Perioperative treatment of gastric cancer- short review

Abstract

Adenocarcinoma of the gastroesophageal junction (GEJ) and gastric cancer have poor outcomes in most patients.Perioperative chemotherapy became a standard of care for resectable adenocarcinoma of the upper GI tract based on the results of the MAGIC trial. The study includes patients with Stage II or III resectable adenocarcinoma of the stomach, GEJ, and lower esophagus. The ACCORD trial essentially supported the results of the MAGIC study.Both studies showed that preoperative chemotherapy could induce downstaging and enhance the possibility of potentially curative R0 resection, thus increasing the probability of disease-free survival and overall survival.The NeoFLOT study investigates the application of prolonged neoadjuvant chemotherapy (NACT). This study indicates that NACT with six cycles of FLOT is highly effective in resectable gastroesophageal cancer. The CRITICS trial compares perioperative chemotherapy with preoperative and postoperative chemoradiotherapy in patients with resectable gastric adenocarcinoma. Postoperative chemoradiotherapy did not improve overall survival compared with postoperative chemotherapy in patients with resectable gastric cancer treated with adequate preoperative chemotherapy and surgery.In recent years, guidelines for the treatment of gastric cancer have changed frequently. Because gastric cancer treatment is complex and perioperative chemotherapy is present in all treatment guidelines, a multidisciplinary team with experienced physicians is the foundation of effective gastric cancer treatment.