Neoadjuvant and adjuvant chemotherapy of locally advanced stomach cancer

Surgical treatment of locally advanced gastric carcinoma still results in unsatisfactory survival results. The addition of adjuvant chemotherapy has been shown to be of little value and is not considered standard practice. Preoperative chemotherapy, however, has a strong theoretical basis and may achieve significant tumor shrinkage and downstaging and thus allow complete resection of cancers previously judged by the responsible surgeon to be inoperable. However, it has not yet been demonstrated whether preoperative chemotherapy prolongs the survival of patients with potentially resectable cancers. Based on theoretical reasons, preoperative chemotherapy may be expected to be more efficient than postoperative chemotherapy. Various phase II trials have shown the feasibility of this approach, and encouraging results were found. Differing diagnostic methods, inclusion criteria, and chemotherapy regimens hamper direct comparisons between the trials. Several useful new drugs including taxanes and camptothecins and promising chemotherapy regimens incorporating continuously infused 5-fluorouracil have been introduced recently. Ongoing large randomized clinical trials (MAGIC trial, EORTC, SAKK) currently study the efficacy of preoperative chemotherapy in locally advanced gastric carcinoma.