Multimodal treatment in oligometastatic gastric cancer

Abstract

Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration. This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes. Oncosurgical approach of metastatic disease could prolong survival in selected patients. The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management. We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.

Keywords: Gastric cancer, Radiotherapy, Chemotherapy, Multimodal treatment, Oligometastatis, Immunotherapy

Core Tip: Oligometastatic gastric cancer is an increasingly recognized clinical entity characterized by limited metastatic spread. With the development of multimodal treatment, curative treatment with complete surgical resection can be achieved. In our review, we have shown evidence that chemotherapy, immunotherapy, and targeted therapy could control the expansion of the tumor or decrease the size of the metastasis to achieve a resectable configuration. Surgery is not only a palliative option for metastatic disease but could be offered with curative intent in selected patients.