Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.7954
Peer-review started: January 28, 2015
First decision: March 10, 2015
Revised: March 25, 2015
Accepted: May 2, 2015
Article in press: May 4, 2015
Published online: July 14, 2015
The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.
Core tip: In advanced gastric cancer (GC), multimodal treatment is currently an option in the west. Adequate surgery and extended lymphadenectomy, together with modern chemotherapy, radiotherapy, targeted therapies, and a combination of all could possibly improve survival in advanced GC. A tailored multimodal approach is strictly necessary in the light of treatment results and recent epidemiological trends, which indicate a relative increase of more aggressive forms, such as proximal location and diffuse Lauren histotype in the west. The main ongoing and completed clinical trials regarding multimodal approach to GC have been reviewed, and an original tailored multimodal protocol to non-cardia GC has been proposed.