Gastric Cancer Trends and Treatment: Strategies in the Netherlands: Challenges Ahead

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.