Chemotherapy and radiotherapy in the management of gastric cancer

Purpose of review The treatment of locally advanced gastric cancer remains a major challenge. After decades of investigation that have yielded little improvement in survival rates, several important studies have recently emerged that provide renewed optimism for future research endeavors. This article reviews the important advances over the past several years in the use of chemotherapy and radiotherapy for gastric cancer. Recent findings As a result of the Intergroup trial, adjuvant chemoradiotherapy after operation has emerged as a new standard of care for patients who have undergone resection for carcinoma of the stomach. Strategies currently being tested to build on the Intergroup results include the use of new chemotherapy combinations with radiotherapy and the development of modern conformal techniques to deliver radiation therapy. The preliminary results of a large neoadjuvant chemotherapy study have demonstrated the efficacy of this approach with tumor downstaging and increase in the curative R0 resection rate. For patients with metastatic gastric cancer, newer generation cytotoxic agents such as oxaliplatin, irinotecan, and taxanes show promising activity. In the near future, these agents will likely be evaluated for their role as adjuvant and neoadjuvant therapy. Summary Major advances in the treatment of gastric cancer have occurred during the past several years and have improved the care of patients with this form of tumor.