NEOADJUVANT CHEMOTHERAPY FOR GASTRIC-CANCER - UPDATE

Neoadjuvant chemotherapy has recently received increasing attention in an attempt to increase the rate of complete tumor resections, combat systemic metastases, and prolong survival in patients with gastric can cer. The available data indicate that neoadjuvant chemotherapy is feas ible and does not increase postoperative morbidity and mortality. Comp ared to the results that can today be obtained with primary resection and lymphadenectomy, however, preoperative chemotherapy has so far fai led to show a dear increase: in the rate of complete tumor removal in patients with resectable gastric cancer. In patients with locally adva nced or unresectable gastric cancer, preoperative chemotherapy may cau se substantial reduction in locoregional tumor mass and thus increase the resection rate. This finding appears to translate into a survival benefit for those who respond to chemotherapy and have subsequent comp lete tumor resection. Because of severe shortcomings in the study desi gn of the published reports, definite conclusions cannot be drawn from the available studies. Randomized controlled prospective trials are t herefore clearly warranted. Exact pretherapeutic tumor staging, standa rdized resection and lymphadenectomy techniques, diligent evaluation o f the resected specimen, and close follow-up are essential when design ing these trials to identify subgroups of patients who may benefit fro m neoadjuvant chemotherapy for gastric carcinoma.