This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bamias, A. Articles by Pavlidis, N. Search for Related Content PubMed PubMed Citation Articles by Bamias, A. Articles by Pavlidis, N.

Systemic Chemotherapy in Gastric Cancer: Where Do We Stand Today?

Oncology Department, University Hospital, Ioannina, Greece

Correspondence: N. Pavlidis, M.D., University of Ioannina, Medical School, Department of Internal Medicine, Ioannina 451 10, Greece. Telephone: 30-651-99394; Fax: 30-651-45944; e-mail: npavlid{at}cc.uoi.gr

Gastric cancer is one of the major causes of cancer-related mortality worldwide. Its prognosis is poor, and surgery offers the only realistic chance of cure. Nevertheless, most of the patients present with inoperable tumors, while the recurrence rate after potentially curable resections is high. In these patients, systemic chemotherapy has been used for palliation of symptoms and possibly for prolongation of survival.

5-fluorouracil (5-FU) is the most widely used agent in chemotherapy of gastric cancer alone or combined with other cytotoxic drugs. Until recently, combination chemotherapy produced modest results, with no significant impact on survival. Progress in research studying the mechanisms of action of various chemotherapeutic agents led to the design of more active chemotherapy regimens. Combinations of 5-FU and cisplatin and the use of modulators of 5-FU activity have produced high response rates, including complete responses in more than 10% of patients with advanced gastric cancer, and, in certain studies, a small but significant survival benefit over older regimens.

Adjuvant chemotherapy has not generally produced a significant survival benefit in patients undergoing curative resection. The use of newer, more effective regimens is currently being investigated and might prove useful in certain high-risk groups.

Neoadjuvant chemotherapy, chemoradiotherapy, and chronomodulated administration of 5-FU, along with the use of novel chemotherapeutic agents, represent exciting areas for clinical research which might further improve the role of systemic chemotherapy in gastric carcinoma.

Key Words. Gastric cancer • Gastric adenocarcinoma • Chemotherapy • Adjuvant chemotherapy • 5-fluorouracil • Continuous infusion