Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 28, 2008; 14(24): 3773-3780
Published online Jun 28, 2008. doi: 10.3748/wjg.14.3773
Multidisciplinary management of gastric and gastroesophageal cancers
Markus Moehler, Orestis Lyros, Ines Gockel, Peter R Galle, Hauke Lang
Markus Moehler, Peter R Galle, First Department of Internal Medicine of Johannes Gutenberg University of Mainz, Mainz 55101, Germany
Orestis Lyros, Ines Gockel, Hauke Lang, Institute of Surgery of Johannes Gutenberg University of Mainz, Mainz 55101, Germany
Author contributions: Moehler M and Lyros O collected the data and wrote the paper; Galle PR, Gockel I and Lang H supervised and commented this work.
Correspondence to: Dr. Markus Moehler, First Department of Internal Medicine, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, Mainz 55101, Germany. moehler@mail.uni-mainz.de
Telephone: +49-6131-177134
Fax: +49-6131-576621
Received: April 8, 2008
Revised: May 19, 2008
Accepted: May 26, 2008
Published online: June 28, 2008

Carcinomas of the stomach and gastroesophageal junction are among the five top leading cancer types worldwide. In spite of radical surgical R0 resections being the basis of cure of gastric cancer, surgery alone provides long-term survival in only 30% of patients with advanced International Union Against Cancer (UICC) stages in Western countries because of the high risk of recurrence and metachronous metastases. However, recent large phase-III studies improved the diagnostic and therapeutic options in gastric cancers, indicating a more multidisciplinary management of the disease. Multimodal strategies combining different neoadjuvant and/or adjuvant protocols have clearly improved the gastric cancer prognosis when combined with surgery with curative intention. In particular, the perioperative (neoadjuvant, adjuvant) chemotherapy is now a well-established new standard of care for advanced tumors. Adjuvant therapy alone should be carefully discussed after surgical resection, mainly in individual patients with large lymph node positive tumors when neoadjuvant therapy could not be done. The palliative treatment options have also been remarkably improved with new chemotherapeutic agents and will further be enhanced with targeted therapies such as different monoclonal antibodies. This article reviews the most relevant literature on the multidisciplinary management of gastric and gastroesophageal cancer, and discusses future strategies to improve locoregional failures.

Keywords: Gastric cancer, Chemotherapy, Chemoradiation, Adjuvant, Neoadjuvant