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World J Gastroenterol. Feb 21, 2014; 20(7): 1635-1649
Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1635
Treatment of gastric cancer
Michele Orditura, Gennaro Galizia, Vincenzo Sforza, Valentina Gambardella, Alessio Fabozzi, Maria Maddalena Laterza, Francesca Andreozzi, Jole Ventriglia, Beatrice Savastano, Andrea Mabilia, Eva Lieto, Fortunato Ciardiello, Ferdinando De Vita
Michele Orditura, Vincenzo Sforza, Valentina Gambardella, Alessio Fabozzi, Maria Maddalena Laterza, Francesca Andreozzi, Jole Ventriglia, Beatrice Savastano, Fortunato Ciardiello, Ferdinando De Vita, Division of Medical Oncology, Dipartimento di Medicina, Clinica e Sperimentale ‘F. Magrassi-A. Lanzara’, Seconda Università degli Studi di Napoli, 80131 Naples, Italy
Gennaro Galizia, Andrea Mabilia, Eva Lieto, Divisione di Chirurgia Oncologia, Dipartimento di Scienze Anestesiologiche, Chirurgiche e delle Emergenze, Seconda Università degli Studi di Napoli, 80131 Naples, Italy
Author contributions: Orditura M, Galizia G, De Vita F and Ciardiello F designed and wrote the paper; Sforza V, Gambardella V, Fabozzi A, Laterza MM, Andreozzi F, Mabilia A, Ventriglia J, Lieto E and Savastano B performed bibliography, research and wrote the paper; Orditura M and Galizia G contributed equally.
Correspondence to: Michele Orditura, MD, PhD, Division of Medical Oncology, Dipartimento di Medicina, Clinica e Sperimentale ‘F. Magrassi-A. Lanzara’, Seconda Università degli Studi di Napoli, c/o II Policlinico, via S. Pansini 5, 80131 Naples, Italy. michele.orditura@unina2.it
Telephone: +39-815-666723  Fax: +39-815-666723-6732
Received: September 23, 2013
Revised: October 29, 2013
Accepted: November 12, 2013
Published online: February 21, 2014
Abstract

The authors focused on the current surgical treatment of resectable gastric cancer, and significance of peri- and post-operative chemo or chemoradiation. Gastric cancer is the 4th most commonly diagnosed cancer and the second leading cause of cancer death worldwide. Surgery remains the only curative therapy, while perioperative and adjuvant chemotherapy, as well as chemoradiation, can improve outcome of resectable gastric cancer with extended lymph node dissection. More than half of radically resected gastric cancer patients relapse locally or with distant metastases, or receive the diagnosis of gastric cancer when tumor is disseminated; therefore, median survival rarely exceeds 12 mo, and 5-years survival is less than 10%. Cisplatin and fluoropyrimidine-based chemotherapy, with addition of trastuzumab in human epidermal growth factor receptor 2 positive patients, is the widely used treatment in stage IV patients fit for chemotherapy. Recent evidence supports the use of second-line chemotherapy after progression in patients with good performance status

Keywords: Gastric cancer, Surgery, Radiotherapy, Adjuvant chemotherapy, Palliative chemotherapy, Chemoradiation

Core tip: Surgery remains the only curative therapy of localized gastric cancer, while perioperative and adjuvant chemotherapy, as well as chemoradiation, can improve outcome. Cisplatin and fluoropyrimidine-based chemotherapy, with addition of trastuzumab in human epidermal growth factor receptor 2 positive patients, is the widely used treatment in stage IV patients. Second-line chemotherapy after progression in patients with good performance status represents a good option.