Multimodal Therapy of Gastric Cancer

Abstract

Adenocarcinoma of the stomach is the 2nd most common cancer worldwide. The 5-year survival rates after curative surgical resection decline from 60–90% in stage I, to 30–50% in stage II and finally drop to only to 10–25% for patients in stage III of this disease. Surgical treatment is the only therapeutic modality that has a potentially curative effect. According to certain criteria, early gastric cancer limited to the mucosa or submucosa is indicated for endoscopic mucosal resection. In advanced gastric cancer with surgical approach, the questions of type of resection, extent of lymph node dissection and indication for splenectomy do arise. R0 resection represented with macroscopic- and microscopic-free resection margins is the ultimate goal for a surgeon. Chemotherapy is the treatment of choice in stage IV for unresectable disease. According to numerous randomized controlled trials, adjuvant chemotherapy versus chemoradiotherapy have been accepted for stages Ib–IIIb of this disease. Combination chemotherapy seems to be more effective than monotherapy. Neoadjuvant chemotherapy is administered with the aim to downstage a locally advanced tumor prior to attempting curative resection. New therapeutic possibilities include agents like angiogenesis inhibitors, human epidermal growth factor receptor family inhibitors and inhibitors of small molecules (tyrosine kinase inhibitors). Survival rates in resectable gastric cancer are influenced mainly by the depth of invasion through the gastric wall and by the presence or absence of regional lymph node involvement. Positive margins in resected patients are associated with very poor prognosis.

Gastric adenocarcinoma in children and adolescents

“…Adult GAC is a very challenging cancer and most patients present with advanced disease at diagnosis 18. Patients with localized disease are candidates for multimodality approach which clearly offers a survival benefit compared to surgery alone 19. Complete surgical resection offers a potential cure though recurrences within 2 years are still common.…”

Effects of PLK1 on proliferation, invasion and metastasis of gastric cancer cells through epithelial-mesenchymal transition

“…The clinical treatment means of early gastric cancer is mainly surgery, but most patients are in the advanced stage when diagnosed, so the chemotherapy-based comprehensive treatment is mainly adopted. Unfortunately, chemotherapy does not significantly improve the survival rate of patients with advanced gastric cancer, and patients have to face the adverse effects brought by chemotherapy ( 3 – 5 ). Gastric cancer does not have typical clinical features in the early stage, so it is often neglected.…”

FGFR2 Gene Amplification in Gastric Cancer Predicts Sensitivity to the Selective FGFR Inhibitor AZD4547

“…Such high incidence rates in this region may be due in part to the preference for a high-salt diet, a high proportion of smokers, and a high prevalence of Helicobacter pylori infection (2,3). Despite advances in diagnostic methods and improvement of both surgical skills and systematic chemotherapy regimens, the overall prognosis for gastric cancer remains disappointing, especially for those with late-stage disease; the 5-year survival rate for patients with stage III/IV metastatic gastric cancer is only around 10% (4,5). Better management of this disease, particularly through the use of targeted therapeutic agents, is required.…”