Buscar en
Revista Colombiana de Cancerología
Toda la web
Inicio Revista Colombiana de Cancerología Enfoque terapéutico del cáncer gástrico. Revisión de la literatura
Información de la revista
Vol. 15. Núm. 1.
Páginas 30-39 (Enero 2011)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 15. Núm. 1.
Páginas 30-39 (Enero 2011)
Acceso a texto completo
Enfoque terapéutico del cáncer gástrico. Revisión de la literatura
Approach to Gastric Cancer-Literature Review
Visitas
7557
Marco Torregroza1,3, Cristina Guarnizo2,4,
Autor para correspondencia
cristinaguarnizo.md@gmail.com

Correspondencia: Cristina Guarnizo, Subdirección de Investigaciones, Vigilancia Epidemiológica, Promoción y Prevención, Instituto Nacional de Cancerología, Av. 1a No. 9-85, Bogotá, Colombia. Teléfono: 3341111 Ext 4003.
1 Grupo de Oncología Clínica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
2 Subdirección de Investigaciones, Vigilancia Epidemiológica, Promoción y Prevención, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
3 Universidad del Bosque, Bogotá D.C., Colombia
4 Escuela Juan N. Corpas, Bogotá D.C., Colombia
Este artículo ha recibido
Información del artículo
Resumen

El cáncer gástrico es un problema de salud en el mundo y en Colombia; la mayoría de los pacientes se diagnostican con una enfermedad local avanzada y de pronóstico cada vez más pobre. La resección quirúrgica es la base del tratamiento, y se debe realizar con la adecuada selección de los pacientes mediante procesos de estadificación clínica, y, en algunos casos, intervencionista. Debido a las altas tasas de recurrencia locorregional y sistémica, la cirugía debe ser complementada con quimioterapia perioperatoria o quimiorradioterapia adyuvantes, según lo amerite el caso; esto mejora la supervivencia libre de enfermedad y la supervivencia global. Los pacientes que por su estado avanzado no puedan ser manejados con cirugía serán derivados a tratamiento paliativo con quimioterapia o quimiorradioterapia. El estudio y el análisis de estos pacientes deben ser multidisciplinarios, por la complejidad de la patología y la diversidad de opciones de tratamiento.

Palabras clave:
Neoplasias gástricas
diagnóstico
cirugía
quimioterapia
radioterapia
Abstract

Gastric cancer is a health problem both worldwide and in Colombia; the majority of patients are diagnosed with locally advanced disease and with increasingly poor prognosis. Surgical resection is the mainstay of treatment, which should be carried out with the proper selection of patients based on clinical staging, and in some cases, interventionist. Due to high rates of locoregional and systemic recurrence, surgery should be complemented with perioperative chemotherapy and adjuvant chemoradiotherapy, as each case warrants; this improves disease-free survival and overall survival. Patients whose advanced state cannot be managed with surgery are to be referred to palliative treatment with chemotherapy or chemoradiotherapy. The study and analysis of these patients should be multidisciplinary due to the complexity of their pathologies and to the diversity of treatment options.

