for patients with locally advanced gastric adenocarcinoma: a Southwest Oncology Group study. Ann Surg Oncol 2(6):488–494
Engstrom PF, Lavin PT, Douglass HO Jr, Brunner KW (1985) Postoperative adjuvant 5-fluorouracil plus methyl-CCNU therapy for gastric cancer patients. Eastern Cooperative Oncology Group study (EST 3275). Cancer 55(9):1868–1873
Higgins GA Jr, Amadeo JH, McElhinney J, McCaughan JJ, Keehn RJ (1984) Efficacy of prolonged intermittent therapy with combined 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel. A Veterans Administration Surgical Oncology Group report. Cancer 53(1):1–8
Hermans J, Bonenkamp JJ, Boon MC et al (1993) Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol 11(8):1441–1447
Earle CC, Maroun JA (1999) Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials. Eur J Cancer 35(7):1059–1064
Mari E, Floriani I, Tinazzi A et al (2000) Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente). Ann Oncol 11(7):837–843
Janunger KG, Hafstrom L, Nygren P, Glimelius B (2001) A systematic overview of chemotherapy effects in gastric cancer. Acta Oncol 40(2–3):309–326
Hallissey MT, Dunn JA, Ward LC, Allum WH (1994) The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up. Lancet 343(8909):1309–1312
Martinez-Monge R, Calvo FA, Azinovic I et al (1997) Patterns of failure and long-term results in high-risk resected gastric cancer treated with postoperative radiotherapy with or without intraoperative electron boost. J Surg Oncol 66(1):24–29
Dent DM, Werner ID, Novis B, Cheverton P, Brice P (1979) Prospective randomized trial of combined oncological therapy for gastric carcinoma. Cancer 44(2):385–391
Moertel CG, Childs DS, O’Fallon JR, Holbrook MA, Schutt AJ, Reitemeier RJ (1984) Combined 5-fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol 2(11):1249–1254
Bleiberg H, Goffin JC, Dalesio O et al (1989) Adjuvant radiotherapy and chemotherapy in resectable gastric cancer. A randomized trial of the gastro-intestinal tract cancer cooperative group of the EORTC. Eur J Surg Oncol 15(6):535–543
Lowy AM, Mansfield PF, Leach SD, Pazdur R, Dumas P, Ajani JA (1999) Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann Surg 229(3):303–308
Ajani JA, Mansfield PF, Lynch PM et al (1999) Enhanced Âstaging and all chemotherapy preoperatively in patients with Âpotentially resectable gastric carcinoma. J Clin Oncol 17(8):2403–2411
Melcher AA, Mort D, Maughan TS (1996) Epirubicin, cisplatin and continuous infusion 5-fluorouracil (ECF) as neoadjuvant chemotherapy in gastro-oesophageal cancer. Br J Cancer 74(10):1651–1654
Fink U, Schuhmacher C, Stein HJ et al (1995) Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection. Br J Surg 82(9):1248–1252
Barone C, Cassano A, Pozzo C et al (2004) Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer. Oncology 67(1):48–53
Hartgrink HH, van de Velde CJ, Putter H et al (2004) Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 30(6):643–649
Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant Âchemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357(18):1810–1820
Lowy AM, Feig BW, Janjan N et al (2001) A pilot study of preoperative chemoradiotherapy for resectable gastric cancer. Ann Surg Oncol 8(6):519–524
Ajani JA, Mansfield PF, Janjan N et al (2004) Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol 22(14):2774–2780
Lim L, Michael M, Mann GB, Leong T (2005) Adjuvant therapy in gastric cancer. J Clin Oncol 23(25):6220–6232
Sumpter K, Harper-Wynne C, Cunningham D et al (2005) Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 92(11):1976–1983
Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M (2007) Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg 246(2):215–221
Bouvier AM, Launoy G, Lepage C, Faivre J (2005) Trends in the management and survival of digestive tract cancers among patients aged over 80 years. Aliment Pharmacol Ther 22(3):233–241
Msika S, Tazi MA, Benhamiche AM, Couillault C, Harb M, Faivre J (1997) Population-based study of diagnosis, treatment and prognosis of gastric cancer. Br J Surg 84(10):1474–1478
Jessup JM, Stewart A, Greene FL, Minsky BD (2005) Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA 294(21):2703–2711
Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067
Graziano F, Santini D, Testa E et al (2003) A phase II study of weekly cisplatin, 6S-stereoisomer leucovorin and fluorouracil as first-line chemotherapy for elderly patients with advanced gastric cancer. Br J Cancer 89(8):1428–1432
Santini D, Graziano F, Catalano V et al (2006) Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial. BMC Cancer 6:125
Nardi M, Azzarello D, Maisano R et al (2007) FOLFOX-4 regimen as fist-line chemotherapy in elderly patients with advanced gastric cancer: a safety study. J Chemother 19(1):85–89
Liu ZF, Guo QS, Zhang XQ et al (2008) Biweekly oxaliplatin in combination with continuous infusional 5-fluorouracil and leucovorin (modified FOLFOX-4 regimen) as first-line chemotherapy for elderly patients with advanced gastric cancer. Am J Clin Oncol 31(3):259–263
Zhao JG, Qiu F, Xiong JP et al (2009) A phase II study of modified FOLFOX as first-line chemotherapy in elderly patients with advanced gastric cancer. Anticancer Drugs 20(4):281–286
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Albo, D., Anaya, D.A., Berger, D.H. (2011). Gastric Cancer in the Elderly. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_62
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DOI: https://doi.org/10.1007/978-1-4419-6999-6_62
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