Skip to main content

Gastric carcinoma

Current Oncology Reports volume 6, pages 192–198 (2004)Cite this article

Abstract

Although gastric cancer is still a worldwide major public health concern, it remains relatively uncommon in the Western countries. Despite improvement in surgical morbidity and mortality, as well as significant advancement of chemotherapy and radiotherapy options, the survival for gastric cancer has not significantly improved over the past decades. In the United States, standard of care for localized resectable gastric cancer is with adjuvant chemoradiotherapy. In this article, we summarize salient randomized and phase II and III clinical trials representing current treatment for gastric cancer.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. American Cancer Society: 2004 Cancer Statistics. ACS: Philadelphia; 2004.

    Google Scholar 

  2. Fuchs CS, Mayer RJ: Gastric carcinoma. N Engl J Med 1995, 333:32–41.

    PubMed  Article  CAS  Google Scholar 

  3. Wiggins CL, Becker TM, Key CR, Samet JM: Stomach cancer among New Mexico’s American Indians, Hispanic whites, and non-Hispanic whites. Cancer Res 1989, 49:1595–1599.

    PubMed  CAS  Google Scholar 

  4. Powell J, McConkey CC: Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 1990, 62:440–443.

    PubMed  CAS  Google Scholar 

  5. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr: Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991, 265:1287–1289. A very important study.

    PubMed  Article  CAS  Google Scholar 

  6. Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut 2001, 49:347–353. A very important study.

  7. Rhyu MG, Park WS, Jung YJ, et al.: Allelic deletions of MCC/APC and p53 are frequent late events in human gastric carcinogenesis. Gastroenterology 1994, 106:1584–1588.

    PubMed  CAS  Google Scholar 

  8. Becker KF, Atkinson MJ, Reich U, et al.: E-cadherin gene mutations provide clues to diffuse type gastric carcinomas. Cancer Res 1994, 54:3845–3852.

    PubMed  CAS  Google Scholar 

  9. Yoshida T, Sakamoto H, Terada M: Amplified genes in cancer in upper digestive tract. Semin Cancer Biol 1993, 4:33–40.

    PubMed  CAS  Google Scholar 

  10. Dooley CP, Larson AW, Stace NH, et al.: Double-contrast barium meal and upper gastrointestinal endoscopy: a comparative study. Ann Intern Med 1984, 101:538–545.

    PubMed  CAS  Google Scholar 

  11. Longo WE, Zucker KA, Zdon MJ, Modlin IM: Detection of early gastric cancer in an aggressive endoscopy unit. Am Surg 1989, 55:100–104.

    PubMed  CAS  Google Scholar 

  12. Graham DY, Schwartz JT, Cain GD, Gyorkey F: Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology 1982, 82:228–231.

    PubMed  CAS  Google Scholar 

  13. Greene F, Page D, Fleming I, eds: American Joint Committee on Cancer (AJCC) Cancer Staging Manual, edn 6. New York: Springer-Verlag; 2002.

    Google Scholar 

  14. Pollack BJ, Chak A, Sivak MV Jr: Endoscopic ultrasonography. Semin Oncol 1996, 23:336–346.

    PubMed  CAS  Google Scholar 

  15. Ott K, Sendler A, Becker K, et al.: Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II study. Gastric Cancer 2003, 6:159–167. A very important study.

    PubMed  Article  CAS  Google Scholar 

  16. Conlon KC, Karpeh MS Jr: Laparoscopy and laparoscopic ultrasound in the staging of gastric cancer. Semin Oncol 1996, 23:347–351.

    PubMed  CAS  Google Scholar 

  17. Macdonald JS, Smalley SR, Benedetti J, et al.: Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001, 345:725–730. A very important study.

    PubMed  Article  CAS  Google Scholar 

  18. Wanebo HJ, Kennedy BJ, Chmiel J, et al.: Cancer of the stomach: a patient care study by the American College of Surgeons. Ann Surg 1993, 218:583–592.

    PubMed  Article  CAS  Google Scholar 

  19. Noguchi Y, Imada T, Matsumoto A, et al.: Radical surgery for gastric cancer: a review of the Japanese experience. Cancer 1989, 64:2053–2062.

    PubMed  Article  CAS  Google Scholar 

  20. Cuschieri A, Fayers P, Fielding J, et al.: Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996. 347:995–999.

    PubMed  Article  CAS  Google Scholar 

  21. Bonenkamp JJ, Hermans J, Sasako M, et al.: Extended lymphnode dissection for gastric cancer. Dutch Gastric Cancer Group. N Engl J Med 1999, 340:908–914.

    PubMed  Article  CAS  Google Scholar 

  22. Karpeh MS, Leon L, Klimstra D, Brennan MF: Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. Ann Surg 2000, 232:362–371.

    PubMed  Article  CAS  Google Scholar 

  23. Middleton G, Cunningham D: Current options in the management of gastrointestinal cancer. Ann Oncol 1995, 6(Suppl 1):17–25.

