research
Gastric Cancer Trends and Treatment: Strategies in the Netherlands: Challenges Ahead
- Publication date
- 20 March 2014
- Publisher
- __Abstract__
In this thesis trends and treatment of gastric cancer in the Netherlands are discussed.
Gastric cancer is a challenging disease, because outcome with respect to postoperative
mortality and long-term survival remains dismal; improvement of diagnostics and
treatment is therefore of utmost importance. The fact that gastric cancer is becoming a
rarer disease may hamper improvement, since a lower incidence might decrease experience
with and attention for this disease. Although improved, postoperative mortality is
still high in the Netherlands in comparison to countries in the Far East and specialized
centers 1-4. Five-year survival rates are comparably lower (21% versus 69%) 1;5. Improvement
of the aforementioned mortality and survival rates has yet to be realized. Several
treatment modalities have been subject of clinical studies.
As surgery is still the only treatment available for cure from gastric cancer, in the 20th
century two surgical phase III trials have been conducted in Europe to determine the
survival benefit of an extended lymphadenectomy, the so-called D2 lymphadenectomy.
Because in both studies postoperative mortality was high after a D2 resection (10-13%)
6;7, nowadays, therefore, in the Netherlands a limited lymphadenectomy is most often
performed. The role of perioperative chemotherapy and/or chemoradiotherapy has
been investigated as well, and led to changes in treatment strategies in the Western
world 8;9. In the Netherlands, patients usually undergo perioperative chemotherapy,
mainly consisting of epirubicin, a platinum based chemotherapeuticum and 5 Fluorouracil
(5-FU) or analogue 10.
In the first two parts of this thesis, an evaluation of gastric cancer with respect to incidence,
mortality, survival, staging and treatment is described. In the latter part, quality
of care is evaluated and the results of the DoCCS study, a multicenter phase II feasibility
study of neoadjuvant docetaxel, cisplatin and capecitabine and protocolized surgery in
resectable gastric cancer are described.