Adjuvant treatment of gastric cancer

Adenocarcinoma of the stomach represents a significant problem worldwide. The only known curative treatment of gastric cancer is complete surgical resection of the stomach tumor with surrounding lymph node-bearing areas. However, as many as 50% to 90% of patients undergoing gastric tumor resection relapse and die of cancer. Adjuvant chemotherapy has been used to prevent recurrence of gastric cancer after surgical resection. Single agents including thiotepa and fluorodeoxyuridine have no benefit as adjuvant therapy. Likewise, combination chemotherapy including 5-fluorouracil (5-FU) plus methyl-CCNU, 5-FU plus Adriamycin plus mitomycin C (FAM), and mitomycin C plus 5-FU plus cytosine arabinoside do not result in overall improved survival. Combined modality irradiation plus fluorinated pyrimidine, however, has resulted in long-term survival of patients with known residual gastric cancer. The newest clinical trial in postoperative gastric cancer being performed in the United States will test 5-FU plus leucovorin plus irradiation in a prospectively randomized study in patients with resected stage IB through stage IV stomach cancer. This surgical study, designed with excellent prospective quality control, is actively accruing patients and will be completed in 1.5 to 2.0 years.