[Stomach cancer: multimodality therapy--reliable and new developments]

The extension of surgical radicality including multivisceral procedures has only improved prognosis in individual cases. The concern now obviously is to achieve an improvement by additional therapeutic measures. Unfortunately, studies in Western countries show that adjuvant chemotherapy does not result in any significant improvement as has been repeatedly reported in Japanese trials. It is possible that differences in time and mode of drug application may be responsible for these discrepancies. Decisive may be the immediate post- or intraoperative therapy as well as its intraperitoneal application. Some phase II trials have also shown that preoperative chemotherapy may improve the resectability rate. Further studies are needed to determine how these findings are generally transferable. In addition of chemotherapy intraoperative radiation (IORT) and photodynamic therapy (PDT) may gain importance in the treatment of gastric cancer for the future.