Abstract
Aims
Gastric cancer in the elderly represents a distinct entity with specific clinicopathological
characteristics and the majority of affected patients belong to this age group. Subtotal
or total gastrectomy with radical lymph node dissection, adjuvant chemoradiotherapy
or perioperative chemotherapy represent the only potentially curative treatment options
and seem to be performed with acceptable morbidity and mortality rates in selected
elderly patients. Published research is very limited due to the strict selection and
under-representation of elderly patients in clinical trials. A review of current recommendations
and practice was performed.
Methods
A comprehensive literature review was performed searching Medline for articles published
since 1974, using “gastric cancer”, “elderly” and “treatment” as keywords.
Observations
The data suggest that elderly patients that fulfill the inclusion criteria of clinical
trials experience the same advantages and toxicities from chemotherapy as younger
patients. Fit elderly patients with operable gastric cancer should be candidates for
the standard surgical resection provided that preoperative comorbidities are taken
into account. Perioperative chemotherapy or postoperative chemoradiotherapy should
be added in case of locally advanced disease. Palliative systemic chemotherapy seems
to prolong survival in recurrent and metastatic disease.
Conclusions
Chronological age alone is not sufficient reason to withhold curative or palliative
treatment from an elderly gastric cancer patient. Performance status does not suffice
in order to estimate the general condition of elderly patients and cofactors regarding
their functional, social and mental status have to be considered.
Keywords
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Article info
Publication history
Accepted:
May 17,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
