Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group

Yıl: 2019 Cilt: 30 Sayı: 7 Sayfa Aralığı: 584 - 598 Metin Dili: İngilizce DOI: 10.5152/tjg.2018.18737 İndeks Tarihi: 17-07-2020

Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group

Öz:
The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence ofgastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern andWestern countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertaintieslead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes.The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized aconsensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practicefor this challenging disease.The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determinedin the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions.The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patientselection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues inthe management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results sectionwith related data.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2018. [CrossRef]
  • 2. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol 2006; 12: 354-62. [CrossRef]
  • 3. HSGM. Cancer Statistics of Turkey in 2014. https://hsgm.saglik. gov.tr/tr/kanser-istatistikleri/yillar/495-2014-y%C4%B1l%C4%B1 -t%C3%BCrkiye-kanser-istatistikleri.html
  • 4. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017; 20: 1-19. [CrossRef]
  • 5. Ajani JA, D’Amico TA, Almhanna K, et al. Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2016; 14: 1286-312. [CrossRef]
  • 6. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27: v38-49. [CrossRef]
  • 7. De Manzoni G, Marrelli D, Baiocchi GL, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer 2017; 20: 20-30. [CrossRef]
  • 8. Zilberstein B, Malheiros C, Lourenco LG, et al. Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil. Arq Bras Cir Dig 2013; 26: 2-6. [CrossRef]
  • 9. Martin-Richard M, Custodio A, Garcia-Giron C, et al. Seom guidelines for the treatment of gastric cancer 2015. Clin Transl Oncol 2015; 17: 996-1004. [CrossRef]
  • 10. Kulig J, Wallner G, Drews M, et al. Polish Consensus on Treatment of Gastric Cancer; update 2017. Pol Przegl Chir 2017; 89: 59-73. [CrossRef]
  • 11. Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg 2017; 6: 119-30. [CrossRef]
  • 12. Yalcin S. Gastric cancer in Turkey-a bridge between west and East. Gastrointest Cancer Res 2009; 3: 29-32.
  • 13. Guner A. Recent trends of gastric cancer treatment in Turkey. Transl Gastroenterol Hepatol 2017; 2: 31. [CrossRef]
  • 14. Roshandel G, Boreiri M, Sadjadi A, Malekzadeh R. A diversity of cancer incidence and mortality in West Asian populations. Ann Glob Health 2014; 80: 346-57. [CrossRef]
  • 15. Pisters PWT, Kelsen DP, Tepper JE. Cancer of the stomach. In: DeVita VTJ, Hellman S, Rosenberg SA editors. Cancer: Principles and Practice of Oncology. 8 ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p.1043-79.
  • 16. Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol 2014; 40: 584-91. [CrossRef]
  • 17. Hatfield AR, Slavin G, Segal AW, Levi AJ. Importance of the site of endoscopic gastric biopsy in ulcerating lesions of the stomach. Gut 1975; 16: 884-6. [CrossRef]
  • 18. Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology 1982; 82: 228-31.
  • 19. Leung WK, Wu MS, Kakugawa Y, et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 2008; 9: 279-87. [CrossRef]
  • 20. Alacali M. Mide Kanseri, Mide Kanseri Taramaları ve Mide Kanserinden Korunma. Ankara Medical Journal 2012; 12: 195-8.
  • 21. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-54. [CrossRef]
  • 22. Chiyo T, Kobara H, Mori H, Katsuki N, Haba R, Masaki T. Submucosal Endoscopic Sampling for Indefinite Gastric Linitis Plastica Infiltrating into the Submucosal Layer. J Gastrointestin Liver Dis 2015; 24: 375-8.
