Neo-adjuvant chemo(radio)therapy in gastric cancer: Current status and future perspectives

Abstract

In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.

Neoadjuvant therapy in pancreatic cancer: a systematic review and meta‐analysis of prospective studies

“…This treatment has a strong rationale and many theoretical advantages, such as inducing tumor regression, early treatment of micrometastatic lesions, reducing the risk of R1 resection and peritoneal implantation during operation, and assessment of tumor chemosensitivity in vivo . Numerous studies investigated the role of neoadjuvant therapy in solid malignant tumor, with some impressive and encouraging results .…”

Computed tomography-based radiomics for prediction of neoadjuvant chemotherapy outcomes in locally advanced gastric cancer: A pilot study

“…Previous studies have indicated that perioperative radio-chemotherapy or chemotherapy regimens had more favorable effects on increasing curative resection rates, disease-free survival, and overall survival ( 3 - 9 ). As a result, the standard treatment for patients with locally advanced gastric cancer no longer relies on surgery alone but also on perioperative radio-chemotherapy or chemotherapy since the 2000s ( 10 ).…”

Systemic immune–inflammation index as a useful prognostic indicator predicts survival in patients with advanced gastric cancer treated with neoadjuvant chemotherapy

“… 5 Many studies have indicated that surgery combined with adjuvant chemoradiotherapy could improve patients’ survival with early detection and treatment advances. 6 – 9 …”