[Presence and future in neoadjuvant chemotherapy against gastric cancer]

The present state and a future of neoadjuvant chemotherapy (NAC) was reviewed. Gastric cancer is classified as a cancer which is resistant against anti-cancer drugs. Consequently, surgery is the only method that offers hope of cure. Candidates for NAC are patients with stage IV disease, especially with T4 disease having no distant metastases. NAC is carried out for an increase of the resectability rate and the judgement of the in vivo chemosensitivity. Regimens with high fractional kill should be used, and and the tumor burden must be periodically estimated by CT scan, endoscopy and the serum levels of tumor markers. If the used regimen showed no response, a new protocol should be tried. Since a histological CR is very rare, not only primary tumor but metastases should be resected as much as possible. A completeness of the cytoreduction is a major factor for a long term survival. Surgery is carried out for the elimination of the drug-resistant cancer cells. Furthermore, early postoperative chemotherapy is very important for the improvement of survival after NAC.