Therapeutic strategies and prognostic challenges in linitis plastica

Abstract

Gastric cancer ranks fifth as the most common cancer and third as the leading cause of death worldwide. Risk factors include advancing age, low-fiber diets, high salt intake and Helicobacter pylori infection. Diagnosis relies on histological examination following endoscopic biopsy with staging accomplished through various imaging modalities. Early gastric cancer is primarily managed via endoscopic resection, while non-early operable cases typically undergo surgery. Advanced cases are addressed through sequential chemotherapy lines, with initial treatment usually comprising a platinum and fluoropyrimidine combination. Linitis plastica (LP) is a rare, aggressive form of gastric cancer characterized by diffuse infiltration of the gastric wall, resulting in poor outcomes even after curative resection. The absence of a standardized definition contributes to uncertainty regarding the precise incidence of these tumors. LP is often diagnosed at advanced stages, with a reported median survival rate of approximately 4%-29%, despite “curative resection”. Its distinctive biological behavior includes perineural invasion, nodal metastasis, and peritoneal dissemination. The bleak prognosis for LP patients partly stems from delayed diagnosis and its aggressive biological nature, posing significant challenges for clinical management. Currently, no specialized treatment strategy exists for LP, and clinical approaches typically align with those used for general gastric cancer treatment. Surgical resection is the primary treatment, but the optimal surgical approach remains contentious. Recent studies have investigated the efficacy of neoadjuvant chemotherapy and radiotherapy in improving survival outcomes for LP patients. However, controversies persist regarding the role of adjuvant chemotherapy and postoperative radiotherapy. LP requires a multidisciplinary approach and personalized treatment strategies tailored to each patient’s condition. Further research is needed to elucidate optimal therapeutic interventions and improve outcomes for LP patients.

Keywords: Linitis plastica; Surgery; Chemotherapy; Radiotherapy; Treatment strategies; Gastric cancer

Core Tip: Linitis plastica (LP) gastric cancer poses a significant challenge due to its aggressive nature and poor prognosis. Early detection and personalized treatment strategies are essential for improving outcomes in LP patients. While surgery remains the mainstay of treatment, the role of adjuvant chemotherapy and postoperative radiotherapy is still under debate. Neoadjuvant chemotherapy, particularly with regimens such as docetaxel plus oxaliplatin and S-1, shows promise in enhancing survival rates for LP patients. Multidisciplinary collaboration and further research are necessary to optimize therapeutic interventions and improve outcomes in this challenging subset of gastric cancer.