Does adjuvant or neoadjuvant therapy improve prognosis of gastric cancer?

Despite the decreasing frequency of gastric cancer in most Western countrie s prognosis could not be improved by surgery alone in the past. Advanced tu mor stage due to late diagnosis is one of the reasons for this observation. Contrary to breast and colorectal cancer, postoperative chemotherapy faile d to improve prognosis in gastric cancer. Small number of patients in Weste rn studies, insufficient surgical procedures and the high frequency of loco regional relapse may be attributed for this observation. Intraperitoneal, a djuvant chemotherapy showed a positive impact on survival in Asian studies only, but was also used sucessfully as a part of a multimodality approach i n Western phase II trials. Since neoadjuvant therapy proved to create downs taging of tumor size in some patients with advanced gastric cancer some wor king groups tried to influence prognosis of potentially resectable tumors b y preoperative chemotherapy, surgical resection and postoperative, adjuvant therapy in the recent past. However, the efficacy of this therapeutic appr oach has to be reconfirmed in a controlled, phase LII fashion.