Key words:
Stomach neoplasm
diagnosis
surgery
drug therapy
brachytherapy
El Texto completo está disponible en PDF
Referencias
[1.]
International Agency for Research on Cancer (IARC), World Health Organization (WHO).
Globocan 2008: Cancer incidence and mortality worldwide in 2008.
IARC, (2008),
[2.]
A. Jemal, R. Siegel, E. Ward, et al.
Cancer statistics, 2008.
CA Cancer J Clin, 58 (2008), pp. 71-96
[3.]
C. Pardo Ramos, R. Cendales Duarte.
Incidencia estimada y mortalidad por cáncer en Colombia 2002–2006.
Instituto Nacional de Cancerología, (2010),
[4.]
M.D. Abeloff, J.O. Armitage, J.E. Niederhuber, et al.
Abeloff's clinical oncology.
4a, Churchill Livingstone, Elsevier, (2008),
[5.]
D.Y. Graham, J.T. Schwartz, G.D. Cain, et al.
Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma.
Gastroenterology, 82 (1982), pp. 228-231
[6.]
R.C. Kurtz, P. Sherlock.
The diagnosis of gastric cancer.
Semin Oncol, 12 (1985), pp. 11-18
[7.]
V.H. Low, M.S. Levine, S.E. Rubesin, et al.
Diagnosis of gastric carcinoma: sensitivity of double-contrast barium studies.
AJR Am J Roentgenol, 162 (1994), pp. 329-334
[8.]
V. Catalano, R. Labianca, G.D. Beretta, et al.
Gastric cancer.
Crit Rev Oncol Hematol, 71 (2009), pp. 127-164
[9.]
AJCC cancer staging manual, 7a,
[10.]
E.K. Abdalla, P.W. Pisters.
Staging and preoperative evaluation of upper gastrointestinal malignancies.
Semin Oncol, 31 (2004), pp. 513-529
[11.]
R.M. Kwee, T.C. Kwee.
Imaging in local staging of gastric cancer: a systematic review.
J Clin Oncol, 25 (2007), pp. 2107-2116
[12.]
Y. Adachi, I. Sakino, T. Matsumata, et al.
Preoperative assessment of advanced gastric carcinoma using computed tomography.
Am J Gastroenterol, 92 (1997), pp. 872-875
[13.]
J.C. Paramo, G. Gómez.
Dynamic CT in the preoperative evaluation of patients with gastric cancer: correlation with surgical findings and pathology.
Ann Surg Oncol, 6 (1999), pp. 379-384
[14.]
T. Fukuya, H. Honda, T. Hayashi, et al.
Lymph-node metastases: efficacy for detection with helical CT in patients with gastric cancer.
Radiology, 197 (1995), pp. 705-711
[15.]
J. Tschmelitsch, M.R. Weiser, M.S. Karpeh.
Modern staging in gastric cancer.
Surg Oncol, 9 (2000), pp. 23-30
[16.]
A. Stahl, K. Ott, W.A. Weber, et al.
FDG PET imaging of locally advanced gastric carcinomas: correlation with endoscopic and histopathological findings.
Eur J Nucl Med Mol Imaging, 30 (2003), pp. 288-295
[17.]
J. Chen, J.H. Cheong, M.J. Yun, et al.
Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography.
Cancer, 103 (2005), pp. 2383-2390
[18.]
T. Tsendsuren, S.M. Jun, X.H. Mian.
Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer.
World J Gastroenterol, 12 (2006), pp. 43-47
[19.]
D.A. Stell, C.R. Carter, I. Stewart, et al.
Prospective comparison of laparoscopy, ultrasonography and computed tomography in the staging of gastric cancer.
Br J Surg, 83 (1996), pp. 1260-1262
[20.]
E.C. Burke, M.S. Karpeh, K.C. Conlon, et al.
Laparoscopy in the management of gastric adenocarcinoma.
Ann Surg, 225 (1997), pp. 262-267
[21.]
A.I. Sarela, R. Leftkowitz, M.F. Brennan, et al.
Selection of patients with gastric adenocarcinoma for laparoscopic staging.
Am J Surg, 191 (2006), pp. 134-138
[22.]
F. Bozzetti, E. Marubini, G. Bonfanti, The Italian Gastrointestinal Tumor Study Group, et al.
Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial.
Ann Surg, 226 (1997), pp. 613-620
[23.]
F. Bozzetti, E. Marubini, G. Bonfanti, Italian Gastrointestinal Tumor Study Group, et al.
Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial.
Ann Surg, 230 (1999), pp. 170-178
[24.]
A. Cuschieri, S. Weeden, J. Fielding, Surgical Cooperative Group, et al.
Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial.
Br J Cancer, 79 (1999), pp. 1522-1530
[25.]
J.J. Bonenkamp, J. Hermans, M. Sasako, et al.
Extended lymph-node dissection for gastric cancer.
N Engl J Med, 340 (1999), pp. 908-914
[26.]
W. Yu, G.S. Choi, H.Y. Chung.
Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer.
Br J Surg, 93 (2006), pp. 559-563
[27.]
D. Cunningham, W.H. Allum, S.P. Stenning, et al.
Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.
N Engl J Med, 355 (2006), pp. 11-20
[28.]
V. Boige, J. Pignon, B. Saint-Aubert, et al.
Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07- FFCD 9703 trial.
Proc Am Soc Clin Oncol, 25 (2007), pp. 4510
[29.]
J.A. Ajani, J.S. Barthel, T. Bekaii-Saab, et al.
Gastric cancer.
J Natl Compr Canc Netw, 8 (2010), pp. 378-409
[30.]
A. Okines, M. Verheij, W. Allum, et al.
Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
Ann Oncol, 21 (2010), pp. v50-v54
[31.]
J.S. Macdonald, S.R. Smalley, J. Benedetti, et al.
Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.
N Engl J Med, 345 (2001), pp. 725-730
[32.]
S. Kim, D.H. Lim, J. Lee, et al.
An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach.
Int J Radiat Oncol Biol Phys, 63 (2005), pp. 1279-1285
[33.]
C.C. Earle, J.A. Maroun.
Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomized trials.
Eur J Cancer, 35 (1999), pp. 1059-1064
[34.]
E. Mari, I. Floriani, A. Tinazzi, et al.
Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomized trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Appararo Digerente).
Ann Oncol, 11 (2000), pp. 837-843
[35.]
I. Panzini, L. Gianni, P.P. Fattori, et al.
Adjuvant chemotherapy in gastric cancer: a meta-analysis of randomized trials and a comparison with previous meta-analyses.
Tumori, 88 (2002), pp. 21-27
[36.]
J.K. Hu, Z.X. Chen, Z.G. Zhou, et al.
Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials.
World J Gastroenterol, 8 (2002), pp. 1023-1028
[37.]
K.G. Janunger, L. Hafström, B. Glimelius.
Chemotherapy in gastric cancer: a review and updated meta-analysis.
Eur J Surg, 168 (2002), pp. 597-608
[38.]
T.S. Liu, Y. Wang, S.Y. Chen, et al.
An updated meta-analysis of adjuvant chemotherapy after curative resection for gastric cancer.
Eur J Surg Oncol, 34 (2008), pp. 1208-1216
[39.]
S. Sakuramoto, M. Sasako, T. Yamaguchi, et al.
Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine.
N Engl J Med, 357 (2007), pp. 1810-1820
[40.]
A.W. Wu, G.W. Xu, H.Y. Wang, et al.
Neoadjuvant chemotherapy versus none for resectable gastric cancer.
Cochrane Database Syst Rev, 2 (2007),
[41.]
L.F. He, K.H. Yang, J.H. Tian, et al.
[Meta-analysis of clinical effectiveness of neoadjuvant chemotherapy for gastric cancer].
Ai Zheng, 27 (2008), pp. 407-412
[42.]
M. Stahl, M.K. Walz, M. Stuschke, et al.
Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction.
J Clin Oncol, 27 (2009), pp. 851-856
[43.]
D. Gallardo-Rincón, L.F. Oñate-Ocaña, G. Calderillo-Ruiz.
Neoadjuvant chemotherapy with P-ELF (cisplatin, etoposide, leucovorin, 5-fluorouracil) followed by radical resection in patients with initially unresectable gastric adenocarcinoma: a phase II study.
Ann Surg Oncol, 7 (2000), pp. 45-50
[44.]
M. Yano, H. Shiozaki, M. Inoue, et al.
Neoadjuvant chemotherapy followed by salvage surgery: effect on survival of patients with primary noncurative gastric cancer.
World J Surg, 26 (2002), pp. 1155-1159
[45.]
E. Van Cutsem, V.M. Moiseyenko, S. Tjulandin, et al.
Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group.
J Clin Oncol, 24 (2006), pp. 4991-4997
[46.]
A.D. Wagner, W. Grothe, J. Haerting, et al.
Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data.
J Clin Oncol, 24 (2006), pp. 2903-2909
[47.]
D. Cunningham, N. Starling, S. Rao, et al.
Capecitabine and oxaliplatin for advanced esophagogastric cancer.
N Engl J Med, 358 (2008), pp. 36-46
[48.]
W. Koizumi, H. Narahara, T. Hara, et al.
S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial.
Lancet Oncol, 9 (2008), pp. 215-221
[49.]
E. Van Cutsem, Y. Kang, H. Chung, et al.
Efficacy results from the ToGA trial: a phase III study of trastuzumab added to standard chemotherapy (CT) in first-line human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (GC).
[50.]
J.S. Waters, A. Norman, D. Cunningham, et al.
Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial.
Br J Cancer, 80 (1999), pp. 269-272
[51.]
A. Ohtsu, Y. Shimada, K. Shirao, et al.
Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: The Japan Clinical Oncology Group Study (JCOG9205).
J Clin Oncol, 21 (2003), pp. 54-59
[52.]
N.C. Tebbutt, A. Norman, D. Cunningham, et al.
A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophagogastric cancer.
Ann Oncol, 13 (2002), pp. 1568-1575
Copyright © 2011. Instituto Nacional de Cancerología
Opciones de artículo
Herramientas