Adjuvant Chemotherapy in Gastric Cancer

Cancers of the stomach rank first in cancer deaths in Korea with a high fatality rate. As for the adjuvant treatment of gastric cancer, a meta-analysis of adjuvant chemotherapy trials suggested a limited survival benefit for adjuvant chemotherapy compared with surgery alone. Most of the trials used combination chemotherapy, usually based on fluorouracil or cisplatin. Although the large intergroup trial 116, comparing surgery alone to surgery followed by postoperative fluorouracil, leucovorin, and radiotherapy, indicated a significant survival benefit for postoperative chemoradiotherapy, inadequate surgical resection of regional lymphnodes was an important issue of this trial. Future trials should address the extensive lymphnode dissection, the inclusion of newer chemotherapeutic agents, the use of preoperative chemotherapy, and the use of intraperitoneal therapy. Randomized trials are mandatory for the establishment of a satisfactory strategy.