Treatment of resectable gastric cancer

Abstract

Stomach cancer is one of the most common cancers worldwide, despite its declining overall incidence. Although there are differences in incidence, etiology and pathological factors, most studies do not separately analyze cardia and noncardia gastric cancer. Surgery is the only potentially curative treatment for advanced, resectable gastric cancer, but locoregional relapse rate is high with a consequently poor prognosis. To improve survival, several preoperative and postoperative treatment strategies have been investigated. Whereas perioperative chemotherapy and postoperative chemoradiation (CRT) are considered standard therapy in the Western world, in Asia postoperative monochemotherapy with S-1 is often used. Several other therapeutic options, although generally not accepted as standard treatment, are postoperative combination chemotherapy, hyperthermic intraperitoneal chemotherapy and preoperative radiotherapy and CRT. Postoperative combination chemotherapy does show a statistically significant but clinically equivocal survival advantage in several meta-analyses. Hyperthermic intraperitoneal chemotherapy is mainly performed in Asia and is associated with a higher postoperative complication rate. Based on the currently available data, the use of postoperative radiotherapy alone and the use of intraoperative radiotherapy should not be advised in the treatment of resectable gastric cancer. Western randomized trials on gastric cancer are often hampered by slow or incomplete accrual. Reduction of toxicity for preoperative and especially postoperative treatment is essential for the ongoing improvement of gastric cancer care.

Examining the gastric cancer survival gap between Asians and whites in the United States

“…Tumors located in the distal part of the stomach are commonly treated by subtotal gastrectomy and reconstruction of digestive continuity. However, tumors located at the middle or proximal (cardia) part of the stomach may require total gastrectomy or esophagogastrectomy, if extended into the lower esophagus, resulting in a relatively worse prognosis [39][40][41][42]. Previous studies have shown that patients from Western countries have a significantly higher proportion of cardia tumors, while patients in Asia have a higher proportion of non-cardia gastric cancer.…”

Sijunzi decoction‑treated rat serum induces apoptosis of side population cells in gastric carcinoma

“…For patients with gastric cancer who are unable to receive surgical treatment or are affected by recurrence and metastasis, chemotherapy is the only therapeutic option. However, the serious side effects of chemotherapeutic drugs drives the search to identify new methods for the treatment of gastric cancer (25). CMs have been used for the prevention and treatment of human cancers in Asian societies for centuries, and are considered as important strategies for the treatment of cancer (26)(27)(28).…”

In vitro analysis of the role of the mitochondrial apoptosis pathway in CSBE therapy against human gastric cancer

“…In 2012, ~950,000 cases of gastic cancer were diagnosed, and ~723,000 cases of gastric cancer-related mortality were recorded. Typical treatments for gastric cancer include surgical tumor excision, chemotherapy, radiotherapy and targeted therapy (16). Various combinations of drugs may be used in the treatment of gastric cancer, including flurouracil, capecitabine, carmustine, semustine and doxorubicin, in addition to mitomycin C, cisplatin and docetaxel.…”