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Tte recommended dose for palliative radiotherapy is

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TTe recommended dose for palliative radiotherapyis DT 30–40 Gy. As a note, the dosage and scope ofirradiation should be based on the patient’s generalcondition, the size of the irradiation ff eld, expectedlifespan, and possible irradiation damage to normaltissues and organs.• For patients who can tolerate chemotherapy, it hasbeen observed that, as compared with best sup-portive care, chemotherapy can prolong the survivalof metastatic gastric cancer patients [91]. As such,for patients presenting with severe gastrointestinalobstruction, hemorrhage, or obstructive jaundiceat ff rst diagnosis, it is suggested that nutrition tube,stent implantation, gastrointestinal bypass surgery,local palliative radiotherapy, acid inhibition, hemo-stasis, and analgesia should be prescribed, prefer-entially within the ff rst 2–4  weeks of presentation,as longer duration may result in tumor progression.Chemotherapy can be considered when the patient’general condition improves. If not, best supportivecare can be continued. TTe main chemotherapy drugregimen includes 5-ff uorouracil-based, platinum-based, taxanes-based, irinotecan regimen. Com-bined chemotherapy can result in a response rateof 30%–54% and a median OS of 8–13 months [91].Although combined chemotherapy is more effectivethan single-drug chemotherapy, 5-FU alone can stillbe considered for those patients who cannot toleratecombined chemotherapy [92].Radiotherapy can signiff cantly alleviate some clinicalsymptoms of late-stage gastric cancer patients, suchas hemorrhage, severe cancer pain, dysphagia, andobstruction and can improve the patients’ generalcondition and quality of life [93]. Palliative radiother-apy may be considered for those patients with oldage, advanced disease, decreased cardio-pulmonaryfunctions, multiple underlying diseases, and diffficultyto sustain surgical intervention.• TTree-dimensionalconformalradiotherapy(3D-CRT) and intensity-modulated radiotherapy (IMRT)are recommended as related studies have dem-onstrated that, compared with conventional two-dimensional radiotherapy, 3D-CRT or IMRT wasexcellent at targeting the dose distribution area and atprotecting normal organ tissue, especially in the gas-trointestinal tract, liver, and kidneys, against adverseevents from irradiation [94,95].3.2Treatment of metastatic gastric cancerFor the patients who cannot undergo radical resection orwith metastatic/recurrent disease, comprehensive treatmentbased on systemic antitumor therapy is recommended.Other therapeutics such as palliative surgery, radiotherapy,radiofrequency ablation, intraperitoneal perfusion, and arte-rial embolization may help to prolong survival and improvequality of life. TTerefore, we must emphasize that treat-ments for such patients should be discussed by an MDT toassess the optimal personalized treatment strategy.

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Term
Winter
Professor
N/A
Tags
Metastasis, gastric cancer, lymph node

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