  • 23. Qiu MZ, Shi SM, Chen M, et al. Comparison of HER2 and Lauren Classification between Biopsy and Surgical Resection Samples, Primary and Metastatic Samples of Gastric Cancer. J Cancer 2017; 8: 3531-7. [CrossRef]
  • 24. Bartley AN, Washington MK, Colasacco C, et al. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society of Clinical Oncology. J Clin Oncol 2017; 35: 446-64. [CrossRef]
  • 25. CAP. Cancer Protocol Templates. http://www.cap.org/web/oracle/webcenter/portalapp/pagehierarchy/cancer_protocol_templates.jspx?_afrLoop=377034583908370#!%40%40%3F_afrLoop%3D377034583908370%26_adf.ctrl-state%3Ds2y2j5tvh_17
  • 26. Abrahao-Machado LF, Scapulatempo-Neto C. HER2 testing in gastric cancer: An update. World J Gastroenterol 2016; 22: 4619-25. [CrossRef]
  • 27. Jorgensen JT, Hersom M. HER2 as a Prognostic Marker in Gastric Cancer - A Systematic Analysis of Data from the Literature. J Cancer 2012; 3: 137-44. [CrossRef]
  • 28. Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 1987; 235: 177-82. [CrossRef]
  • 29. Richman S. Deficient mismatch repair: Read all about it (Review). Int J Oncol 2015; 47: 1189-202. [CrossRef]
  • 30. Lei YY, Huang JY, Zhao QR, et al. The clinicopathological parameters and prognostic significance of HER2 expression in gastric cancer patients: a meta-analysis of literature. World J Surg Oncol 2017; 15: 68. [CrossRef]
  • 31. Kim JW, Nam KH, Ahn SH, et al. Prognostic implications of immunosuppressive protein expression in tumors as well as immune cell infiltration within the tumor microenvironment in gastric cancer. Gastric Cancer 2016; 19: 42-52. [CrossRef]
  • 32. Muro K, Chung HC, Shankaran V, et al. Pembrolizumab for patients with PD-L1-positive advanced gastric cancer (KEYNOTE-012): a multicentre, open-label, phase 1b trial. Lancet Oncol 2016; 17: 717- 26. [CrossRef]
  • 33. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074-84. [CrossRef]
  • 34. Lundsgaard Hansen M, Fallentin E, Lauridsen C, et al. Computed tomography (CT) perfusion as an early predictive marker for treatment response to neoadjuvant chemotherapy in gastroesophageal junction cancer and gastric cancer--a prospective study. PLoS One 2014; 9: e97605. [CrossRef]
  • 35. Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 2000; 174: 1005-8. [CrossRef]
  • 36. Huang S, Sun C, Li X, et al. [Comprehensive application of CT and PET/CT in diagnosing colorectal mucinous and non-mucinous adenocarcinoma]. Zhonghua Wei Chang Wai Ke Za Zhi 2014; 17: 230-4.
  • 37. Murakami S, Saito H, Karino F, et al. (1)(8)F-fluorodeoxyglucose uptake on positron emission tomography in mucinous adenocarcinoma. Eur J Radiol 2013; 82: e721-5. [CrossRef]
  • 38. Pak KH, Yun M, Cheong JH, Hyung WJ, Choi SH, Noh SH. Clinical implication of FDG-PET in advanced gastric cancer with signet ring cell histology. J Surg Oncol 2011; 104: 566-70. [CrossRef]
  • 39. Hasuike N, Ono H, Boku N, et al. A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer 2018; 21: 114-23. [CrossRef]
  • 40. Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol 2007; 25: 2107-16. [CrossRef]
  • 41. Park KJ, Lee MW, Koo JH, et al. Detection of early gastric cancer using hydro-stomach CT: blinded vs unblinded analysis. World J Gastroenterol 2011; 17: 1051-7. [CrossRef]
  • 42. Goense L, van Rossum PS, Reitsma JB, et al. Diagnostic Performance of (1)(8)F-FDG PET and PET/CT for the Detection of Recurrent Esophageal Cancer After Treatment with Curative Intent: A Systematic Review and Meta-Analysis. J Nucl Med 2015; 56: 995- 1002. [CrossRef]
  • 43. Machairas N, Charalampoudis P, Molmenti EP, et al. The value of staging laparoscopy in gastric cancer. Ann Gastroenterol 2017; 30: 287-94. [CrossRef]
  • 44. Nath J, Moorthy K, Taniere P, Hallissey M, Alderson D. Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma. Br J Surg 2008; 95: 721-6. [CrossRef]
  • 45. Frattini F, Rausei S, Chiappa C, Rovera F, Boni L, Dionigi G. Prognosis and treatment of patients with positive peritoneal cytology in advanced gastric cancer. World J Gastrointest Surg 2013; 5: 135-7. [CrossRef]
  • 46. Lee SD, Ryu KW, Eom BW, Lee JH, Kook MC, Kim YW. Prognostic significance of peritoneal washing cytology in patients with gastric cancer. Br J Surg 2012; 99: 397-403. [CrossRef]
