R E V I E W Reﬂections on adjuvant treatment of gastric cancer Albert Abad José Luis Manzano Cristina Martí Servicio de Oncología Médica (Medical Oncology Service), Hospital Universitari Germans Trias i Pujol, Institut Català d’Oncologia (ICO) Badalona, Barcelona, Spain Correspondence:Albert Abad Section Chief, Medical Oncology Service, University Hospital Germans Trias i Pujol, Catalan Institute of Oncology (ICO Badalona), Ct Canyet s/n. 08916 Badalona, Barcelona, Spain Tel + 34 93 4978925 Fax + 34 93 4978950 Email aabad@ico.scs.es Abstract: Gastric cancer constitutes a signiﬁcant health problem in the world due to its high incidence in certain geographical areas. The basic treatment of this tumor in its localized stages is surgery. Unfortunately, survival is less than 5 years, despite radical surgery. Radical and extensive surgery has proved to be crucial to survival, although there is no agreement on the need for reaching the nodes until there is more than 3 cm of tumor. However, even with the most extensive surgery, survival does not reach more than approximately 35% at 5 years, if we consider all the localized stages. Adjuvant treatment is therefore necessary for this neoplasm. The role of post-operative chemotherapy, as that of radiochemotherapy, is not well established and there is no standard. However, there is relative evidence of the beneﬁt of adjuvant treatment in some chemotherapy studies and in combination with radiotherapy, so that it is an option for treatment in these patients. Keywords: gastric cancer, adjuvant, chemotherapy, radiotherapy Introduction Gastric cancer constitutes an important social and health problem worldwide, due to its high incidence in particular geographical areas. In Europe it ranks ﬁfth after lung, prostate, colorectal and bladder cancer in men, and breast, colorectal, lung and uter- ine cancer in women. On a global scale it represents 24% of all malignant neoplasia (Ferlay et al 2001). The survival at 5 years has increased slightly from 17% to 22%, with the stage being the determining prognostic factor. The rate is 2% at 5 years for disseminated neoplasia, and approximately 60% in more localized tumors. Surgery is still the treatment chosen for patients with localized gastric cancer, but adjuvant treatment is necessary as a result of these patients’ low overall survival, even after radical R0 D2 surgery. (In Table 1, the concepts of R and D used in this paper are deﬁned.) The survival rate after curative resection is 30%–40%, with the stage and location of the tumor being the major inﬂuential factors. A proximal location has the worst prognosis, as can be seen in Table 2 (Meyerhardt and Fuchs 2003). In any case, it is remarkable that even for stage IA, more than 20% of patients are expected to relapse and die within 5 years. The failure of the treatment is produced by a com- bination of local relapses and distance dissemination, with local relapse showing a very signiﬁcant percentage. The distribution of relapses is summarized in Table 3, and includes the analysis of four recent series. Loco-regional relapses reach between 30%–50% as a whole, with distance dissemination between 18%–54% according to the series. This high percentage of local relapses favors the inclusion of radiotherapy in the adjuvant treatment of this tumor. Extent of surgery and adjuvant chemotherapy The efﬁcacy of the extent of surgery is a controversial aspect with great importance in the indication of adjuvant treatment. Two large studies have been published on this Therapeutics and Clinical Risk Management 2007:3(4) 563–567 © 2007 Dove Medical Press Limited. All rights reserved 563