Gastric cancer in the elderly: an overview.
OBJECTIVE
Gastric cancer in the elderly represents a distinct entity with specific clinicopathological characteristics and the majority of affected patients belong to this age group. Subtotal or total gastrectomy with radical lymph node dissection, adjuvant chemoradiotherapy or perioperative chemotherapy represent the only potentially curative treatment options and seem to be performed with acceptable morbidity and mortality rates in selected elderly patients. Published research is very limited due to the strict selection and under-representation of elderly patients in clinical trials. A review of current recommendations and practice was performed.


METHODS
A comprehensive literature review was performed searching Medline for articles published since 1974, using "gastric cancer", "elderly" and "treatment" as keywords.


METHODS
The data suggest that elderly patients that fulfill the inclusion criteria of clinical trials experience the same advantages and toxicities from chemotherapy as younger patients. Fit elderly patients with operable gastric cancer should be candidates for the standard surgical resection provided that preoperative comorbidities are taken into account. Perioperative chemotherapy or postoperative chemoradiotherapy should be added in case of locally advanced disease. Palliative systemic chemotherapy seems to prolong survival in recurrent and metastatic disease.


CONCLUSIONS
Chronological age alone is not sufficient reason to withhold curative or palliative treatment from an elderly gastric cancer patient. Performance status does not suffice in order to estimate the general condition of elderly patients and cofactors regarding their functional, social and mental status have to be considered.
Saif
M W
MW
Department of Clinical Oncology, Yale University School of Medicine New Haven, CT, USA.
Makrilia
N
N
Zalonis
A
A
Merikas
M
M
Syrigos
K
K
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D015897:Comorbidity; D005060:Europe; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000628:therapy; D010166:Palliative Care / Q000379:methods; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D014481:United States