Gastric Cancer: Perioperative Adjunctive Therapy: Introduction
Gastric carcinoma, even when clinically localized, continues to resist curative surgical extirpation despite progressively more extensive operations, including subtotal gastrectomy, total gastrectomy, radical gastrectomy with splenectomy and distal pancreatectomy, and more recently, extended nodal dissections. Current efforts are now focused on designing and testing multimodal, perioperative strategies with the aim of achieving the same salutary effects observed with combined, multidisciplinary therapies employed in the treatment of other solid tumors, such as colon and rectal cancers, anal cancer, and breast cancer.
Systemic postoperative chemotherapy (adjuvant chemotherapy) and, to a lesser extent, preoperative chemotherapy (neoadjuvant chemotherapy) have been the adjunctive approaches most commonly studied. Although numerous phase 2 protocols have shown promise in improving survival, many such regimens have failed to withstand the rigors of randomized, controlled assessment while many others still await such confirmatory trials. Other therapeutic modalities currently under investigation in the clinic or in the laboratory include external-beam irradiation, often in combination with chemotherapy, intraoperative radiotherapy (IORT), hypothermia, intraperitoneal chemotherapy, immunotherapy, angiogenesis inhibitors, and blockers of oncogene function.