  • 47. Lorenzen S, Panzram B, Rosenberg R, et al. Prognostic significance of free peritoneal tumor cells in the peritoneal cavity before and after neoadjuvant chemotherapy in patients with gastric carcinoma undergoing potentially curative resection. Ann Surg Oncol 2010; 17: 2733-9. [CrossRef]
  • 48. Deans DA, Tan BH, Wigmore SJ, et al. The influence of systemic inflammation, dietary intake and stage of disease on rate of weight loss in patients with gastro-oesophageal cancer. Br J Cancer 2009; 100: 63-9. [CrossRef]
  • 49. Dewys WD, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980; 69: 491-7. [CrossRef]
  • 50. Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors 2016; 2: 178-87. [CrossRef]
  • 51. Newton AD, Datta J, Loaiza-Bonilla A, Karakousis GC, Roses RE. Neoadjuvant therapy for gastric cancer: current evidence and future directions. J Gastrointest Oncol 2015; 6: 534-43.
  • 52. Cardoso R, Coburn N, Seevaratnam R, et al. A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer. Gastric Cancer 2012; 15(Suppl 1): S19-26. [CrossRef]
  • 53. Hartgrink HH, van de Velde CJ, Putter H, et al. Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 2004; 30: 643-9. [CrossRef]
  • 54. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20. [CrossRef]
  • 55. Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011; 29: 1715-21. [CrossRef]
  • 56. Schuhmacher C, Gretschel S, Lordick F, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 2010; 28: 5210-8. [CrossRef]
  • 57. Shapiro J, van Lanschot JJB, Hulshof M, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015; 16: 1090-8. [CrossRef]
  • 58. Ajani JA, Mansfield PF, Janjan N, et al. Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol 2004; 22: 2774-80. [CrossRef]
  • 59. Lutz MP, Zalcberg JR, Ducreux M, et al. Highlights of the EORTC St. Gallen International Expert Consensus on the primary therapy of gastric, gastroesophageal and oesophageal cancer - differential treatment strategies for subtypes of early gastroesophageal cancer. Eur J Cancer 2012; 48: 2941-53. [CrossRef]
  • 60. Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60: 1449-72. [CrossRef]
  • 61. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg 1999; 230: 170-8. [CrossRef]
  • 62. Gouzi JL, Huguier M, Fagniez PL, et al. Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study. Ann Surg 1989; 209: 162-6. [CrossRef]
  • 63. Haverkamp L, Ruurda JP, van Leeuwen MS, Siersema PD, van Hillegersberg R. Systematic review of the surgical strategies of adenocarcinomas of the gastroesophageal junction. Surg Oncol 2014; 23: 222-8. [CrossRef]
  • 64. Huang YL, Lin HG, Yang JW, et al. Laparoscopy-assisted versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a meta-analysis. Int J Clin Exp Med 2014; 7: 1490-9.
  • 65. Hu Y, Huang C, Sun Y, et al. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol 2016; 34: 1350- 7. [CrossRef]
  • 66. Quan Y, Huang A, Ye M, et al. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 2016; 19: 939-50. [CrossRef]
  • 67. Seevaratnam R, Bocicariu A, Cardoso R, et al. How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer 2012; 15 Suppl 1: S70-88. [CrossRef]
  • 68. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymphnode dissection for gastric cancer. N Engl J Med 1999; 340: 908-14. [CrossRef]
  • 69. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004; 22: 2069-77. [CrossRef]
  • 70. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347: 995-9. [CrossRef]
  • 71. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999; 79: 1522-30. [CrossRef]
  • 72. Degiuli M, Sasako M, Ponti A. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 2010; 97: 643-9. [CrossRef]
  • 73. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11: 439-49. [CrossRef]
  • 74. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008; 359: 453-62. [CrossRef]
  • 75. Sano T, Sasako M, Mizusawa J, et al. Randomized Controlled Trial to Evaluate Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma. Ann Surg 2017; 265: 277-83. [CrossRef]
  • 76. Terashima M, Doki Y, Kurokawa Y, et al. Primary results of a phase III trial to evaluate bursectomy for patients with subserosal/ serosal gastric cancer (JCOG1001). 2017.
