Gastric cancer: a neoplastic enigma

Effective therapy for gastric cancer remains elusive, and thus surgeons, oncologists, and radiotherapists are continually confounded. Multiple attempts to improve survival in gastric cancer patients have failed, including extended lymphadenectomy (by American surgeons), single- or multiple-agent chemotherapy, and combined-modality therapy (multiple-agent chemotherapy combined with radiation therapy). Such studies have been plagued by the high volume of inadequate antitumor responses or by lethal toxicity. At present, chemotherapy remains the best hope for effective adjuvant therapy, but new routes of drug delivery that will decrease systemic toxicity must be developed. Since gastric cancer recurs locoregionally and infrequently metastasizes to distant sites until very late in its course, theory suggests intraperitoneal (IP) chemotherapy applied to locoregional sites should decrease recurrence without significant systemic toxicity. Such treatments have been effective in other malignancies that commonly occur IP, such as ovarian cancer. Intracavitary chemotherapy protocols for gastric cancer are under development and will soon produce data on treatment efficacy. Such studies offer a theoretic basis for improved survival from gastric cancer; however, only well-controlled treatment trials will confirm if theory can be translated into clinical reality.