J Gastric Cancer.  2013 Jun;13(2):73-78.

Neoadjuvant Treatment for Gastric Cancer

Affiliations
  • 1Department of Surgery, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Muenchen, Germany. christoph.schuhmacher@tum.de
  • 2National Cancer Center Korea, Gastric Cancer Service, Goyang, Korea.
  • 3Diakonie Klinikum Stuttgart, Stuttgart, Germany.

Abstract

Surgery is still considered to be the mainstay for the treatment of localized gastric cancer with negative margins (R0-resection) and an adequate lymph-node-dissection (D2-lymphadenectomy). Unfortunately, most cases of gastric cancer are only diagnosed at an advanced stage due to frequent recurrences after primary resection in curative intent. In order to improve prognosis after curative resection, in the recent past, patients with locally advanced tumors were subjected to a pre-, peri-, or postoperative treatment. Interestingly, postoperative chemotherapy has significantly improved survival after gastric resection in Asia, adjuvant radiochemotherapy is favored in North America and perioperative chemotherapy is considered as a treatment of choice in Europe indicating region specific approach towards the treatment. Recently there has also been growing evidence of positive outcomes of neoadjuvant radiochemotherapy on patient survival. In the present article, we discuss the concepts of neoadjuvant treatment approach and provide recommendations to surgeons based on current evidence.

Keyword

Gastric cancer; Neoadjuvant therapy; Chemotherapy; Chemoradiotherapy; Surgery

MeSH Terms

Asia
Chemoradiotherapy
Chemoradiotherapy, Adjuvant
Europe
Humans
Neoadjuvant Therapy
North America
Prognosis
Recurrence
Stomach Neoplasms

Reference

1. Meyer HJ, Hölscher AH, Lordick F, Messmann H, Mönig S, Schumacher C, et al. Current S3 guidelines on surgical treatment of gastric carcinoma. Chirurg. 2012. 83:31–37.
2. Agboola O. Adjuvant treatment in gastric cancer. Cancer Treat Rev. 1994. 20:217–240.
Article
3. Middleton G, Cunningham D. Current options in the management of gastrointestinal cancer. Ann Oncol. 1995. 6:Suppl 1. 17–25.
Article
4. Wilke H, Preusser P, Fink U, Gunzer U, Meyer HJ, Meyer J, et al. Preoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol. 1989. 7:1318–1326.
Article
5. D'Ugo D, Rausei S, Biondi A, Persiani R. Preoperative treatment and surgery in gastric cancer: friends or foes? Lancet Oncol. 2009. 10:191–195.
6. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006. 355:11–20.
Article
7. Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011. 29:1715–1721.
Article
8. Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol. 2010. 28:5210–5218.
Article
9. Stahl M, Walz MK, Stuschke M, Lehmann N, Meyer HJ, Riera-Knorrenschild J, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol. 2009. 27:851–856.
Article
10. van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012. 366:2074–2084.
Article
11. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A. ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007. 357:1810–1820.
Article
12. Sasako M, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, et al. Five-year results of the randomized phase III trial comparing S-1 monotherapy versus surgery alone for stage II/III gastric cancer patients after curative D2 gastrectomy (ACTS-GC study). Ann Oncol. 2010. 21:viii225–viii249.
13. Ott K, Lordick F, Blank S, Büchler M. Gastric cancer: surgery in 2011. Langenbecks Arch Surg. 2011. 396:743–758.
Article
14. Feussner H, Omote K, Fink U, Walker SJ, Siewert JR. Pretherapeutic laparoscopic staging in advanced gastric carcinoma. Endoscopy. 1999. 31:342–347.
Article
15. Li H, Zhu F, Cao Y, Zhai L, Lin T. Meta-analyses of randomized trials assessing the effect of neoadjuvant chemotherapy in locally advanced gastric cancer. J Clin Oncol. 2010. 28:4042. (Meeting Abstracts).
Article
16. Ronellenfitsch U, Schwarzbach M, Hofheinz R, Kienle P, Hohenberger P, Jensen K, et al. GE Adenocarcinoma Meta-analysis Group. Meta-analysis of preoperative chemotherapy (CTX) versus primary surgery for locoregionally advanced adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus (GE adenocarcinoma). J Clin Oncol. 2010. 28:15s.
Article
17. Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Upper Gastrointestinal Clinical Studies Group of the National Cancer Research Institute of the United Kingdom. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008. 358:36–46.
Article
18. Fiorica F, Cartei F, Enea M, Licata A, Cabibbo G, Carau B, et al. The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data. Cancer Treat Rev. 2007. 33:729–740.
Article
19. Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J. Australasian Gastro-Intestinal Trials Group. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol. 2007. 8:226–234.
Article
20. Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg. 2003. 185:538–543.
Article
21. Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001. 345:725–730.
Article
22. Botterweck AA, Schouten LJ, Volovics A, Dorant E, van Den Brandt PA. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol. 2000. 29:645–654.
Article
23. Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev. 1992. 1:265–269.
Article
24. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991. 265:1287–1289.
Article
25. Okabayashi T, Gotoda T, Kondo H, Inui T, Ono H, Saito D, et al. Early carcinoma of the gastric cardia in Japan: is it different from that in the West? Cancer. 2000. 89:2555–2559.
26. Chung JW, Lee GH, Choi KS, Kim DH, Jung KW, Song HJ, et al. Unchanging trend of esophagogastric junction adenocarcinoma in Korea: experience at a single institution based on Siewert's classification. Dis Esophagus. 2009. 22:676–681.
Article
27. Reim D, Gertler R, Novotny A, Becker K, zum Büschenfelde CM, Ebert M, et al. Adenocarcinomas of the esophagogastric junction are more likely to respond to preoperative chemotherapy than distal gastric cancer. Ann Surg Oncol. 2012. 19:2108–2118.
Article
28. Ajani JA, Faust J, Ikeda K, Yao JC, Anbe H, Carr KL, et al. Phase I pharmacokinetic study of S-1 plus cisplatin in patients with advanced gastric carcinoma. J Clin Oncol. 2005. 23:6957–6965.
Article
29. Messager M, Lefevre JH, Pichot-Delahaye V, Souadka A, Piessen G, Mariette C. FREGAT working group. The impact of perioperative chemotherapy on survival in patients with gastric signet ring cell adenocarcinoma: a multicenter comparative study. Ann Surg. 2011. 254:684–693.
Article
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