International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape

Morgagni P, Bencivenga M, Carneiro F, Cascinu S, Derks S, Di Bartolomeo M, Donohoe C, Eveno C, Gisbertz S, Grimminger P, Gockel I, Grabsch H, Kassab P, Langer R, Lonardi S, Maltoni M, Markar S, Moehler M, Marrelli D, Mazzei MA, Melisi D, Milandri C, Moenig PS, Mostert B, Mura G, Polkowski W, Reynolds J, Saragoni L, Van Berge Henegouwen MI, Van Hillegersberg R, Vieth M, Verlato G, Torroni L, Wijnhoven B, Tiberio GAM, Yang HK, Roviello F, de Manzoni G (2024)

Publication Type: Journal article

Publication year: 2024

Journal

Book Volume: 27

Pages Range: 649-671

Journal Issue: 4

DOI: 10.1007/s10120-024-01479-5

Abstract

Background: Many gastric cancer patients in Western countries are diagnosed as metastatic with a median overall survival of less than twelve months using standard chemotherapy. Innovative treatments, like targeted therapy or immunotherapy, have recently proved to ameliorate prognosis, but a general agreement on managing oligometastatic disease has yet to be achieved. An international multi-disciplinary workshop was held in Bertinoro, Italy, in November 2022 to verify whether achieving a consensus on at least some topics was possible. Methods: A two-round Delphi process was carried out, where participants were asked to answer 32 multiple-choice questions about CT, laparoscopic staging and biomarkers, systemic treatment for different localization, role and indication of palliative care. Consensus was established with at least a 67% agreement. Results: The assembly agreed to define oligometastases as a “dynamic” disease which either regresses or remains stable in response to systemic treatment. In addition, the definition of oligometastases was restricted to the following sites: para-aortic nodal stations, liver, lung, and peritoneum, excluding bones. In detail, the following conditions should be considered as oligometastases: involvement of para-aortic stations, in particular 16a2 or 16b1; up to three technically resectable liver metastases; three unilateral or two bilateral lung metastases; peritoneal carcinomatosis with PCI ≤ 6. No consensus was achieved on how to classify positive cytology, which was considered as oligometastatic by 55% of participants only if converted to negative after chemotherapy. Conclusion: As assessed at the time of diagnosis, surgical treatment of oligometastases should aim at R0 curativity on the entire disease volume, including both the primary tumor and its metastases. Conversion surgery was defined as surgery on the residual volume of disease, which was initially not resectable for technical and/or oncological reasons but nevertheless responded to first-line treatment.

Authors with CRIS profile

Involved external institutions

Università Vita-Salute San Raffaele (UniSR) Italy (IT) Vrije Universiteit Amsterdam (VU) / University Amsterdam Netherlands (NL) St. James's Hospital Ireland (IE) Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille) France (FR) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Faculdade de Ciências Médicas da Santa Casa de São Paulo Brazil (BR) Johannes Kepler Universität (JKU) Linz Austria (AT) Trinity College Dublin Ireland (IE) Santa Maria delle Croci Hospital / Ospedale "Santa Maria delle Croci" di Ravenna Italy (IT) Klinikum Bayreuth Germany (DE) University of Verona / Università degli Studi di Verona Italy (IT) Erasmus University Medical Center (MC) Netherlands (NL) National Cancer Center (NCC) / 국립암센터 Korea, Republic of (KR) Ospedale G.B. Morgagni - L.Pierantoni Italy (IT) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) Italy (IT) Hospital de São João / Saint John Hospital Portugal (PT) Fondazione IRCCS: Istituto Nazionale dei Tumori Italy (IT) University of Amsterdam Netherlands (NL) Universitätsklinikum Leipzig Germany (DE) Maastricht University Medical Center (UMC+) Netherlands (NL) Istituto Oncologico Veneto (IOV), IRCCS Italy (IT) Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) Italy (IT) University of Oxford United Kingdom (GB) Università degli Studi di Siena (UNISI) / University of Siena Italy (IT) Azienda ospedaliero-universitaria Senese Italy (IT) Gruppo Ospedaliero San Donato Italy (IT) Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG) Switzerland (CH) Medical University of Lublin / Uniwersytet Medyczny w Lublinie Poland (PL) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Università degli Studi di Brescia Italy (IT)

How to cite

APA:

Morgagni, P., Bencivenga, M., Carneiro, F., Cascinu, S., Derks, S., Di Bartolomeo, M.,... de Manzoni, G. (2024). International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape. Gastric Cancer, 27(4), 649-671. https://doi.org/10.1007/s10120-024-01479-5

MLA:

Morgagni, Paolo, et al. "International consensus on the management of metastatic gastric cancer: step by step in the foggy landscape." Gastric Cancer 27.4 (2024): 649-671.

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