title: Adjuvant treatment for gastric cancer: chemotherapy versus radiation.
abstract: Gastric cancer is among the leading causes of cancer death worldwide. Surgery is the only curative modality, but mortality remains high because a significant number of patients have recurrence after complete surgical resection. Chemotherapy, radiation, and chemoradiotherapy have all been studied in an attempt to reduce the risk for relapse and improve survival. There is no globally accepted standard of care for resectable gastric cancer, and treatment strategies vary across the world. Postoperative chemoradiation with 5-fluorouracil/leucovorin is most commonly practiced in the United States; however, recent clinical trials from Asia have shown benefit of adjuvant chemotherapy alone and have questioned the role of radiation. In this review, we examine the current literature on adjuvant treatment of gastric cancer and discuss the roles of radiation and chemotherapy, particularly in light of these new data and their applicability to the Western population. We highlight some of the ongoing and planned clinical trials in resectable gastric cancer and identify future directions as well as areas where further research is needed.
authors: Department of Hematology/Oncology, University of South Florida/James A. Haley Veterans' Hospital, Tampa, Florida, USA;
authors: Noman
authors: N
authors: Ashraf
authors: Sarah
authors: S
authors: Hoffe
authors: Richard
authors: R
authors: Kim
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000639:trends; D006801:Humans; D018714:Radiotherapy, Adjuvant / Q000639:trends; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
keywords: Adjuvant treatment; Chemotherapy; Gastric cancer; Radiation
references: Lancet. 2010 Aug 28;376(9742):687-97
references: 20728210
references: Gastric Cancer. 2013 Jan;16(1):1-27
references: 22729699
references: Semin Radiat Oncol. 2002 Apr;12(2):187-95
references: 11979420
references: World J Surg. 1997 Jul-Aug;21(6):622-7; discussion 627-8
references: 9230660
references: J Clin Oncol. 2010 Mar 20;28(9):1547-53
references: 20159816
references: J Clin Oncol. 2004 Jul 15;22(14):2774-80
references: 15254045
references: J Clin Oncol. 2011 Nov 20;29(33):4387-93
references: 22010012
references: Am J Med. 1988 Nov;85(5):658-61
references: 3189369
references: Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):581-6
references: 22137021
references: Gastric Cancer. 2011 Jun;14(2):113-23
references: 21573742
references: Ann Surg Oncol. 2002 Apr;9(3):278-86
references: 11923135
references: Cancer J. 2008 Jul-Aug;14(4):269-75
references: 18677137
references: Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1279-85
references: 16099596
references: Dig Surg. 1998;15(4):317-22
references: 9845606
references: Br J Surg. 2010 May;97(5):643-9
references: 20186890
references: Int J Radiat Oncol Biol Phys. 2009 Dec 1;75(5):1430-6
references: 19540072
references: Lancet Oncol. 2010 May;11(5):439-49
references: 20409751
references: Lancet Oncol. 2007 Sep;8(9):797-805
references: 17693134
references: Nat Rev Clin Oncol. 2012 Feb 28;9(4):192-4
references: 22371135
references: Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):929-34
references: 9869212
references: BMC Cancer. 2011 Aug 02;11:329
references: 21810227
references: Gastrointest Cancer Res. 2008 Nov;2(6):287-94
references: 19259277
references: N Engl J Med. 2007 Nov 1;357(18):1810-20
references: 17978289
references: J Clin Oncol. 2004 Nov 15;22(22):4495-9
references: 15542799
references: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references: 22237781
references: J Clin Oncol. 1998 Jan;16(1):301-8
references: 9440757
references: Postgrad Med J. 2005 Jul;81(957):419-24
references: 15998815
references: Lancet Oncol. 2011 Jul;12(7):681-92
references: 21684205
references: Int J Cancer. 2010 Dec 15;127(12):2893-917
references: 21351269
references: Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1167-74
references: 18234440
references: Ann Oncol. 2010 May;21 Suppl 5:v50-4
references: 20555102
references: J Clin Oncol. 2012 Jan 20;30(3):268-73
references: 22184384
references: Int J Radiat Oncol Biol Phys. 2005 Nov 1;63(3):732-8
references: 15978742
references: Cancer. 2010 Aug 15;116(16):3943-52
references: 20564136
references: J Clin Oncol. 2012 Jul 1;30(19):2327-33
references: 22585691
references: Semin Radiat Oncol. 2002 Apr;12(2):150-61
references: 11979416
references: Front Radiat Ther Oncol. 2007;40:272-288
references: 17641515
references: N Engl J Med. 1996 Aug 15;335(7):462-7
references: 8672151
references: Ann Surg. 2010 Apr;251(4):640-6
references: 20224369
references: Lancet. 1994 May 28;343(8909):1309-12
references: 7910321
references: J Clin Oncol. 2004 Jul 15;22(14):2767-73
references: 15199090
references: Clin Oncol (R Coll Radiol). 2005 Apr;17(2):91-5
references: 15830570
references: N Engl J Med. 1999 Mar 25;340(12):908-14
references: 10089184
references: N Engl J Med. 2008 Jul 31;359(5):453-62
references: 18669424
references: Br J Surg. 1999 Jan;86(1):119-22
references: 10027374
references: J Gastric Cancer. 2012 Jun;12(2):55-62
references: 22792517
references: J Clin Oncol. 2008 Mar 1;26(7):1086-92
references: 18309943
references: N Engl J Med. 2001 Sep 6;345(10):725-30
references: 11547741
references: J Clin Oncol. 2004 Jun 1;22(11):2069-77
references: 15082726
references: Langenbecks Arch Surg. 2011 Aug;396(6):743-58
references: 21234760
references: N Engl J Med. 2006 Jul 6;355(1):11-20
references: 16822992
references: Eur J Surg Oncol. 2004 Apr;30(3):303-8
references: 15028313
references: Ann Oncol. 2009 May;20 Suppl 4:34-6
references: 19454457
references: Int J Radiat Oncol Biol Phys. 2002 Feb 1;52(2):283-93
references: 11872272
references: J Clin Oncol. 2010 May 10;28(14):2430-6
references: 20368551
references: Cancer. 2000 Dec 1;89(11):2237-46
references: 11147594
references: Lancet. 2012 Jan 28;379(9813):315-21
references: 22226517
references: Br J Surg. 1990 Sep;77(9):1020-3
references: 1698501
references: J Nucl Med. 2007 Dec;48(12):1945-50
references: 18006614
references: J Clin Oncol. 2005 Oct 1;23(28):6957-65
references: 16145066
references: J Clin Oncol. 2009 Feb 20;27(6):851-6
references: 19139439
references: JAMA. 2010 May 5;303(17):1729-37
references: 20442389
references: J Clin Oncol. 2011 Oct 20;29(30):3968-76
references: 21844504
references: Jpn J Surg. 1981 Mar;11(2):127-39
references: 7300058
references: Br J Cancer. 1999 Mar;79(9-10):1522-30
references: 10188901
references: N Engl J Med. 2012 May 31;366(22):2074-84
references: 22646630