Combined Modality Treatment for Locally Advanced Gastric Cancer: Current Evidences and New Perspectives

Abstract

Since benefits have been demonstrated in trials with perioperative chemotherapy, postoperative chemoradiotherapy, and preoperative chemoradiotherapy for patients with locally advanced gastric cancer, a second generation of randomized clinical trials evaluated some refinements of these treatment strategies. These trials included innovative combined modality programs with new drug-radiation combinations and advanced radiation therapy techniques followed by standardized gastric radical surgery to answer the several questions that emerged from the original landmark trials. The results of these trials have been recently reported and will be analyzed. Questions about patient selection and the optimal sequence and timing of treatments in the integrated approach still remain. As tumor location and histologic subtypes are associated to different aggressiveness, treatment response, and prognosis, future studies need to give more focus on gastroesophageal junction and stomach cancer as separate diseases to provide more solid data in these established tumor types. Furthermore, the new insights into histological patterns and molecular characterization of individual tumor subtype could address new and more individualized generation of combined modality treatment programs.