• Gastric cancer
• Human epidermal growth factor receptor 2
• Review
• Targeted therapy

Tumors of the upper gastrointestinal tract are increasing in incidence; yet, approaches to the treatment of advanced gastric and/or gastroesophageal junction cancer vary widely, with no internationally agreed first‐line regimens. Recent clinical trials have shown that second‐line treatment is now possible for selected patients with advanced disease, and current data suggest that the combination of ramucirumab plus paclitaxel may become a standard of care in the second‐line setting for metastatic gastric cancer. Several prognostic factors have been identified for overall survival in the second‐line setting; this emphasizes the need for careful sequencing of all treatments to ensure that individual patients receive optimum care. This article reviews published data on the treatment of advanced gastric cancer, with a particular emphasis on second‐line chemotherapy, and suggests treatment sequences based on current understanding.

• Adenocarcinoma
• gastric cancer
• paclitaxel
• ramucirumab
• treatment

• Cancer
• Gastric
• Gastro-oesophageal junction
• Health state utility values
• Oesophageal

• Adenocarcinoma/psychology
• Esophageal Neoplasms/psychology
• Gastrointestinal Neoplasms/psychology
• Health Status
• Humans
• Neoplasm Staging
• Quality of Life
• Reproducibility of Results
• Stomach Neoplasms/psychology

Gastric cancer, one of the most common cancers in the world, rarely metastasizes to the ovaries. Ovarian metastases of gastric signet ring cell cancer (SRCC) are referred to as Krukenberg tumors and account for 1–2% of all ovarian cancers. Here, we analyze the characteristics, treatment, and prognosis of patients with Krukenberg tumors.

We retrospectively analyzed the demographic characteristics, treatment modalities, progression-free survival (PFS), and overall survival (OS) of patients who were diagnosed with Krukenberg tumors of gastric cancer origin and who underwent treatment and follow-up between January 2005 and January 2012 in the Ankara Oncology Education and Research Hospital.

Among 1755 patients diagnosed with gastric cancer between January 2005 and January 2012, eight patients (0.45%) with histopathologically identified Krukenberg tumors were enrolled. The median age of the eight patients was 42.2 years (range, 32–69 years). Two (25%) of the patients were stage 3A, two (25%) were stage 3C, and four (50%) were stage 4 at the time of diagnosis. The median PFS was 13.2 months (1–25 months), the median OS after the original diagnosis was 16.7 months (1–41 months), and the median OS after ovarian metastasis was 3.6 months (1–10 months).

Krukenberg tumors were seen particularly in young patients and more frequently during the premenopausal period. The prognosis was poor. When only the ovaries were affected, metastasectomy prolonged the survival time.

• Krukenberg tumor
• gastric cancer
• metastasectomy
• ovary