Treatment of Resectable Gastric Cancer: An Update on the Role of Radiation and Chemotherapy

The operative and perioperative management of gastric cancer has been an area of controversy and ongoing study in both Eastern and Western patient populations. The extent of lymphadenectomy varies across regions. Various combinations of chemotherapy and radiation in the neoadjuvant and adjuvant setting have been studied in large randomized controlled trials. In the West, two major trials, the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial and the SWOG/INT 0116 trial by Macdonald et al. have influenced perioperative therapy, but the efficacy of one versus the other has not yet been determined. Newer studies, such as the CRITICS trial, are investigating the potential benefits of neoadjuvant therapy in combination with adjuvant chemoradiation. This review describes the ongoing controversies in gastric cancer multimodal management and encompasses the evidence to date supporting current practices in the West. Sarwat Ahmad* and Nader Hanna Department of Surgery, University of Maryland School of Medicine, USA