title: Multimodality treatment of potentially curative gastric cancer: geographical variations and future prospects.
abstract: After much controversy, multimodality therapy is now accepted worldwide as the gold standard for treatment of resectable bulky localized gastric cancer. There is significant regional variation in the style of multimodality treatment with adjuvant chemoradiation the North American standard, neoadjuvant chemotherapy preferred in Europe and Australasia, whilst adjuvant chemotherapy is preferred in Asia. With further standardization of surgery and D1+/D2 resections increasingly accepted world wide, and in particular in the West, as the surgical standard of care for potentially curable disease, it is timely to reassess the multimodality regimes being used. The challenge in the use of multimodality therapy is how current outcomes can be standardized and improved further. Recent studies indicate that mere intensification of the regime in time, dosage or addition of further agents does not improve localized gastric cancer outcomes. More novel strategies including early commencement of adjuvant therapies, intra-peritoneal chemotherapy or assessing neoadjuvant response with positron emission tomography scanning may give improvements in outcomes. The introduction of targeted therapies means that the adjuvant use of biological agents needs to be explored. By proper assessment of the patient's co-morbidities, full tumour staging, and a better understanding of the tumour's molecular pathology, multimodality therapy for gastric adenocarcinoma may be individualized to optimize the likelihood of cure.
authors.affiliation: Neil D Merrett, Discipline of Surgery, School of Medicine, University Of Western Sydney, Penrith, NSW 2751, Australia.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Merrett
mesh_terms: D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D005544:Forecasting; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards / Q000639:trends; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality / Q000592:standards / Q000639:trends; D009367:Neoplasm Staging; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D057285:Precision Medicine; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Adjuvant treatment; Gastrectomy; Gastric cancer; Human epidermal growth factor receptor; Multimodality; Neoadjuvant; Targeted therapy