ABSTRACT
Gastric cancer still remains a major health problem worldwide despite a decrease in incidence in the USA and Northwest Europe . Surgery resulting in a complete (R0) tumor resection with D2 lymphadenectomy, if feasible by tumor stage, is the standard approach. Adjuvant chemotherapy can significantly improve overall survival but there is still controversy on optimal regimen and timing of administration (neoadjuvant, perioperative, postoperative). Adjuvant radiotherapy is standard in the USA but its application is limited in Europe or Asia because of its toxicity. Most recently, trastuzumab for advanced HER2-positive gastric cancer has demonstrated substantial efficacy and tolerable toxicity improving overall survival when it is added to systemic chemotherapy. Despite these advances cure rates in advanced stages II and III remain low. Here it is described the effort to achieve the best possible multimodality treatment in individual patients and the future perspectives based on latest advances in cancer genome sequencing, epigenetics, transcriptome and miRNA research towards development of novel agents and markers.

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