Recent advances in therapy for gastric cancer.

Gastric cancer is the fourth leading cause of death from cancer in Taiwan. Complete surgical resection is the only potentially curative treatment for gastric cancer. Randomized trials have failed to show the superiority of D2 over D1 dissection, and comparisons showing higher survival rates following more extensive surgery in Japan may have been influenced at least in part by the fact that D1 dissection underestimates disease stage in Western populations. No studies have shown convincing evidence of a survival benefit from adjuvant chemotherapy. A regimen of postoperative 5-fluorouracil (5-FU)-based chemoradiotherapy can improve disease-free and overall survival compared with surgery alone. Inadequate lymph node dissection for local control is a major concern. For advanced disease, HDFL (weekly 24-hour infusion of high-dose 5-FU and leucovorin)-based 'doublet' chemotherapy forms a cornerstone of combination chemotherapy in gastric cancer, but the effect on prolonged median survival is minimal. A 'sequential' non-cross-resistant strategy may be useful to prolong overall survival in patients with advanced gastric cancer. There are indications that preoperative neoadjuvant chemotherapy or chemoradiotherapy may increase the resectability of tumors and reduce the risk of postoperative recurrence. In the future, substantial improvements of treatment outcome will likely depend on the integration of novel, molecularly targeted agents into multimodality treatment strategies for all stages of gastric cancer. Further clinical research is mandatory to develop optimal therapies for gastric cancer.