Neoadjuvant chemotherapy for locally advanced gastric cancer: With or without radiation

Abstract

The role of perioperative chemotherapy for gastric cancer has been established for gastric cancers in their advanced stage. In most parts of the world, even in Japan and Korea, local recurrence of gastric cancer following curative resection remains a problem. Should radiation be added to chemotherapy to achieve better local and regional control? What is the current evidence? What are the concerns regarding neoadjuvant chemoradiation in terms of safety, efficacy and survival benefit? After a serious review of the literature, the authors conclude that it is still too early to get a definitive answer but radiation seems promising. It may bring a higher pathological response rate. Rationally, more high level clinical trials are needed to confirm the role of radiotherapy in the neoadjuvant setting or to ascertain subsets of patients who may benefit from it. It is of note that surgeons should pay attention to possible complicated circumstances following radiotherapy, maintain proper nutrition status and minimize the occurrence of postoperative complications. As few data are available in Japan and Korea, interpretation and implementation of neoadjuvant radiation or chemoradiation should be done with caution.

The staged treatment of locally advanced stomach cancer complicated by relapsing hemorrhage under conditions of the multi-speciality hospital

“…В настоящее время вопрос о выборе лечебной тактики и методов оперативного лечения у больных кровоточащим раком желудка остается дискутабельным [4,5,16]. Используемые эндоскопические методы гемостаза не всегда оказываются окончательными методами остановки кровотечения из распадающейся опухоли.…”

“…В этих случаях применяют такие способы эндоваскулярного гемостаза, как селективное введение вазоконстрикторов или эмболизацию афферентного сосуда. Ангиографические лечебные процедуры при злокачественных новообразованиях желудочно-кишечного тракта используют нечасто [9,15,16] в связи с высоким риском ишемического стеноза или перфорации полого органа, имеющего только артериальный источник кровоснабжения, а также техническими трудностями катетеризации небольших по диаметру питающих артерий.…”

New possibilities for the treatment of gastric cancer

“…The results of studies were often contradictory. Therefore, the question arises whether patients with resectable gastric cancer should receive systemic treatment and what this treatment should be -neoadjuvant or adjuvant [12][13][14].…”

Concurrent Neoadjuvant Chemoradiotherapy for Siewert II and III Adenocarcinoma at Gastroesophageal Junction

“… 3 However, debate still exists regarding gastroesophageal junction adenocarcinoma therapy selection. 4 , 5 Some clinical studies 6 , 7 show that preoperative concurrent neoadjuvant chemoradiotherapy may result in increased pathological complete response and R0 resection rates with tolerable side effects, such as lower negative pathological nodes. 6 However, most of these studies were conducted in the United States and Europe.…”