Adjuvant therapy for gastric cancer.

The curative management of gastric adenocarcinoma depends on complete resection of the primary tumor. In patients with lymph node metastases in the resected specimen, the relapse and death rates from recurrent cancer are 70% to 80%. There is continued debate over whether more extensive lymph node dissection (D2) improves survival when compared with less extensive operations. Until recently, attempts at preventing recurrence, usually using adjuvant chemotherapy, have been ineffective. A large United States Intergroup study (INT-0116) showed that combined chemoradiation following gastric resection improves median time to relapse (30 months v 19 months, P <.0001) and overall survival (35 months v 28 months, P =.01). This treatment has become a standard of care. Future advances in the therapy for resectable gastric cancer may come from studies of preoperative neoadjuvant chemoradiation and the application of targeted therapies such as growth receptor antagonists and anti-angiogenesis agents.