P-0039 - Variations in practice - a need for regular institutional reviews and participation in clinical trials
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Bioethics, Legal, and Economic Issues
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
P. McLaughlin1, A. Mahmud2
There is a lack of consensus in the management of gastric cancer given varying treatment approaches reported by the Intergroup 0116 trial (IG) and the MAGIC trial (MT). In order to review the real life patterns of practice at a Canadian cancer centre and to assess our ability to participate in the new TROG 08.08 (TOPGEAR) trial, a chart review was planned. Our purpose was to evaluate the presentation, natural history and patterns of management for gastric cancer.
After institutional ethics approval, 120 cases of gastric malignancy managed at the Cancer Centre of Southeastern Ontario were identified from our database diagnosed between January 2008 and December 2012. A chart review was conducted for 108, with the rest of the cohort excluded due to histology other than an adenocarcinoma.
Median age was 70.5 years (range 34-96) and 70% were male. Most common presentations were anemia, melena, dysphagia, pain and dyspepsia. 55% patients presented with localized disease, 75% of which underwent curative surgery. 15% had total gastrectomy whereas the rest had sub-total or partial gastrectomies. Two underwent endoscopic mucosal resection. Of all the patients who underwent curative treatment, one patient had Tis, 5 had 1A and the rest had 1B to IIIC stage disease. The MT protocol was attempted in 11 and the IG protocol attempted in 8 patients. Patients on IG received a dose of 4500 cGy in 25 fractions over 5 weeks with concomitant chemotherapy. Patient's refusal or the presence of significant co-morbidities were the main reasons for not undergoing curative treatment. The median survival for patients with localized disease who underwent surgery was 26 months compared to 8.5 months (range 5.5-14) for the patients who did not have surgery. Patients presenting with metastatic disease had a median survival of 4.5 months where palliative radiotherapy, chemotherapy and supportive care were the mainstays of treatment.
Our review shows a significant variation in patterns of practice in the management of gastric adenocarcinoma in a single Canadian cancer centre. The additional issues of a timely referral, physician's experience in managing less common malignancies and a need for institutional policies for radiotherapy, chemotherapy and surgery need addressing. In this era of financial constraints, there are limitations in terms of participating in clinical trials. However, participation in trials such as the new TROG 08.08 trial may help in clarifying the role of radiotherapy in the treatment of gastric cancer and may also provide an opportunity to standardize the technical details of the management approaches at an institution.