Clinical trials have convincingly confirmed effectiveness of the multimodal approach in the treatment of malignant tumors of the stomach. Radical surgical treatment with endoscopic and laparoscopic techniques is performed at the initial stages of cancer. In patients with locally advanced and metastatic tumors, perioperative chemotherapy and molecular targeted therapy are additionally applied. The specialists of German cancer clinics combine classic and innovative treatment methods, offering each patient an individual approach that takes into account his personal advantages and risks.
Radical and cytoreductive surgery
Surgery is considered the only radical technique for the treatment of local and locally advanced gastric cancer. According to current recommendations of the reputable European Society of Gastrointestinal Endoscopy (ESGE), the endoscopic submucosal dissection and mucosal resection provide total removal of malignant cells in 90-98% of cases. At the same time, the endoscopic interventions have an extremely low risk of complications, for example, the risk of gastric perforation does not exceed 1%.
More extensive resection of the stomach in Germany is performed if the tumor affects the deep layers of the stomach, as well as if the process extends to the pancreas and transverse colon. If possible, the experts prefer pylorus-preserving and proximal endoscopic resection, in which the digestive function of the stomach is preserved. This facilitates the postoperative period and significantly improves patients’ quality of life.
As a rule, a total gastrectomy is combined with D1 (limited) or D2 (radical) dissection of lymph nodes. The results of the research of German Gastric Cancer Study Group have showed that D2 dissection provides more favorable long-term treatment outcomes.
Conformal radiation therapy on the innovative equipment
Radiation therapy is applied as the part of combined stomach cancer treatment in Germany. The German cancer clinics offer three modalities of exposure, such as:
- Preoperative irradiation reduces size of the tumor and its blood supply. This facilitates surgical removal of the neoplasm.
- Postoperative irradiation, including chemoradiotherapy, serves for the prevention of the disease recurrence. Radiation therapy in combination with prescription of 5-fluorouracil inhibits growth and reproduction of atypical cells, which may remain in the patient's body after surgery.
- Palliative irradiation helps to relieve such symptoms of stomach cancer as pain, eating discomfort, and stomach haemorrhages.
Depending on the general condition of a patient and the success of previously performed therapy, a doctor may recommend conventional external beam radiation therapy, 3D conformal radiation therapy or intensity-modulated radiation therapy.
Systemic therapy is the gold standard in advanced cancer
Systemic therapy slows progression of cancer process in patients with advanced gastric cancer. As a rule, systemic therapy is carried out in courses and includes intravenous injections or drugs for oral administration. Current clinical trials are aimed at the elaboration of drugs with high selectivity and minimal side effects.
Chemotherapy in stomach cancer is used as an independent therapeutic technique, as well as in combination with surgical treatment and radiation therapy. ECF (epirubicin, cisplatin and fluorouracil) and EOX (epirubicin, oxaliplatin and capecitabine) are the most effective chemotherapy protocols in Germany.
Targeted therapy is more selective than the standard chemotherapy, which has the same effect on cancer and healthy cells. The drugs of this group are most effective in the treatment of patients with HER2-positive tumors. Trastuzumab (Herceptin) has already received approval for use in clinical practice. Lapatinib and Pertuzumab are at the stage of clinical trials.
Immunotherapy boosts the antitumor immunity of the patient, helping him to detect and destroy malignant cells. The first immunotherapeutic drug which received FDA approval was pembrolizumab (Keytruda). Pembrolizumab is the immune checkpoint inhibitor, which affects PD-L1 protein located on the membrane of stomach cancer cells.
Top cancer hospitals in Germany
Selection of the hospital and attending physician is an important issue for every patient, who plans to undergo treatment of stomach cancer in Germany. According to current statistics, the leaders in the list of top cancer hospitals in Germany are:
- University Hospital Frankfurt am Main
- University Hospital Heidelberg
- University Hospital Würzburg
- University Hospital Bonn
- University Hospital Hamburg-Eppendorf
In addition to the information about specialization of the hospital, number of operations performed and effectiveness of conservative treatment, it is also worth taking into account level of technical equipment and opportunity to participate in clinical trials.
Comfortable treatment in Germany with the Booking Health company
Organization of treatment of gastric cancer abroad is a painstaking and responsible task that influences the final treatment result. The certified medical tourism operator Booking Health helps patients from 75 countries at all stages of this process.
The Booking Health company provides the following services:
- Selection of the right hospital based on the annual qualification profile
- Establishment of direct communication with your attending physician
- Preparation of a medical program in advance, without repeating previous examinations
- Provision of favorable costs for a treatment in the hospital, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Booking the appointment with a doctor on the necessary date
- Monitoring of the medical program at all its stages
- Assistance in buying and forwarding of medicines
- Communication with the hospital after treatment completion
- Control of invoices and return of unspent funds
- Organization of additional examinations
- Top-class service: booking hotels and plane tickets, transfer organization
Please, describe the medical problem in the "Send request" form on the Booking Health website, and the appropriate specialist will contact you within 24 hours.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova