Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer

Gastric & Breast Cancer
DOI: 10.2122/gbc.2003.0018

May 2003

Tumor Stage-Based Tailored Therapeutic Strategy: Rational Approach or New Trend?
Currently, many patients with gastric cancer are overtreated or undertreated. Gastrectomy with less (D1) or more (D2) extensive lymph node dissection usually followed by adjuvant treatment is the standardized treatment in all stages-cancer, early or late. However, there is little scientific evidence that aggressive treatment, as compared with less extensive surgery, provides better clinical outcome especially in earlier-stages cancer.
Since the principal goal for a curative (R0) resection in early stage-cancers can be achieved with a less extensive surgery, a trend towards a tumor stage-based extent of surgery with or without adjuvant treatment seems to be rational. Such a strategy has already been started in Japan.
Here, we discuss the risks (local, distant recurrences, death) and benefits (lower adverse-effects profile), of a tumor stage-oriented therapeutic strategy, as well as whether decision-making based on tumor stage is evidence-based or not.
Studies with new biologic markers, as gene expression signature, provide currently promising data that microarrays, in addition to other classic predictors, will be used in the future towards improvement of outcome prediction and treatment in both survival and quality of life (QOL) by reducing the rate of overtreatment or undertreatment of the patients with gastric cancer.

Online ISSN : 1109 - 7647
   Print ISSN : 1109 - 7655

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last update: 22 May 2003