Treatment options for surgically resectable gastric cancer

Surgery is the only curative therapy for gastric cancer. The standard recommendations for resectable gastric adenocarcinoma are free-margin surgery with at least D1 resection and the removal of a minimum of 15 lymph nodes. The overall 5-year survival rate for resected gastric patients remains poor due to locoregional recurrence. The results of a large North American study (Gastrointestinal Cancer Intergroup Trial INT 0116) reported that postoperative chemoradiotherapy conferred a survival advantage compared with surgery alone, which led to the regimen being adopted as a standard of care. More recently the MAGIC/UK Medical Research Council (MRC) trial demonstrated that perioperative chemotherapy resulted in an improvement in overall survival and progression free survival. Thus, two successful strategies are available to improve outcomes in patients with localized gastric cancer. This article reviews data on adjuvant and perioperative treatment modalities for gastric cancer. The article discusses ongoing randomized adjuvant and perioperative trials that are designed to optimize chemotherapy regimens and also investigate combinations of chemotherapy and biologic agents. It is important to understand the mechanisms or pathways involved in gastric cancer development and metastasis. Identification of novel molecules pivotal to tumor biology may lead to new therapeutic approaches for this malignancy.