Drs. Silberman and Iqbal have provided an exhaustive and very timely review of approaches to adjunctive therapies to surgery in patients with resectable gastric adenocarcinomas. It is essential for clinicians to be aware of the applicable therapeutic strategies that may increase survival in patients with gastric cancers because these tumors will occur in over 900,000 people throughout the world each year (1).

Drs. Silberman and Iqbal delve into the clinical science of strategies employed over the last 30 years to increase the cure rate in patients with resectable gastric cancer. Not only do they provide a very complete cataloguing of what has been done, but they also give some insight into why clinical investigations in this area have very infrequently yielded compelling results. The authors also demonstrate how clinical trials might have been done better in patients with resectable stomach cancer.

There has been a plethora of approaches taken, including pre and postoperative chemotherapy and external-beam irradiation, and intraperitoneal chemotherapy with and without hyperthermia. Also, various schemes of immunotherapy have been evaluated. As noted by Drs. Silberman and Iqbal, all of these approaches were translated into clinical trials and had reasonable rationales that were potentially testable in well-designed clinical investigations. As also noted by the authors, most of these research concepts failed in clinical trials to produce any result that had an impacted on the standard of care in patients with resectable gastric cancer. Why was this the case? Were the ideas bad ...