Optimal locoregional treatment in gastric cancer

Worldwide, gastric cancer is one of the leading causes of cancer-related death. The mainstay of curative treatment is radical surgery. But even with optimal surgical resection, the prognosis remains modest in the Western world. Numerous attempts have been undertaken to improve clinical outcome. More extensive lymph node dissection, adjuvant radiotherapy and adjuvant chemotherapy did not result in a survival benefit in randomized trials. Only postoperative chemoradiotherapy has proven to be valuable in prospective randomized trials. Questions are to be answered about optimization of surgery, radiotherapy and chemotherapy, and fine tuning of the three modalities. One of the key issues that should be addressed is whether pre- or postoperative chemoradiotherapy will benefit survival or locoregional control in the case of optimal surgery with an "over-D1" lymphadenectomy and without splenectomy. In this article the most relevant literature on locoregional treatment in operable gastric cancer will be reviewed and future strategies will be discussed.