Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11586
Revised: March 10, 2014
Accepted: May 28, 2014
Published online: September 7, 2014
Gastric cancer is one of the most frequently diagnosed cancers worldwide. Although the rate of gastric cancer has declined dramatically over the past decades in most developed Western countries, it has not declined in East Asia. Currently, a radical gastrectomy is still the only curative treatment for gastric cancer. Over the last twenty years, however, surgery alone has been replaced by a multimodal perioperative approach. To achieve the maximum benefit from the perioperative treatment, a thorough evaluation of the tumor must first be performed. A complete assessment of gastric cancer is divided into two parts: staging and histology. According to the stage and histology of the cancer, perioperative chemotherapy or radiochemotherapy can be implemented, and perioperative targeted therapies such as trastuzumab may also play a role in this field. However, perioperative treatment approaches have not been widely accepted until a series of clinical trials were performed to evaluate the value of perioperative treatment. Although multimodal perioperative treatment has been widely applied in clinical practice, personalization of perioperative treatment represents the next stage in the treatment of gastric cancer. Genomic-guided treatment and efficacy prediction using molecular biomarkers in perioperative treatment are of great importance in the evolution of treatment and may become an ideal treatment method.
Core tip: Multimodal perioperative treatment of advanced gastric cancer is playing an increasingly important role in patient treatment. Different strategies, including preoperative and postoperative chemotherapy and radiochemotherapy, are implemented in clinical practice and a new concept of perioperative-targeted therapy is emerging. Although many randomized clinical trials have been performed to determine the effectiveness of these therapies over surgery alone, little evidence exists regarding the comparison of the different therapies. Personalized treatment should be based on the results of randomized clinical trials as well as subgroup analyses, tailored by histology, demography, and predictors, including tumor markers and genomic profiling.