演題抄録

International Session

開催概要
開催回
第54回・2016年・横浜
 

本邦における胃癌治療ガイドラインと胃癌診療の実際

演題番号 : IS3-1

[筆頭演者]
肥田 圭介:1 

1:岩手医科大学・外科

 

The standard treatment for gastric cancer has been generally regulated by treatment guideline in Japan. The Japanese Gastric Cancer Treatment Guide Line (JGL) was first published in 2001 to provide general as well as specialized clinicians with knowledge on standard treatments, based on evidence where available, and consensus. The current fourth edition of JGL was published in 2014.
The JGL has been updated promptly on the website from the Japanese Gastric Cancer Association. Here I describe the latest topics of surgery and chemotherapy with some introductions in our daily practice.
Surgery: The standard operations are total and distal gastrectomy with D2 lymph-nodes dissection. Several limited operations such as proximal gastrectomy, pylorus preserving gastrectomy, and laparoscopic gastrectomy are often performed mainly for early stage cancers. Recently, the results of two RCTs by Japanese Clinical Oncology Group (JCOG) have been reported. JCOG 0110 recommends that prophylactic splenectomy should be avoided in total gastrectomy for proximal gastric cancer because cancer does not invade the greater curvature. JCOG 0705 (REGATTA) showed no survival benefit of additional gastrectomy over chemotherapy alone in patients with non-curative advanced gastric cancer.
Chemotherapy: Two agents, oxaliplatin and ramcirumab, have been newly approved for gastric cancer. Oxaliplatin is mainly used for first-line treatment in non-resectable or recurrent cancer, and for adjuvant chemotherapy. Ramcirumab is used for second-line treatment with or without paclitaxel. The prolonged overall survival may be expected by these agents, but there seems to be issues that should be resolved (patient selection, appropriate dose and toxicity management).

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