Ethical issues related to chemotherapy in patients with gastric cancer (EN)

Triantafillidis, J.K.

Peros, G.

Postoperative chemotherapy and radiation therapy is standard care in high risk patients who had undergone a curative resection of the primary tumor. Best survival results are achieved with three-drug regimens containing FU, an anthracycline, and cisplatin (ECF), although the recently presented REAL-2-trial, demonstrated a significant survival benefit for EOX (epirubicin, oxaliplatin, capecitabine) over ECF. Consequently, chemotherapy could be offered to some proportion of patients with advanced gastric cancer taking into account the results of the available clinical trials. Neo-adjuvant chemotherapy has the ability to downsize gastric tumours. It remains unclear however, how the neoadjuvant therapy may be integrated into the multimodality management of localized gastric cancer. According to recent studies, adjuvant chemotherapy resulted in a significant survival benefit in patients with gastric cancer. However, others did not recommend adjuvant chemotherapy as routine therapy. A lot of case reports with metastatic cancer treated with S-1 plus cisplatin have appeared in the recent literature with promising results. Therefore, such treatment could be offered to some patients with metastatic gastric cancer as a last hope. Patients with peritoneal dissemination should be submitted to chemotherapy after full explanation of the expected results. The use of chemotherapy in patients with linitis plastica remains controversial. Chemotherapy should be offered to patients with gastric cancer at advanced age. Nutrition therapy in advanced gastric cancer might offer improved quality of life especially to those with gastric outlet obstruction despite the associated increased cost. Other parameters related to the decision to give chemotherapy or not to gastric cancer patients are related to the role of patient relatives, the doctors' training and availability, the psychological support of the patient, the doctor's-patient relationships, and the right of the patient to receive the best available medical treatment. These parameters must be taken into account where dealing with a patient with gastric cancer who is a candidate for chemotherapy. Key words: Gastric cancer, Chemotherapy, Ethics (EN)

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Ελληνική Γαστροεντερολογική Εταιρία

Annals of Gastroenterology

Reviews

Αγγλική γλώσσα

2007-09-10

http://www.annalsgastro.gr/index.php/annalsgastro/article/view/592

Hellenic Society of Gastroenterology (EN)

1792-7463

1108-7471

Annals of Gastroenterology; Volume 20, No 3 (2007) (EN)