Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2016; 8(5): 439-449
Published online May 15, 2016. doi: 10.4251/wjgo.v8.i5.439
Current adjuvant treatment modalities for gastric cancer: From history to the future
Leyla Kilic, Cetin Ordu, Ibrahim Yildiz, Fatma Sen, Serkan Keskin, Rumeysa Ciftci, Kezban Nur Pilanci
Leyla Kilic, Department of Medical Oncology, Acibadem University Hospital, Istanbul 34394, Turkey
Cetin Ordu, Department of Medical Oncology, Istanbul Bilim University, Istanbul 34394, Turkey
Ibrahim Yildiz, Fatma Sen, Serkan Keskin, Rumeysa Ciftci, Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul 34394, Turkey
Kezban Nur Pilanci, Department of Medical Oncology, Haseki Training and Research Hospital, Istanbul 34394, Turkey
Author contributions: Kilic L and Ordu C contributed equally to this work as first authors; Kilic L, Ordu C and Yildiz I wrote the paper; Kilic L, Sen F, Keskin S, Pilanci KN performed the research; Ordu C, Yildiz I and Sen F designed the research; Ordu C, Yildiz I, Ciftci R, Pilanci KN analyzed the data.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Cetin Ordu, MD, Department of Medical Oncology, Istanbul Bilim University, Büyükdere Cad. No.120, Şişli, Istanbul 34394, Turkey.
Telephone: +90-532-2276179 Fax: +90-212-2889812
Received: September 22, 2015
Peer-review started: October 3, 2015
First decision: November 6, 2015
Revised: January 24, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: May 15, 2016

The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials. However, the benefits were evident for only certain patients, which were not very homogeneous regarding the type of surgery, chemotherapy regimens, and stage of disease. Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate. Regardless of the extent of surgery, multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement. Moreover, in the era of individualized treatment for most of the other cancer types, identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation. The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients.

Keywords: Adjuvant chemoradiotherapy, Biomarker, Gastric cancer, Lymph nodes

Core tip: Despite extensive surgery, gastric cancer will likely recur for most patients. Fortunately, additional treatment modalities either in the perioperative or postoperative setting provide varying degrees of survival advantage. Although there is considerable data regarding adjuvant chemotherapy and chemoradiotherapy since the Intergroup-0116 study, there is still no established uniform treatment protocol depending on the type of surgery, histological subgroup, or extent of disease. The present review is aimed at identifying the advances in treatment strategies and discussing the pros and cons of each strategy.