Gastric & Breast Cancer
DOI: 10.2122/gbc.2005.0041

VIEWPOINT

Perioperative Adjuvant Treatment for Gastric Cancer: Options and Decisions

Michael Fatouros, MD, Theodore Liakakos, MD, Dimosthenis Ziogas, MD, Ioannis Arampatzis, MD, Evaggelos Briasoulis, MD, Pericles Tsekeris , MD, and Dimitrios H. Roukos, MD.

Although the very high locoregional recurrence rates reported with limited D0/D1 surgery can be reduced with extended D2 gastrectomy for operable gastric cancer, overall relapse and survival rates remain poor and can be improved only with adequate perioperative adjuvant treatment.

Despite intensive research however, no regimen has been established as standard. Meta-analyses have demonstrated a marginal survival benefit with adjuvant chemotherapy. Recently, the INT-0116 US trial provided evidence for better outcomes with postoperative adjuvant chemoradiation. But these findings are limited to patients with D0/D1 surgery and stage-specific survival rates and complication rates are better with appropriate D2 surgery.

Optimization of surgery and perioperative adjuvant chemotherapy and radiotherapy might improve clinical outcomes of patients with gastric cancer. Rapid research advances with gene expression profiling assays using microarrays or RT-PCR techniques will enable prediction of clinical outcomes and response to specific therapies. Translating this progress into individualized clinical practice will substantially benefit patients regarding both survival and quality of life.