Recent trends in the treatment of advanced gastric cancer

Kim, Yeul Hong

Abstract

Despite its decreasing incidence, gastric cancer is the most common type of cancer in Korea. Surgical resection is the only therapeutic modality capable of cure and improvements in early diagnosis, preoperative assessment, and surgical techniques have increased the number of potentially curative resections over the last 20 years. However, despite of these improvements, survival of advanced gastric cancer has not been improved. Numerous trials of postoperative adjuvant chemotherapy or immunotherapy have been conducted with the hope of improving on the results of surgery alone. However, conclusive evidence of any survival benefit has been lacking. During the past few decades, the principle of combined-multimodality treatment has been developed and applied in practice for various solid tumors, including gastric cancer. This article reviews the current status of the postoperative adjuvant chemoradiatherapy and preoperative chemotherapy with or without radiotherapy in potentially resectable gastric cancer patients including discussion on the application in Korean gastric cancer patients. Issues such as the early assessment of metabolic changes in the tumor by PET was also addressed. Further clinical trials are needed to move towards better consensus and standardization of treatment.