title: Management strategies for locoregional recurrence in early-stage gastric cancer: retrospective analysis and comprehensive literature review.
abstract: OBJECTIVE
  To present a comprehensive account and literature review addressing the anatomical distribution, natural history, and management strategies for locoregional recurrence in early-stage gastric cancer (EGC).
  
  
  METHODS
  Retrospective chart review of patients presenting with EGC recurrence at King Hussein Cancer Center (Amman, Jordan) between July 2006 and May 2009. A literature review of publications addressing recurrence following surgery for EGC was undertaken via a systematic search of PUBMED database and National Comprehensive Cancer Network (NCCN) guideline updates.
  
  
  RESULTS
  Seventeen patients presented with EGC, three of whom (17.6%) were pathologically staged as T2N1 [1/33 lymph nodes (LNs)], T1N0, and T1N0 were afflicted by recurrence following R0 partial gastrectomy. Literature review yielded 18 studies specifically addressing recurrence in EGC. Several management strategies have been proposed for isolated recurrence following gastrectomy in EGC. NCCN clinical practice guideline updates do not take into consideration whether the recurrence is isolated or widespread and whether the initial stage is early or advanced.
  
  
  CONCLUSIONS
  While acknowledging the limitations of this study, including the small sample size and the short follow-up period, it appears clear that oncologic treatment is possible for EGC recurrence, particularly, in patients with isolated relapse. Guideline updates should differentiate between management strategies suitable for recurrence occurring in early versus advanced initial cancer stage.
authors.affiliation: Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.forename: Sameh
authors.initials: S
authors.lastname: Hashem
authors.forename: Layth Y I
authors.initials: LY
authors.lastname: Mula-Hussain
authors.forename: Issa
authors.initials: I
authors.lastname: Mohammed
authors.forename: Ala'a
authors.initials: A
authors.lastname: Nour
authors.forename: Wael
authors.initials: W
authors.lastname: Shelpai
authors.forename: Faiez
authors.initials: F
authors.lastname: Daoud
authors.forename: Basem
authors.initials: B
authors.lastname: Morcos
authors.forename: Yasser
authors.initials: Y
authors.lastname: Yamin
authors.forename: Imad
authors.initials: I
authors.lastname: Jaradat
authors.forename: Jamal
authors.initials: J
authors.lastname: Khader
authors.forename: Abdelatief
authors.initials: A
authors.lastname: Almousa
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*