From the Guidelines
For a 78-year-old patient with T2N0 gastric carcinoma, the recommended treatment is surgical resection with either subtotal or total gastrectomy with D2 lymphadenectomy, depending on tumor location, as this approach prioritizes minimizing morbidity, mortality, and optimizing quality of life. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of multidisciplinary team management in the treatment of gastric cancer 1.
Key Considerations
- Preoperative evaluation should include comprehensive staging with endoscopic ultrasound, CT scans, and assessment of functional status to ensure the patient can tolerate surgery given their age.
- If the patient has significant comorbidities limiting surgical candidacy, endoscopic submucosal dissection may be considered for select cases, though this is less common for T2 lesions.
- Perioperative nutritional optimization is important, and a geriatric assessment should be performed to evaluate the patient's overall fitness for surgery.
- Following resection, regular surveillance with physical examinations, imaging, and endoscopy every 3-6 months for the first 2 years, then annually thereafter is recommended.
Rationale
The approach of surgical resection for T2N0 gastric carcinoma is supported by guidelines that highlight the role of surgery in the management of gastric cancer, particularly for early-stage disease 1. While neoadjuvant chemoradiotherapy and other treatments are discussed in the context of more advanced disease or specific tumor locations, the primary recommendation for a patient with T2N0 disease, given the information provided, remains surgical intervention. The consideration of the patient's age and potential comorbidities underscores the need for a comprehensive preoperative assessment to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
Additional Considerations
- The use of targeted therapies and immunotherapies, as discussed in the guidelines 1, may be relevant for patients with specific tumor characteristics or more advanced disease but are not the primary consideration for a patient with T2N0 gastric carcinoma.
- The importance of multidisciplinary team discussion in deciding the treatment plan, especially for patients who may not be ideal candidates for surgery or who have disease progression, is emphasized in the guidelines 1.
From the Research
Treatment Sequence for Gastric Carcinoma
The treatment sequence for a 78-year-old patient with gastric carcinoma, stage T2 N0, involves several considerations, including the patient's age, performance status, and the stage of the disease.
- The patient's age and performance status are crucial factors in determining the treatment approach, as elderly patients may have comorbidities that affect their ability to tolerate certain treatments 2.
- For a patient with stage T2 N0 gastric carcinoma, the treatment options may include surgery, chemotherapy, or a combination of both.
- Surgery is a potentially curative treatment option for patients with resectable gastric cancer, and it is recommended that fit elderly patients with operable gastric cancer undergo standard surgical resection, taking into account preoperative comorbidities 2.
- Perioperative chemotherapy or postoperative chemoradiotherapy may be added in case of locally advanced disease 2.
- The use of capecitabine, a fluoropyrimidine, has been established as an integral part of multi-agent regimens in the management of patients with gastric cancers 3.
- A study on the treatment of locally advanced gastric adenocarcinoma using oxaliplatin and capecitabine in combination with D2 gastrectomy showed that this approach is effective and safe 4.
Treatment Options
The treatment options for a 78-year-old patient with gastric carcinoma, stage T2 N0, may include:
- Subtotal or total gastrectomy with radical lymph node dissection 2, 5
- Perioperative chemotherapy using capecitabine and oxaliplatin 4
- Postoperative chemoradiotherapy 2
- Palliative systemic chemotherapy for recurrent or metastatic disease 2
Considerations
When determining the treatment sequence for a 78-year-old patient with gastric carcinoma, stage T2 N0, several factors should be considered, including: