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Рак желудка
Рак желудка
Бесова Н.С., Калинин А.Е., Неред С.Н., Трякин А.А., Гамаюнов С.В., Козлов Н.А., Стилиди И.С., Карачун А.М., Кононец П.В., Малихова О.А., Рябов А.Б., Хомяков В.М., Феденко А.А., Болотина Л.В., Фалалеева Н.А., Невольских А.А., Иванов С.А., Хайлова Ж.В., Геворкян Т.Г., Бутенко А.В., Гильмутдинова И.Р., Еремушкин М.А., Иванова Г.Е., Кондратьева К.О., Кончугова Т.В., Крутов А.А., Обухова О.А., Семиглазова Т.Ю., Филоненко Е.В., Хуламханова М.М., Романов А.И. Рак желудка. Клинические рекомендации. Современная Онкология. 2021;23(4):541–571. DOI: 10.26442/18151434.2021.4.20123
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Аннотация
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.
Ключевые слова: рак желудка, клинические рекомендации
Keywords: gastric cancer, clinical guidelines
Ключевые слова: рак желудка, клинические рекомендации
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Keywords: gastric cancer, clinical guidelines
Полный текст
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Авторы
Н.С. Бесова1, А.Е. Калинин1, С.Н. Неред1,2, А.А. Трякин1, С.В. Гамаюнов3, Н.А. Козлов1, И.С. Стилиди1,2,7, А.М. Карачун4, П.В. Кононец1, О.А. Малихова1,2, А.Б. Рябов5, В.М. Хомяков5, А.А. Феденко5, Л.В. Болотина5, Н.А. Фалалеева3,
А.А. Невольских3, С.А. Иванов3, Ж.В. Хайлова3, Т.Г. Геворкян1, А.В. Бутенко1, И.Р. Гильмутдинова6, М.А. Еремушкин6, Г.Е. Иванова7, К.О. Кондратьева4, Т.В. Кончугова6, А.А. Крутов4, О.А. Обухова1, Т.Ю. Семиглазова4,8, Е.В. Филоненко5,
М.М. Хуламханова1, А.И. Романов9
1 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Обнинск, Россия;
4 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России, Санкт-Петербург, Россия;
5 Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Москва, Россия;
6 ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава России, Москва, Россия;
7 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
8 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
9 ФГБУ «Центр реабилитации» Управления делами Президента РФ, поселок санатория им. Герцена, Россия
Tatiana Iu. Semiglazova4,8, Elena V. Filonenko5, Marina M. Khulamkhanova1, Aleksandr I. Romanov9
1 Blokhin National Medical Research Center of Oncology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
3 Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology, Obninsk, Russia;
4 Petrov National Medical Research Center of Oncology, Saint Petersburg, Russia;
5 Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology, Moscow, Russia;
6 National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia;
7 Pirogov Russian National Research Medical University, Moscow, Russia;
8 Mechnikov North-Western State Medical University, Saint Petersburg, Russia;
9 Rehabilitation Center of the President of the Russian Federation, Herzen sanatorium village, Russia
А.А. Невольских3, С.А. Иванов3, Ж.В. Хайлова3, Т.Г. Геворкян1, А.В. Бутенко1, И.Р. Гильмутдинова6, М.А. Еремушкин6, Г.Е. Иванова7, К.О. Кондратьева4, Т.В. Кончугова6, А.А. Крутов4, О.А. Обухова1, Т.Ю. Семиглазова4,8, Е.В. Филоненко5,
М.М. Хуламханова1, А.И. Романов9
1 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Обнинск, Россия;
4 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России, Санкт-Петербург, Россия;
5 Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Москва, Россия;
6 ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава России, Москва, Россия;
7 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
8 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия;
9 ФГБУ «Центр реабилитации» Управления делами Президента РФ, поселок санатория им. Герцена, Россия
________________________________________________
Tatiana Iu. Semiglazova4,8, Elena V. Filonenko5, Marina M. Khulamkhanova1, Aleksandr I. Romanov9
1 Blokhin National Medical Research Center of Oncology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
3 Tsyb Medical Radiological Scientific Center – branch of the National Medical Research Center for Radiology, Obninsk, Russia;
4 Petrov National Medical Research Center of Oncology, Saint Petersburg, Russia;
5 Herzen Moscow Scientific Research Institute of Oncology – branch of the National Medical Research Center for Radiology, Moscow, Russia;
6 National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia;
7 Pirogov Russian National Research Medical University, Moscow, Russia;
8 Mechnikov North-Western State Medical University, Saint Petersburg, Russia;
9 Rehabilitation Center of the President of the Russian Federation, Herzen sanatorium village, Russia
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