  • 77. Mine S, Sano T, Hiki N, et al. Proximal margin length with transhiatal gastrectomy for Siewert type II and III adenocarcinomas of the oesophagogastric junction. Br J Surg 2013; 100: 1050-4. [CrossRef]
  • 78. Sugita S, Kinoshita T, Kaito A, Watanabe M, Sunagawa H. Shortterm outcomes after laparoscopic versus open transhiatal resection of Siewert type II adenocarcinoma of the esophagogastric junction. Surg Endosc 2018; 32: 383-90. [CrossRef]
  • 79. Kim MG, Lee JH, Ha TK, Kwon SJ. The distance of proximal resection margin dose not significantly influence on the prognosis of gastric cancer patients after curative resection. Ann Surg Treat Res 2014; 87: 223-31. [CrossRef]
  • 80. Datta J, McMillan MT, Shang EK, et al. Omission of adjuvant therapy after gastric cancer resection: development of a validated risk model. J Natl Compr Canc Netw 2015; 13: 531-41. [CrossRef]
  • 81. Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012; 379: 315-21. [CrossRef]
  • 82. Paoletti X, Oba K, Burzykowski T, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. Jama 2010; 303: 1729-37. [CrossRef]
  • 83. Janunger KG, Hafstrom L, Glimelius B. Chemotherapy in gastric cancer: a review and updated meta-analysis. Eur J Surg 2002; 168: 597-608. [CrossRef]
  • 84. Park SH, Sohn TS, Lee J, et al. Phase III Trial to Compare Adjuvant Chemotherapy With Capecitabine and Cisplatin Versus Concurrent Chemoradiotherapy in Gastric Cancer: Final Report of the Adjuvant Chemoradiotherapy in Stomach Tumors Trial, Including Survival and Subset Analyses. J Clin Oncol 2015; 33: 3130-6. [CrossRef]
  • 85. Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J Gastroenterol 2015; 21: 7343-8. [CrossRef]
  • 86. Lee J, Lim DH, Kim S, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol 2012; 30: 268-73. [CrossRef]
  • 87. Cats A, Jansen EPM, van Grieken NCT, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemo therapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. Lancet Oncol 2018; 19: 616- 28. [CrossRef]
  • 88. Schoffski P. The modulated oral fluoropyrimidine prodrug S-1, and its use in gastrointestinal cancer and other solid tumors. Anticancer Drugs 2004; 15: 85-106. [CrossRef]
  • 89. Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011; 29: 4387-93. [CrossRef]
  • 90. Moehler M, Delic M, Goepfert K, et al. Immunotherapy in gastrointestinal cancer: Recent results, current studies and future perspectives. Eur J Cancer 2016; 59: 160-70. [CrossRef]
  • 91. Kawamoto M, Onishi H, Koya N, et al. Stage IV gastric cancer successfully treated by multidisciplinary therapy including chemotherapy, immunotherapy, and surgery: a case report. Surg Case Rep 2017; 3: 112. [CrossRef]
  • 92. Zhandossov O, Kaussova G, Koten A. Combined treatment for gastric cancer: Immunological approach. Turk J Gastroenterol 2018; 29: 151-6. [CrossRef]
  • 93. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687-97. [CrossRef]
