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.2005.0041
VIEWPOINT
Perioperative Adjuvant Treatment
for Gastric Cancer: Options and Decisions
Michael Fatouros, MD, Theodore Liakakos,
MD, Dimosthenis Ziogas, MD, Ioannis Arampatzis, MD, Evaggelos
Briasoulis, MD, Pericles Tsekeris , MD, and Dimitrios H. Roukos,
MD.
Abstract
Although the very high locoregional recurrence
rates reported with limited D0/D1 surgery can be reduced with
extended D2 gastrectomy for operable gastric cancer, overall
relapse and survival rates remain poor and can be improved only
with adequate perioperative adjuvant treatment.
Despite intensive research however, no regimen
has been established as standard. Meta-analyses have demonstrated
a marginal survival benefit with adjuvant chemotherapy. Recently,
the INT-0116 US trial provided evidence for better outcomes
with postoperative adjuvant chemoradiation. But these findings
are limited to patients with D0/D1 surgery and stage-specific
survival rates and complication rates are better with appropriate
D2 surgery.
Optimization of surgery and perioperative
adjuvant chemotherapy and radiotherapy might improve clinical
outcomes of patients with gastric cancer. Rapid research advances
with gene expression profiling assays using microarrays or RT-PCR
techniques will enable prediction of clinical outcomes and response
to specific therapies. Translating this progress into individualized
clinical practice will substantially benefit patients regarding
both survival and quality of life.