STOMACH CANCER PANEL DISCUSSION

1. DR KANHU CHARAN PATRO
MD,DNB [RADIATION ONCOLOGY], MBA. PDCR. CEPC, FAROI
HOD, RADIATION ONCOLOGY. MGCHRI. VISAKHAPATNAM
1
drkcpatro@gmail.com
M-9160470564
MULTIDISCIPLINARY TUMOR BOARD
[CANCER STOMACH]

3. Case details
• 27 years female.
• Presented with complaints of fullness after
meals, intermittent vomiting since last few
days associated with significant weight loss,
for which the she was evaluated.

4. Upper GI Endoscopy
Upper GI Endoscopy (01/04/2020) reported A
hard nodular growth in the antro-pyloric region
with gastric outlet obstruction.

5. Endoscopy and biopsy
• UGI endoscopy guided Biopsy (19.02.2020)
reported mild focal acute on chronic gastritis,
no H.pylori seen, D2 Biopsy reported
Giardiasis.
• Gastritic Biopsy (02.04.2020) reported a focus
of atypical single cell infiltrate (low volume);
favours poorly cohesive carcinoma,
superimposed candida infection present.

6. Dr Ashutosh please
• Are you happy with histology report?
• Do you want Review/rebiopsy?
• Any molecular profile?
• Any further investigation?

9. Whole Body PET CT Scan (04/04/2020) reported Mildly FDG avid circumferential
concentric enhancing mural wall thickening (Max Thickness 1.8cm) with mildly increase
FDG uptake SUVm0061 2.7 is seen involving anteropyloric region of stomach, causing
significant luminal narrowing and gastric outlet obstruction (GOO) - Likely malignant No
other focal abnormal FDG avid lesion in rest of the body

10. Surgical detail
• Patient underwent Exploratory Laparotomy +
Radical Distal Gastrectomy +
Gastrojejunostomy + Feeding Jejunostomy
done under GA on 09/04/2020.

11. Histopathology detail
• Post operative histopathology (10/04/2020) s/o
poorly cohesive carcinoma,
– Poorly differentiated carcinoma,
– Non-signet ring cell type,
– Maximum dimesnion:5cm,
– LVI +ve,
– PNI +ve(multifocal),
– 1/9 regional lymph nodes shows metastatic tumour
deposits,
– 1/5 common hepatic lymph node positive for metastatic
carcinoma.
– TNM stage - T4aN1.

12. Dr Suvadip please
• Comment on surgery performed?
• Which case do you prefer total gastrectomy?
• How do you define margin?
• Optimum number of nodes to be dissected?

14. Dr Moses please
• How do you decide adjuvant treatment?
• CT
• CT+RT
• CTCT+RTCT

22. Preoperative chemotherapy
SL TRIAL ARM RESULT
1 MAGIC SX
VS
ECF-SX-ECF
1. 5-YEAR SURVIVAL FROM 23% TO 36% FOR
PATIENTS WITH RESECTABLE STAGE II AND III
GASTRIC CANCERS
2 FRENCH SX
VS
C5F-SX-C5F
1. 5-YEAR RATE 24% VS 38%
2. ADENOCARCINOMA OF THE LOWER ESOPHAGUS,
GEJ, OR STOMACH, PERIOPERATIVE
CHEMOTHERAPY USING FLUOROURACIL PLUS
CISPLATIN SIGNIFICANTLY INCREASED THE
CURATIVE RESECTION RATE, DISEASE-FREE
SURVIVAL, AND OS
3 GERMAN AIO ECF-SX-ECF
Vs
FLOT-SX-FLOT
1. HIGHER RATES OF PATHOLOGICAL RESPONSE FOR
FLOT (15.6% VERSUS 5.8%);
2. HOWEVER, CORRELATION WITH SURVIVAL
OUTCOMES IS AWAITED
EVEN IN RESPECTABLE PERIOPERATIVE CHEMOTHERAPY HAVING ADDED BENEFIT

23. Postoperative chemoradiotherapy
SL TRIAL ARM RESULT
1 CRITCS CT-SX-CT
VS
CT-SX-CRT
1. No significant difference in overall survival was
found between postoperative chemotherapy
and chemoradiotherapy
3 DUTCH D1D2 1. CRT reduces local recurrence rates following
D1 resection, but provides no benefit in
patients who have undergone D2 resection
4 INTERGROUP 0116 SX
VS
SX-CRT
[5FU-LV]
1. 50% 3-year survival for patients treated with
CRT versus 41% for those treated with surgery
alone
2. After 10 years of follow-up, this OS
improvement remains significant
In current postoperative CRT regimens, RT should preferably be given as a concomitant
regimen of fluoropyrimidine-based CRT to a total dose of 45 Gy in 25 fractions of 1.8 Gy, 5
fractions/ week by intensity-modulated RT techniques

24. 1. No radiotherapy if used preoperative chemotherapy and use adjuvant chemo
2. If indicated use chemoradiotherapy in postoperative settings if no preoperative chemo
3. FLOT is the standard/

25. Dr Vikas please
• Which type of chemo?
• How many cycles?
• Role of targeted agents

28. Capecitabine and oxaliplatin

30. Adjuvant treatment
• She received 6 cycles FOLFOX based adjuvant
chemo, last on 26/10/2020.

32. Dr Avinash please
• Role of targeted agents?

37. Dr Ashutosh please
• Pattern of follow up?
• Any supplementations

39. Supplementations

40. Whole body PET CT (17-Nov-2020)
• Post radical distal gastrectomy and gastro
jejunostomy status.
• No focal abnormal FDG avid lesion seen at
surgical bed / anastomotic site.
• No other focal abnormal FDG avid lesion in
rest of the body.
• As compared to previous PET CT scan dated
27.07.2020, there is no significant interval
change.

41. PET CT (27/7/2020): Mass in anteropyloric region of stomach not visualised with
no new FDG avid lesion seen in present study.