Journal of Modern OncologyJournal of Modern OncologyСовременная онкология1815-14341815-1442LLC Obyedinennaya Redaktsiya9997010.26442/18151434.2021.4.201239CLINICAL ONCOLOGYКЛИНИЧЕСКАЯ ОНКОЛОГИЯResearch ArticleGastric cancer: Russian clinical guidelinesРак желудкаBesovaNataliia S.БесоваНаталия Сергеевна
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, ст. науч. сотр. онкологического отд-ния лекарственной терапии (химиотерапевтического) №1

editor@consiliummedicum.ruKalininAleksei E.КалининАлексей Евгеньевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, ст. науч. сотр. хирургического отд-ния №6 торакоабдоминального отд.

editor@consiliummedicum.ruNeredSergei N.НередСергей Николаевич
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, вед. науч. сотр. хирургического отд-ния №6 торакоабдоминального отд.; проф. каф. онкологии и паллиативной медицины им. акад. А.И. Савицкого

editor@consiliummedicum.ruTriakinAleksei A.ТрякинАлексей Александрович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, гл. науч. сотр. онкологического отд-ния лекарственной терапии (химиотерапевтического) №2

editor@consiliummedicum.ruGamaiunovSergei V.ГамаюновСергей Викторович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, зав. отд-нием лучевого и хирургического лечения заболеваний торакальной области

editor@consiliummedicum.ruKozlovNikolai A.КозловНиколай Александрович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, врач отд-ния патологоанатомического отд. морфологической и молекулярно-генетической диагностики опухолей

editor@consiliummedicum.ruhttps://orcid.org/0000-0002-0493-1166StilidiIvan S.СтилидиИван Сократович
Russian Federation

D. Sci. (Med.), Prof., Corr. Memb. RAS;

чл.-кор. РАН, д-р мед. наук, дир.; зав. каф. онкологии и лучевой терапии лечебного фак-та; проф. каф. онкологии и паллиативной медицины им. акад. А.И. Савицкого

editor@consiliummedicum.ruKarachunAleksei M.КарачунАлексей Михайлович
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., зав. хирургическим отд-нием абдоминальной онкологии

editor@consiliummedicum.ruKononetsPavel V.КононецПавел Вячеславович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, зам. дир. по научной и лечебной работе, дир.

editor@consiliummedicum.ruhttps://orcid.org/0000-0003-2245-214XMalikhovaOlga A.МалиховаОльга Александровна
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, зав. эндоскопическим отд-нием; проф. каф. онкологии и паллиативной медицины им. акад. А.И. Савицкого

editor@consiliummedicum.ruRiabovAndrei B.РябовАндрей Борисович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, рук. отд. торакоабдоминальной онкохирургии

editor@consiliummedicum.ruKhomiakovVladimir M.ХомяковВладимир Михайлович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, рук. торакоабдоминального отд-ния

editor@consiliummedicum.ruFedenkoAleksandr A.ФеденкоАлександр Александрович
Russian Federation

Department Head

зав. отд. лекарственного лечения опухолей

editor@consiliummedicum.ruhttps://orcid.org/0000-0003-4879-2687BolotinaLarisa V.БолотинаЛариса Владимировна
Russian Federation

Department Head

зав. отд-нием химиотерапии отд. лекарственного лечения опухолей

editor@consiliummedicum.ruhttps://orcid.org/0000-0002-0023-4216FalaleevaNatalia A.ФалалееваНаталья Александровна
Russian Federation

Department Head

зав. отд. лекарственного лечения злокачественных новообразований

editor@consiliummedicum.ruNevol'skikhAleksei A.НевольскихАлексей Алексеевич
Russian Federation

D. Sci. (Med.)

д-р мед. наук, зам. дир. по лечебной работе

editor@consiliummedicum.ruhttps://orcid.org/0000-0001-7689-6032IvanovSergei A.ИвановСергей Анатольевич
Russian Federation

D. Sci. (Med.), Prof. RAS

проф. РАН, д-р мед. наук, дир.

editor@consiliummedicum.ruKhailovaZhanna V.ХайловаЖанна Владимировна
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, зам. дир. по организационно-методической работе

editor@consiliummedicum.ruGevorkianTigran G.ГеворкянТигран Гагикович
Russian Federation

Deputy Director

зам. дир.; гл. специалист-онколог Московской области

editor@consiliummedicum.ruButenkoAleksei V.БутенкоАлексей Владимирович
Russian Federation

D. Sci. (Med.)

д-р мед. наук, проф., глав. врач, председатель национального союза «Ассоциация специалистов по онкологической реабилитации»

editor@consiliummedicum.ruGil'mutdinovaIlmira R.ГильмутдиноваИльмира Ринатовна
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, врач-трансфузиолог, дерматовенеролог, зав. отд. биомедицинских технологий и лаборатории клеточных технологий, специалист в области клеточных технологий

editor@consiliummedicum.ruEremushkinMikhail A.ЕремушкинМихаил Анатольевич
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., зав. отд-нием ЛФК и клинической биомеханики

editor@consiliummedicum.ruIvanovaGalina E.ИвановаГалина Евгеньевна
Russian Federation

D. Sci. (Med.)

д-р мед. наук, зав. отд. медико-социальной реабилитации инсульта; гл. специалист по медицинской реабилитации Минздрава России

editor@consiliummedicum.ruKondrat'evaKristina O.КондратьеваКристина Орхановна
Russian Federation

medical psychologist

мед. психолог

editor@consiliummedicum.ruKonchugovaTatiana V.КончуговаТатьяна Венедиктовна
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., врач-физиотерапевт, зав. отд. преформированных физических факторов

editor@consiliummedicum.ruKrutovAnton A.КрутовАнтон Андреевич
Russian Federation

oncologist

врач-онколог клинико-диагностического отд-ния

editor@consiliummedicum.ruObukhovaOlga A.ОбуховаОльга Аркадьевна
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, врач-физиотерапевт, зав. отд-нием медицинской реабилитации, член Европейской ассоциации парентерального и энтерального питания (ESPEN), член Российской ассоциации парентерального и энтерального питания (RESPEN)

editor@consiliummedicum.ruSemiglazovaTatiana Iu.СемиглазоваТатьяна Юрьевна
Russian Federation

D. Sci. (Med.)

д-р мед. наук, зав. отд. и вед. науч. сотр. науч. отд. инновационных методов терапевтической онкологии и реабилитации; доц. каф. онкологии

editor@consiliummedicum.ruFilonenkoElena V.ФилоненкоЕлена Вячеславовна
Russian Federation

D. Sci. (Med.), Prof.

д-р мед. наук, проф., врач-онколог, зав.

editor@consiliummedicum.ruKhulamkhanovaMarina M.ХуламхановаМарина Муратовна
Russian Federation

physiotherapist, oncologist

врач-физиотерапевт, врач-онколог отд-ния медицинской реабилитации

editor@consiliummedicum.ruRomanovAleksandr I.РомановАлександр Иванович
Russian Federation

D. Sci. (Med.), Prof., Acad. RAS

кад. РАН, д-р мед. наук, проф., глав. врач

editor@consiliummedicum.ruBlokhin National Medical Research Center of OncologyФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииRussian Medical Academy of Continuous Professional EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииTsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for RadiologyМедицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииPirogov Russian National Research Medical UniversityФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииPetrov National Medical Research Center of OncologyФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава РоссииHerzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for RadiologyМосковский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииNational Medical Research Center of Rehabilitation and BalneologyФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава РоссииMechnikov North-Western State Medical UniversityФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииRehabilitation Center of the President of the Russian FederationФГБУ «Центр реабилитации» Управления делами Президента РФ151220212345415713101202231012022Copyright ©; 2021, Consilium MedicumCopyright ©; 2021, ООО "Консилиум Медикум"2021Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc/4.0https://modernonco.orscience.ru/1815-1434/article/view/99970

Gastric cancer remains one of the most common malignancies in Russia. Despite steady decrease of gastric cancer incidence it still reaches 24.65 per 100 000 population (crude rate) in 2019 with about 36 000 new cases annually. More than 29 000 people die of gastric cancer every year. High mortality rate is mostly caused by an extremely significant proportion of patients with metastatic disease which reached 40.1% in 2019. The majority of cases is related to Helicobacter pylori infection, salty diet, tobacco exposure as well as hereditary syndromes. Staging of locally advanced gastric cancer includes contrast-enhanced computed tomography of the thorax, abdomen and pelvis as well as diagnostic laparoscopy with peritoneal washings. In patients with inoperable or disseminated cancer of the stomach additional analysis for HER2, microsatellite instability and PD-L1 status is recommended. Endoscopic or laparoscopic resection remains the mainstay of treatment in patients with early cancer. Laparoscopic gastrectomy in patients with locally advanced cancer is reserved for high-volume centers with extensive experience with the procedure. Recently, perioperative cytotoxic therapy became the standard of treatment in patients with locally advanced gastric cancer. FLOT regimen is recommended while FOLFOX6 or XELOX are considered possible in the elderly or frail patients. Drug therapy includes standard doublet or triplet chemotherapy regimens for metastatic disease with trastuzumab for HER2(+++) patients. Patients with MSI-H tumors can be treated with pembrolizumab starting with 2nd line while nivolumab is reserved for the 3rd and further lines regardless of PD-L1 status. Importantly, this year guidelines include multimodal prehabilitation including physical exercise, nutritional support and psychological counselling as a possibility in all patients in need of surgery. Also standardized enhanced recovery protocols are recommended for usage during the perioperative period.

Рак желудка (РЖ) находится в числе наиболее распространенных видов злокачественных опухолей в России. Несмотря на постепенное снижение заболеваемости, в 2019 г. показатель грубой заболеваемости равен 24,65 на 100 тыс. человек, что в абсолютных цифрах составляет около 36 тыс. заболевших ежегодно. Более 29 тыс. пациентов ежегодно погибают от РЖ. Высокий показатель летальности обусловлен прежде всего частым выявлением метастатических форм заболевания – 40,1% в 2019 г. Среди важнейших причин развития РЖ выделяют инфекцию Helicobacter pylori, диету с высоким содержанием соли, курение, наследственные синдромы. Стадирование при местно-распространенном раке основано на сочетании компьютерной томографии грудной клетки, брюшной полости и малого таза с внутривенным контрастированием и диагностической лапароскопии с перитонеальными смывами. У пациентов с неоперабельными или диссеминированными формами РЖ дополнительно рекомендуются проведение анализа на HER2-статус, определение уровня микросателлитной нестабильности и экспрессии PD-L1 в опухоли. При раннем РЖ основной вариант лечения – эндоскопическая или лапароскопическая резекция. При местно-распространенных формах лапароскопические вмешательства могут применяться лишь в высокопоточных центрах специалистами с большим опытом их проведения. В последние годы стандартом лечения таких пациентов является периоперационная химиотерапия. Рекомендуется применение режима FLOT, у пожилых и ослабленных пациентов возможно использование схем FOLFOX6 и XELOX. Лекарственная терапия при метастатическом раке основана на использовании двойных или тройных комбинаций с добавлением трастузумаба при статусе HER2(+++). При наличии в опухоли микросателлитной нестабильности (MSI-H) возможно использование пембролизумаба, начиная со 2-й линии терапии. Начиная с 3-й линии и далее возможно применение ниволумаба вне зависимости от экспрессии PD-L1. Серьезным дополнением к руководству этого года является упоминание о важности мультимодальной предреабилитации (сочетание лечебной физкультуры, нутриционной и психологической поддержки) при подготовке к хирургическому этапу лечения. Также рекомендуется в периоперационном периоде опираться на стандартизованные протоколы ускоренного выздоровления.

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