Current Progress in the Adjuvant Treatment of Gastric Cancer

Staging of locally advanced gastric cancer includes imaging with computed tomography scan and laparoscopic assessment to rule out peritoneal disease or positive peritoneal washings. Preoperative and postoperative chemotherapy improves survival compared with surgery alone. After primary D2 resection, adjuvant chemotherapy with a fluorinated pyrimidine with or without a platinum agent improves survival. Inclusion of postoperative radiation therapy appears required in combination with chemotherapy in patients with less than a D1-D2 resection. Potential lower rates of R0 resection with preoperative chemotherapy alone in tumors of the gastroesophageal junction argue that combined preoperative chemotherapy and radiotherapy is required.