Adjuvant therapy for gastric carcinoma patients in the past 15 years - A review of western and oriental trials

BACKGROUND. The early detection of gastric carcinoma is neither feasible no r practiced around the world, except on a limited basis in Japan. Thus, bec ause gastric carcinoma is detected later in most patients throughout the wo rld, those who undergo curative resection still remain at high risk for rel apse. Adjuvant therapy therefore has a potentially important place in the t reatment of these patients. It has been extensively investigated in the Ori ent, North America, and Europe. The authors reviewed;ed the results of thes e trials to determine the current status of adjuvant therapy. METHODS. All randomized studies published in the world literature since 198 4 were reviewed. These studies were divided into those performed in the Wes t and those performed in Asia and also by the type of therapy investigated (chemotherapy, chemoimmunotherapy, or radiotherapy). These findings were th en summarized and tabulated. RESULTS, In the process of evaluating the results of these studies, the aut hors uncovered some marked differences in the methodologies employed. For e xample, the use of no treatment control is a norm in the West, whereas a tr eatment control is commonly used in Asia. In addition, there is a greater e mphasis on chemoimmunotherapy in Asia than in the West. Furthermore, result s of Western studies suggest that postoperative adjuvant therapy is ineffec tive, whereas the results of the Asian trials do not give a clear indicatio n. Despite this, most Asian patients receive postoperative or perioperative adjuvant chemoimmunotherapy. CONCLUSIONS. Postoperative chemotherapy as an adjuvant to potentially curat ive resection of gastric carcinoma remains investigational despite more tha n 30 years of investigation in the West. Newer therapeutic combinations or strategies (preoperative chemotherapy or chemoradiotherapy) have the potent ial to benefit the high risk patients. (C) 1999 American Cancer Society.