Multimodality Therapy of Localized Gastric Adenocarcinoma

Surgical resection is the primary method of obtaining a potential cure for patients with gastric adenocarcinoma. However, chemotherapy or chemoradiotherapy offer significant improvement in survival over surgery alone. Much of the difficulty in deciding the optimal treatment strategy is choosing between perioperative chemotherapy or adjuvant chemoradiotherapy. Adding to the complexity is the potential for incorporating treatment strategies based on clinical trials performed in Asia. There is likely a difference in tumor biology between Eastern and Western patients with gastric adenocarcinoma, in addition to the clear differences in screening, pathologic assessment, and surgical technique. Even among tumors in Western populations, heterogeneity of histology, anatomy, and staging among studies make cross-trial comparisons difficult. There is also active controversy surrounding the staging and management of gastroesophageal junction tumors. Lastly, the benefit of extended lymph node dissection is not clear based on the existing studies and has not been firmly established as a surgical standard of care for all patients. Future goals include better classification of gastric cancer, continued pursuit of randomized trials in Western populations, standardization of surgical technique, and incorporation of targeted therapies.