  • 94. Weinberg BA, Xiu J, Hwang JJ, Shields AF, Salem ME, Marshall JL. Immuno-Oncology Biomarkers for Gastric and Gastroesophageal Junction Adenocarcinoma: Why PD-L1 Testing May Not Be Enough. Oncologist 2018. [CrossRef]
  • 95. Joshi SS, Maron SB, Catenacci DV. Pembrolizumab for treatment of advanced gastric and gastroesophageal junction adenocarcinoma. Future Oncol 2018; 14: 417-30. [CrossRef]
  • 96. Fuchs CS, Doi T, Jang RW, et al. Safety and Efficacy of Pembrolizumab Monotherapy in Patients With Previously Treated Advanced Gastric and Gastroesophageal Junction Cancer: Phase 2 Clinical KEYNOTE-059 Trial. JAMA Oncol 2018; 4: e180013. [CrossRef]
  • 97. Palma DA, Salama JK, Lo SS, et al. The oligometastatic state - separating truth from wishful thinking. Nat Rev Clin Oncol 2014; 11: 549-57. [CrossRef]
  • 98. Chiapponi C, Berlth F, Plum PS, et al. Oligometastatic Disease in Upper Gastrointestinal Cancer - How to Proceed? Visc Med 2017; 33: 31-4. [CrossRef]
  • 99. Weichselbaum RR, Hellman S. Oligometastases revisited. Nat Rev Clin Oncol 2011; 8: 378-82. [CrossRef]
  • 100. Riihimaki M, Hemminki A, Sundquist K, Sundquist J, Hemminki K. Metastatic spread in patients with gastric cancer. Oncotarget 2016; 7: 52307-16. [CrossRef]
  • 101. Grimes N, Devlin J, Dunne DF, Poston G, Fenwick S, Malik H. The role of hepatectomy in the management of metastatic gastric adenocarcinoma: a systematic review. Surg Oncol 2014; 23: 177-85. [CrossRef]
  • 102. Fugazzola P, Coccolini F, Montori G, et al. Overall and disease-free survival in patients treated with CRS + HIPEC with cisplatin and paclitaxel for gastric cancer with peritoneal carcinomatosis. J Gastrointest Oncol 2017; 8: 572-82. [CrossRef]
  • 103. Brandl A, Weiss S, von Winterfeld M, et al. Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience. Int J Hyperthermia 2018; 34: 512-7. [CrossRef]
  • 104. Thompson RJ, Ranaghan L, Kennedy R, Clements W, Carey PD, Kennedy JA. Survival following operative management of gastric linitis plastica compared with non-operative management. Ann R Coll Surg Engl 2017; 99: 228-32. [CrossRef]
  • 105. Yalcin B, Zengin N, Aydin F, et al. The clinical and pathological features of patients with gastric cancer in Turkey: A Turkish Oncology Group Study. 2006.
  • 106. Bor S, Vardar R, Ormeci N, et al. Prevalence patterns of gastric cancers in Turkey: model of a developing country with high occurrence of Helicobacter pylori. J Gastroenterol Hepatol 2007; 22: 2242-5. [CrossRef]
  • 107. Carneiro F. Hereditary gastric cancer. Eur J Cancer 2018; 92(Suppl 2): S4. [CrossRef]
APA Aytac E, Aslan F, Cicek B, Erdamar S, gürses b, Güven K, FALAY O, KARAHASANOĞLU T, Selcukbiricik F, SELEK U, Atalar B, BALIK E, Tozun A, Rozanes İ, ARICAN A, Hamzaoglu I, Baca B, MOLİNAS-MANDEL N, Saruç M, GÖKSEL S, Demir G, Agaoglu F, YAKICIER C, ÖZBEK U, Ozben V, ÖZYAR E, GÜNER A, ER O, KABAN K, bolukbasi y, Bugra D, Group T (2019). Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. , 584 - 598. 10.5152/tjg.2018.18737
