Multimodality Treatment of Gastric Cancer Multimodale Therapie des Magenkarzinoms

Summary: Background: The incidence of gastric cancer has fallen dramatically from 35/100 000 in 1930 to 3/100 000 in 1970. The clinical forms of presentation of gastric cancer vary and oscillate between two forms, one including intestinal metaplasia, achlorhydrosis, and infection with Helicobacter pylori, whereas the other includes gastric metaplasia of the oesophagus resulting from gastro-oesophageal (GO) reflux. These two forms are mutually exclusive. With this being said, the question turns to the best available treatment, which has consisted in surgery until today and has been defined to necessitate gastrectomy of various extension with en bloc N2 resection (D2). Adjuvant radiochemotherapy has recently been shown to improve survival.Methods: The results of adjuvant chemotherapy and multimodality regimens in patients with gastric cancer are discussed.Results: Although patients do not benefit from D2 resection as compared to D1 resection concerning survival, D2 resection results in a significantly better staging of the disease. This resulted in the universally accepted recommendation of D2 resection as surgical state of the art in gastric tumours. Better staging itself should not detract, however, from the detrimental prognosis of gastric cancer, which is mirrored in a 30 % overall survival of patients with N1 disease.Due to all of these aspects, a series of polychemotherapy regimens have been applied for advanced gastric cancer. All of these regimens have yielded a maximum rate of 15 % complete remissions, which were of short duration only.Recently it was shown that a multimodality approach combining surgery and chemoradiation was significantly superior over surgery alone concerning both disease-free (49 % and 32 %, respectively; P = 0.001) and overall survival (52 % and 41 %, respectively; P = 0.03) at 3 years.Conclusions: Despite limited efficacy of cytotoxic therapy in advanced gastric cancer, adjuvant chemotherapy has no beneficial effect upon survival. In contrast, multimodality treatment including chemotherapy, radiotherapy, and surgery is the treatment of choice for resectable disease. Multimodality treatment including surgery, chemo- and radiotherapy has to be considered as state of the art treatment of adenocarcinoma of the stomach and the GO junction.