Abstract
Gastric cancer (GC) is the fifth-most common cancer worldwide and an important cause of cancer-related-death. The growing knowledge of its molecular pathogenesis has shown that GC is not a single entity, but a constellation of different diseases, each with its own molecular and clinical characteristics. Currently, surgery represents the only curative approach for localized GC, but only 20% of patients (pts) showed resectable disease at diagnosis and, even in case of curative resection, the prognosis remains poor due to the high rate of disease relapse. In this context, multimodal perioperative approaches were developed in western and eastern countries in order to decrease relapse rates and improve survival. However, there is little consensus about the optimal treatment for non-metastatic GC. In this review, we summarize the current status and future developments of perioperative chemotherapy in resectable GC, attempting to find clear answers to the real problems in clinical practice.
Highlights
Gastric cancer (GC) represents the fifth-most common tumor and the third-leading cause of cancer-related death worldwide [1], showing similar trends in Europe [2]
The FNCLCC/FFCD ACCORD trial [8] evaluated the role of perioperative treatment with cisplatin plus 5-fluorouracil (CF: two or three preoperative cycles and three or four postoperative cycles) compared to surgery alone in 224 pts affected by resectable adenocarcinoma of the stomach (25%), esophagogastric junction (GEJ) (64%) and lower esophagus (11%)
The overall population included in these trials reached almost 1300 pts and included different tumor sites: MAGIC trial [7] mostly included GC (75%); the majority of FNCLCC-ACCORD [8] pts had a gastro-esophageal junction tumors (GEJ) cancer; CALGB [24] and CROSS [25,26] were mainly based on esophageal cancer and EORTC [23] included Siewert II/III adenocarcinoma (53% of cases)
Summary
Gastric cancer (GC) represents the fifth-most common tumor and the third-leading cause of cancer-related death worldwide [1], showing similar trends in Europe [2]. Even in case of curative resection, the prognosis of patients (pts) with a node positive status at diagnosis remains poor, with five-year survival rates of 20–30%. In this context, perioperative and adjuvant approaches have been developed over the last decades as part of a multimodality treatment in order to decrease local and distant relapses after gastrectomy and improve survival rates. We summarize the current status and future developments of perioperative multimodality treatment for resectable GC, reporting the “state of the art” about the role of radiotherapy, early metabolic assessment, molecular prognostic and predictive factors and new biological or immunological agents, and trying to offer clear answers to the real problems in clinical practice
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