Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3850
Peer-review started: December 9, 2014
First decision: January 8, 2015
Revised: January 27, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: April 7, 2015
Gastric cancer is one of the main cancer-related causes of death worldwide. The curative treatment of gastric cancer consists of tumor resection and lymphadenectomy. However, surgical treatment alone is associated with high recurrence rates. Adjuvant treatment strategies have been studied over the last decades, but there have been controversial results from the initial studies. The pivotal INT0116 study demonstrated that the use of adjuvant chemoradiotherapy with 5-fluorouracil increases relapse-free and overall survival, and it has been adopted across the Western world. The high toxicity of radiochemotherapy and suboptimal surgical treatment employed, with fewer than 10% of the patients submitted to D2 lymphadenectomy, were the main study limitations. Since its publication, other adjuvant treatment modalities have been studied, and radiochemotherapy is being refined to improve its efficacy and safety. A multimodal approach has been demonstrated to significantly increase relapse-free and overall survival, and it can be offered in the form of perioperative chemotherapy, adjuvant chemoradiotherapy or adjuvant chemotherapy, regardless of the extent of lymphadenectomy. The objective of the present review is to report the major advances obtained in the last decades in the adjuvant treatment of gastric cancer as well as the perspectives of treatment based on recent knowledge of the molecular biology of the disease.
Core tip: Adjuvant therapy of gastric cancer significantly improves overall survival. The most accepted adjuvant therapy in the Western world is chemoradiotherapy according to the pivotal INT0116 study. However, in the time following its publication, other adjuvant treatment modalities have been discussed, and significant improvements have been obtained in our understanding of the multimodal approach of gastric cancer. The present review reports on the major advances obtained in the last decades in the adjuvant treatment of gastric cancer as well as the perspectives of treatment based on recent knowledge of the molecular biology of the disease.