Neoadjuvant and adjuvant chemotherapy of locally advanced stomach cancer

Surgical treatment of locally advanced gastric carcinoma still results in u nsatisfactory survival results. The addition of adjuvant chemotherapy has b een shown to be of little value and is not considered standard practice. Pr eoperative chemotherapy, however, has a strong theoretical basis and may ac hieve significant tumor shrinkage and downstaging and thus allow complete r esection of cancers previously judged by the responsible surgeon to be inop erable. However, it has not yet been demonstrated whether preoperative chem otherapy prolongs the survival of patients with potentially resectable canc ers. Based on theoretical reasons, preoperative chemotherapy may be expecte d to more efficient than postoperative chemotherapy. Various phase II trial s have shown the feasibility of this approach, and encouraging results were found. Differing diagnostic methods, inclusion criteria, and chemotherapy regimens hamper direct comparisons between the trials. Several useful new d rugs including taxanes and camptothecins and promising chemotherapy regimen s incorporating continuously infused 5-fluorouracil have been introduced re cently. Ongoing large randomized clinical trials (MAGlC trial, EORTC, SAKK) currently study the efficacy of preoperative chemotherapy in locally advan ced gastric carcinoma.