Chicago Aytac Erman,Aslan Fatih,Cicek Bahattin,Erdamar Sibel,gürses bengi,Güven Koray,FALAY Okan,KARAHASANOĞLU Tayfun,Selcukbiricik Fatih,SELEK UGUR,Atalar Banu,BALIK Emre,Tozun Ayse Nurdan,Rozanes İzzet,ARICAN Ali,Hamzaoglu Ismail,Baca Bilgi,MOLİNAS-MANDEL Nil,Saruç Murat,GÖKSEL Süha,Demir Gökhan,Agaoglu Fulya,YAKICIER Cengiz,ÖZBEK Uğur,Ozben Volkan,ÖZYAR Enis,GÜNER Ahmet Levent,ER OZLEM,KABAN Kerim,bolukbasi yasemin,Bugra Dursun,Group The İstanbul Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. (2019): 584 - 598. 10.5152/tjg.2018.18737
MLA Aytac Erman,Aslan Fatih,Cicek Bahattin,Erdamar Sibel,gürses bengi,Güven Koray,FALAY Okan,KARAHASANOĞLU Tayfun,Selcukbiricik Fatih,SELEK UGUR,Atalar Banu,BALIK Emre,Tozun Ayse Nurdan,Rozanes İzzet,ARICAN Ali,Hamzaoglu Ismail,Baca Bilgi,MOLİNAS-MANDEL Nil,Saruç Murat,GÖKSEL Süha,Demir Gökhan,Agaoglu Fulya,YAKICIER Cengiz,ÖZBEK Uğur,Ozben Volkan,ÖZYAR Enis,GÜNER Ahmet Levent,ER OZLEM,KABAN Kerim,bolukbasi yasemin,Bugra Dursun,Group The İstanbul Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. , 2019, ss.584 - 598. 10.5152/tjg.2018.18737
AMA Aytac E,Aslan F,Cicek B,Erdamar S,gürses b,Güven K,FALAY O,KARAHASANOĞLU T,Selcukbiricik F,SELEK U,Atalar B,BALIK E,Tozun A,Rozanes İ,ARICAN A,Hamzaoglu I,Baca B,MOLİNAS-MANDEL N,Saruç M,GÖKSEL S,Demir G,Agaoglu F,YAKICIER C,ÖZBEK U,Ozben V,ÖZYAR E,GÜNER A,ER O,KABAN K,bolukbasi y,Bugra D,Group T Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. . 2019; 584 - 598. 10.5152/tjg.2018.18737
Vancouver Aytac E,Aslan F,Cicek B,Erdamar S,gürses b,Güven K,FALAY O,KARAHASANOĞLU T,Selcukbiricik F,SELEK U,Atalar B,BALIK E,Tozun A,Rozanes İ,ARICAN A,Hamzaoglu I,Baca B,MOLİNAS-MANDEL N,Saruç M,GÖKSEL S,Demir G,Agaoglu F,YAKICIER C,ÖZBEK U,Ozben V,ÖZYAR E,GÜNER A,ER O,KABAN K,bolukbasi y,Bugra D,Group T Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. . 2019; 584 - 598. 10.5152/tjg.2018.18737
IEEE Aytac E,Aslan F,Cicek B,Erdamar S,gürses b,Güven K,FALAY O,KARAHASANOĞLU T,Selcukbiricik F,SELEK U,Atalar B,BALIK E,Tozun A,Rozanes İ,ARICAN A,Hamzaoglu I,Baca B,MOLİNAS-MANDEL N,Saruç M,GÖKSEL S,Demir G,Agaoglu F,YAKICIER C,ÖZBEK U,Ozben V,ÖZYAR E,GÜNER A,ER O,KABAN K,bolukbasi y,Bugra D,Group T "Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group." , ss.584 - 598, 2019. 10.5152/tjg.2018.18737
ISNAD Aytac, Erman vd. "Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group". (2019), 584-598. https://doi.org/10.5152/tjg.2018.18737
APA Aytac E, Aslan F, Cicek B, Erdamar S, gürses b, Güven K, FALAY O, KARAHASANOĞLU T, Selcukbiricik F, SELEK U, Atalar B, BALIK E, Tozun A, Rozanes İ, ARICAN A, Hamzaoglu I, Baca B, MOLİNAS-MANDEL N, Saruç M, GÖKSEL S, Demir G, Agaoglu F, YAKICIER C, ÖZBEK U, Ozben V, ÖZYAR E, GÜNER A, ER O, KABAN K, bolukbasi y, Bugra D, Group T (2019). Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. Turkish Journal of Gastroenterology, 30(7), 584 - 598. 10.5152/tjg.2018.18737
