Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 7954-7969
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.7954
Multimodal treatment of gastric cancer in the west: Where are we going?
Daniele Marrelli, Karol Polom, Giovanni de Manzoni, Paolo Morgagni, Gian Luca Baiocchi, Franco Roviello
Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
Giovanni de Manzoni, Department of Surgery, University of Verona, 37134 Verona, Italy
Paolo Morgagni, Depertment of Surgery, “Morgani-Pierantoni” Hospital, 47100 Forlì, Italy
Gian Luca Baiocchi, Surgical Clinic, University of Brescia, 25100 Brescia, Italy
Author contributions: Marrelli D and Polom K contributed equally to this manuscript; Marrelli D and Roviello F were responsible for study conception and design; Marrelli D and Polom K wrote the paper; Marrelli D and Polom K analyzed the data; de Manzoni G, Morgagni P and Baiocchi GL carried out the research; de Manzoni G, Morgagni P, Baiocchi GL and Roviello F performed critical revision of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniele Marrelli, MD, Associate Professor, Department of Medicine, Surgery and Neurosciences, University of Siena, 55 Via Banchi di Sotto, 53100 Siena, Italy. daniele.marrelli@unisi.it
Telephone: +39-577-585882 Fax: +39-577-233337
Received: January 28, 2015
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.

Keywords: Epidemiology, Hyperthermic intraperitoneal chemotherapy, Chemotherapy, Radiotherapy, Gastric cancer, Targeted therapy

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.