Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13718
Revised: July 6, 2014
Accepted: July 29, 2014
Published online: October 14, 2014
The management of gastric cancer continues to evolve. Whilst surgery alone is effective when tumours present early, a large proportion of patients are diagnosed with loco-regionally advanced disease, resulting in high loco-regional and distant relapse rates, with subsequent poor survival. Early attempts at improving outcomes following resection were disappointing; however, randomized trials have now established either post-operative chemoradiotherapy (INT0116) or peri-operative chemotherapy as standard adjuvant therapies in the Western world. There remain, however, significant differences in the approach to management between the West and East. In Asia, where there is the highest incidence of gastric cancer, extended resection followed by adjuvant chemotherapy represents the standard of care. This review discusses current standard adjuvant therapy in gastric adenocarcinoma, as well as recent and ongoing trials investigating novel (neo)adjuvant approaches, which hope to build on the successes of previous studies.
Core tip: Surgery remains the cornerstone of curative therapy in gastric cancer. However, a large proportion of patients are diagnosed with locally advanced disease, resulting in poor survival. Randomized trials have now established either post-operative chemoradiotherapy or perioperative chemotherapy as standard adjuvant therapies in the Western world. There remain, however, significant differences in the approach to management between the West and East. In Asia, extended resection followed by adjuvant chemotherapy represents the standard of care. This review discusses the evidence supporting current standard adjuvant therapy in gastric cancer, as well as recent and ongoing trials investigating novel (neo)adjuvant approaches.