title: Multimodal treatment of gastric cancer in the west: Where are we going?
abstract: The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.
authors.affiliation: Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
authors.forename: Karol
authors.initials: K
authors.lastname: Polom
authors.affiliation: Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Manzoni
authors.affiliation: Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Morgagni
authors.affiliation: Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.affiliation: Daniele Marrelli, Karol Polom, Franco Roviello, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
mesh_terms: D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D019366:Western World
keywords: Chemotherapy; Epidemiology; Gastric cancer; Hyperthermic intraperitoneal chemotherapy; Radiotherapy; Targeted therapy