Adjuvant therapy in gastric cancer: can we prevent recurrences?

Despite a dramatic decline in the incidence of gastric carcinoma in the United States during the past century, treatment remains a challenging problem for oncologists. Surgery continues to be the primary modality for managing early-stage gastric cancer, but up to 80% of patients who undergo a "curative" resection develop locoregional or distant recurrence. Given these sobering statistics, there has been great interest in developing strategies to prevent recurrences after surgery and improve overall mortality. In this article, we review data on adjuvant treatment modalities for this disease, including radiotherapy, chemotherapy, combination chemotherapy and radiation, intraperitoneal treatment, and immunotherapy. We focus attention on the recent widespread acceptance of adjuvant chemoradiotherapy, based on the results of Intergroup trial 0116. Future strategies incorporating different modalities of treatment will be outlined.