Fast Five Quiz: Gastric Cancer Management

Elwyn C. Cabebe, MD

Disclosures

April 06, 2022

Surgical resection is the principal therapy for gastric cancer, as it offers the only potential for cure. The most common surgical procedures are total, subtotal, or distal gastrectomy. The choice of procedure and the extent of nodal dissection are determined by the ability to obtain clear microscopic margins. In patients who present with regionally advanced disease, removal of involved adjacent organs, such as the spleen, may be required.

Chemotherapy, used in conjunction with surgery (either before or after), has several functions, including downstaging of disease to increase resectability, decreasing micrometastatic disease burden prior to surgery, determining patient tolerability prior to surgery, determining chemotherapy sensitivity overall, reducing the rate of local and distant recurrences, and ultimately, improving survival. However, the choice of preoperative and postoperative chemotherapy vs postoperative chemoradiation therapy remains controversial.

Radiotherapy is most often administered postoperatively and can provide positive outcomes. Several studies have shown that patients who received adjuvant radiotherapy experienced improvements in both overall and relapse-free survival and reductions in locoregional failure.

For medically fit patients, perioperative neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is appropriate. Perioperative therapy is common practice, with chemoradiotherapy after surgery showing a clear survival benefit in patients who did not receive preoperative chemotherapy. For patients who received preoperative chemotherapy, the addition of postoperative radiotherapy has not demonstrated additional benefit. Medically unfit patients can be treated with chemoradiotherapy or chemotherapy.

Learn more about the treatment and management of gastric cancer.

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