Gastric cancer: Russian clinical guidelines

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Abstract

Gastric cancer remains one of the most common malignancies in Russia. Despite steady decrease of gastric cancer incidence it still reaches 24.65 per 100 000 population (crude rate) in 2019 with about 36 000 new cases annually. More than 29 000 people die of gastric cancer every year. High mortality rate is mostly caused by an extremely significant proportion of patients with metastatic disease which reached 40.1% in 2019. The majority of cases is related to Helicobacter pylori infection, salty diet, tobacco exposure as well as hereditary syndromes. Staging of locally advanced gastric cancer includes contrast-enhanced computed tomography of the thorax, abdomen and pelvis as well as diagnostic laparoscopy with peritoneal washings. In patients with inoperable or disseminated cancer of the stomach additional analysis for HER2, microsatellite instability and PD-L1 status is recommended. Endoscopic or laparoscopic resection remains the mainstay of treatment in patients with early cancer. Laparoscopic gastrectomy in patients with locally advanced cancer is reserved for high-volume centers with extensive experience with the procedure. Recently, perioperative cytotoxic therapy became the standard of treatment in patients with locally advanced gastric cancer. FLOT regimen is recommended while FOLFOX6 or XELOX are considered possible in the elderly or frail patients. Drug therapy includes standard doublet or triplet chemotherapy regimens for metastatic disease with trastuzumab for HER2(+++) patients. Patients with MSI-H tumors can be treated with pembrolizumab starting with 2nd line while nivolumab is reserved for the 3rd and further lines regardless of PD-L1 status. Importantly, this year guidelines include multimodal prehabilitation including physical exercise, nutritional support and psychological counselling as a possibility in all patients in need of surgery. Also standardized enhanced recovery protocols are recommended for usage during the perioperative period.

About the authors

Nataliia S. Besova

Blokhin National Medical Research Center of Oncology

Author for correspondence.
Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Aleksei E. Kalinin

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Sergei N. Nered

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Email: editor@consiliummedicum.ru

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Aleksei A. Triakin

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

D. Sci. (Med.)

Russian Federation, Moscow

Sergei V. Gamaiunov

Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Obninsk

Nikolai A. Kozlov

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Ivan S. Stilidi

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education; Pirogov Russian National Research Medical University

Email: editor@consiliummedicum.ru
ORCID iD: 0000-0002-0493-1166

D. Sci. (Med.), Prof., Corr. Memb. RAS; 

Russian Federation, Moscow

Aleksei M. Karachun

Petrov National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

D. Sci. (Med.), Prof.

Russian Federation, Saint Petersburg

Pavel V. Kononets

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Olga A. Malikhova

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Email: editor@consiliummedicum.ru
ORCID iD: 0000-0003-2245-214X

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Andrei B. Riabov

Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

D. Sci. (Med.)

Russian Federation, Moscow

Vladimir M. Khomiakov

Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Aleksandr A. Fedenko

Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

Department Head

Russian Federation, Moscow

Larisa V. Bolotina

Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru
ORCID iD: 0000-0003-4879-2687

Department Head

Russian Federation, Moscow

Natalia A. Falaleeva

Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru
ORCID iD: 0000-0002-0023-4216

Department Head

Russian Federation, Obninsk

Aleksei A. Nevol'skikh

Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

D. Sci. (Med.)

Russian Federation, Obninsk

Sergei A. Ivanov

Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru
ORCID iD: 0000-0001-7689-6032

D. Sci. (Med.), Prof. RAS

Russian Federation, Obninsk

Zhanna V. Khailova

Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Obninsk

Tigran G. Gevorkian

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

Deputy Director

Russian Federation, Moscow

Aleksei V. Butenko

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

D. Sci. (Med.)

Russian Federation, Moscow

Ilmira R. Gil'mutdinova

National Medical Research Center of Rehabilitation and Balneology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Mikhail A. Eremushkin

National Medical Research Center of Rehabilitation and Balneology

Email: editor@consiliummedicum.ru

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Galina E. Ivanova

Pirogov Russian National Research Medical University

Email: editor@consiliummedicum.ru

D. Sci. (Med.)

Russian Federation, Moscow

Kristina O. Kondrat'eva

Petrov National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

medical psychologist

Russian Federation, Saint Petersburg

Tatiana V. Konchugova

National Medical Research Center of Rehabilitation and Balneology

Email: editor@consiliummedicum.ru

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Anton A. Krutov

Petrov National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

oncologist

Russian Federation, Saint Petersburg

Olga A. Obukhova

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Tatiana Iu. Semiglazova

Petrov National Medical Research Center of Oncology; Mechnikov North-Western State Medical University

Email: editor@consiliummedicum.ru

D. Sci. (Med.)

Russian Federation, Saint Petersburg

Elena V. Filonenko

Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology

Email: editor@consiliummedicum.ru

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Marina M. Khulamkhanova

Blokhin National Medical Research Center of Oncology

Email: editor@consiliummedicum.ru

physiotherapist, oncologist

Russian Federation, Moscow

Aleksandr I. Romanov

Rehabilitation Center of the President of the Russian Federation

Email: editor@consiliummedicum.ru

D. Sci. (Med.), Prof., Acad. RAS

Russian Federation, Herzen sanatorium village

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2. Fig. 1. The algorithm for primary diagnosis of GC.

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3. Fig. 2. GC screening.

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4. Fig. 3. The prognostic groups for GC.

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5. Fig. 4. The results from GC surgery.

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6. Fig. 5. Gastric cancer. The algorithm of conducting.

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