Gastric Cancer Treatment in Istanbul
Gastric (stomach) cancer is treated with a multidisciplinary approach in Istanbul JCI-accredited centers. Treatment depends on stage, HER2 status, and PD-L1 expression.
Treatment by Stage
- Early stage (I-II): Gastrectomy (total or subtotal). D2 lymph node dissection. Laparoscopic or robotic approach
- Locally advanced (III): Perioperative chemotherapy (FLOT: fluorouracil+leucovorin+oxaliplatin+docetaxel) + surgery
- Metastatic (IV): Chemotherapy + targeted therapy. HER2+ (20%): trastuzumab+XELOX. PD-L1 CPS≥5: nivolumab+chemotherapy (CheckMate-649: OS improvement)
TRASTUZUMAB FOR HER2+
HER2-positive gastric cancer (20% of cases): trastuzumab+XELOX significantly improves OS in first-line metastatic setting (ToGA trial). Testing at diagnosis is essential.
Cost
Gastrectomy Istanbul: $12,000-22,000 vs $50,000-120,000 USA. FLOT chemotherapy cycle: $2,500-4,500 vs $8,000-18,000 USA.