Chicago Aytac Erman,Aslan Fatih,Cicek Bahattin,Erdamar Sibel,gürses bengi,Güven Koray,FALAY Okan,KARAHASANOĞLU Tayfun,Selcukbiricik Fatih,SELEK UGUR,Atalar Banu,BALIK Emre,Tozun Ayse Nurdan,Rozanes İzzet,ARICAN Ali,Hamzaoglu Ismail,Baca Bilgi,MOLİNAS-MANDEL Nil,Saruç Murat,GÖKSEL Süha,Demir Gökhan,Agaoglu Fulya,YAKICIER Cengiz,ÖZBEK Uğur,Ozben Volkan,ÖZYAR Enis,GÜNER Ahmet Levent,ER OZLEM,KABAN Kerim,bolukbasi yasemin,Bugra Dursun,Group The İstanbul Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. Turkish Journal of Gastroenterology 30, no.7 (2019): 584 - 598. 10.5152/tjg.2018.18737
MLA Aytac Erman,Aslan Fatih,Cicek Bahattin,Erdamar Sibel,gürses bengi,Güven Koray,FALAY Okan,KARAHASANOĞLU Tayfun,Selcukbiricik Fatih,SELEK UGUR,Atalar Banu,BALIK Emre,Tozun Ayse Nurdan,Rozanes İzzet,ARICAN Ali,Hamzaoglu Ismail,Baca Bilgi,MOLİNAS-MANDEL Nil,Saruç Murat,GÖKSEL Süha,Demir Gökhan,Agaoglu Fulya,YAKICIER Cengiz,ÖZBEK Uğur,Ozben Volkan,ÖZYAR Enis,GÜNER Ahmet Levent,ER OZLEM,KABAN Kerim,bolukbasi yasemin,Bugra Dursun,Group The İstanbul Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. Turkish Journal of Gastroenterology, vol.30, no.7, 2019, ss.584 - 598. 10.5152/tjg.2018.18737
AMA Aytac E,Aslan F,Cicek B,Erdamar S,gürses b,Güven K,FALAY O,KARAHASANOĞLU T,Selcukbiricik F,SELEK U,Atalar B,BALIK E,Tozun A,Rozanes İ,ARICAN A,Hamzaoglu I,Baca B,MOLİNAS-MANDEL N,Saruç M,GÖKSEL S,Demir G,Agaoglu F,YAKICIER C,ÖZBEK U,Ozben V,ÖZYAR E,GÜNER A,ER O,KABAN K,bolukbasi y,Bugra D,Group T Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. Turkish Journal of Gastroenterology. 2019; 30(7): 584 - 598. 10.5152/tjg.2018.18737
Vancouver Aytac E,Aslan F,Cicek B,Erdamar S,gürses b,Güven K,FALAY O,KARAHASANOĞLU T,Selcukbiricik F,SELEK U,Atalar B,BALIK E,Tozun A,Rozanes İ,ARICAN A,Hamzaoglu I,Baca B,MOLİNAS-MANDEL N,Saruç M,GÖKSEL S,Demir G,Agaoglu F,YAKICIER C,ÖZBEK U,Ozben V,ÖZYAR E,GÜNER A,ER O,KABAN K,bolukbasi y,Bugra D,Group T Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. Turkish Journal of Gastroenterology. 2019; 30(7): 584 - 598. 10.5152/tjg.2018.18737
IEEE Aytac E,Aslan F,Cicek B,Erdamar S,gürses b,Güven K,FALAY O,KARAHASANOĞLU T,Selcukbiricik F,SELEK U,Atalar B,BALIK E,Tozun A,Rozanes İ,ARICAN A,Hamzaoglu I,Baca B,MOLİNAS-MANDEL N,Saruç M,GÖKSEL S,Demir G,Agaoglu F,YAKICIER C,ÖZBEK U,Ozben V,ÖZYAR E,GÜNER A,ER O,KABAN K,bolukbasi y,Bugra D,Group T "Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group." Turkish Journal of Gastroenterology, 30, ss.584 - 598, 2019. 10.5152/tjg.2018.18737
ISNAD Aytac, Erman vd. "Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group". Turkish Journal of Gastroenterology 30/7 (2019), 584-598. https://doi.org/10.5152/tjg.2018.18737