    PubMed  Google Scholar 

  24. Agboola O: Adjuvant treatment in gastric cancer. Cancer Treat Ref 1994, 20:217–240.

    Article  CAS  Google Scholar 

  25. Gunderson LL, Sosin H: Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 1982, 8:1–11.

    PubMed  CAS  Google Scholar 

  26. Gez E, Sulkes A, Peretz T, et al.: Combined 5-fluorouracil and radiation therapy following resection of locally advanced gastric carcinoma: a 5-year follow-up. Recent Results Cancer Res 1988, 110:52–56.

    PubMed  CAS  Google Scholar 

  27. Moertel CG, Childs DS, O’Fallon JR, et al.: Combined 5-fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol 1984, 2:1249–1254.

    PubMed  CAS  Google Scholar 

  28. Bleiberg H, Goffin JC, Dalesio O, et al.: Adjuvant radiotherapy and chemotherapy in respectable gastric cancer: a randomized trial of the gastro-intestinal tract cancer cooperative group of the EORTC. Eur J Surg Oncol 1989, 15:535–543.

    PubMed  CAS  Google Scholar 

  29. Yao JC, Ajani JA: Therapy of localized gastric cancer: preoperative and postoperative approaches. Ann Oncol 2002, 13(suppl 4):7–12. An important study.

    PubMed  Google Scholar 

  30. Sautner T, Hofbauer F, Depisch D, et al.: Adjuvant intraperitoneal cisplatin chemotherapy does not improve long-term survival after surgery for advanced gastric cancer. J Clin Oncol 1994, 12:970–974.

    PubMed  CAS  Google Scholar 

  31. Yu W, Whang I, Suh I, et al.: Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer. Ann Surg 1998, 228:347–354.

    PubMed  Article  CAS  Google Scholar 

  32. Rosen HR, Jatzko G, Repse S, et al.: Adjuvant intraperitoneal chemotherapy with carbon-adsorbed mitomycin in patients with gastric cancer: results of a randomized multicenter trial of the Austrian Working Group for Surgical Oncology. J Clin Oncol 1998, 16:2733–2738. important study

    PubMed  CAS  Google Scholar 

  33. Kelsen D, Karpeh M, Schwartz G, et al.: Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil. J Clin Oncol 1996, 14:1818–1828.

    PubMed  CAS  Google Scholar 

  34. Newman E, Marcus SG, Potmesil M, et al.: Neoadjuvant chemotherapy with CPT-11 and cisplatin downstages locally advanced gastric cancer. J Gastrointest Surg 2002, 6:212–223.

    PubMed  Article  Google Scholar 

  35. Songun I, Keizer HJ, Hermans J, et al.: Chemotherapy for operable gastric cancer: results of the Dutch randomized FAMTX trial. The Dutch Gastric Cancer Group (DGCG). Eur J Cancer 1999, 35:558–562.

    PubMed  Article  CAS  Google Scholar 

  36. Allum WH, Cunningham D, Weeden S: Perioperative chemotherapy in operable gastric and lower oesophageal cancer: a randomized, controlled trial (the MAGIC trial, ISRCTN 93793971) [abstract 998]. Proc Am Soc Clin Oncol 2003, 22:249. ery important study

    Google Scholar 

  37. Ajani JA, Komaki R, Putnam JB, et al.: A three-step strategy of induction chemotherapy then chemoradiation followed by surgery in patients with potentially resectable carcinoma of the esophagus or gastroesophageal junction. Cancer 2001, 92:279–286. important study

    PubMed  Article  CAS  Google Scholar 

  38. Findlay M, Cunningham D, Norman A, et al.: A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF). Ann Oncol 1994, 5:609–616.

    PubMed  CAS  Google Scholar 

  39. Webb A, Cunningham D, Scarffe JH, et al.: Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997, 15:261–267. ery important study

    PubMed  CAS  Google Scholar 

  40. Ajani JA, Van Cutsem E, Moiseyenko V, et al.: Docetaxel (D), cisplatin, 5-fluorouracil compare to cisplatin (C) and 5-fluorouracil (F) for chemotherapy-naïve patients with metastatic or locally recurrent, unresectable gastric carcinoma (MGC): interim results of a randomized phase III trial (V325) [abstract 999]. Proc Am Soc Clin Oncol 2003, 22:249. ery important study

    Google Scholar 

  41. Imanaga H, Nakazato H: Results of surgery for gastric cancer and effect of adjuvant mitomycin C on cancer recurrence. World J Surg 1977, 2:213–221.

    PubMed  Article  CAS  Google Scholar 

  42. Estape J, Grau JJ, Alcobendas F, et al.: Mitomycin C as an adjuvant treatment to resected gastric cancer: a 10-year follow-up. Ann Surg 1991, 213:219–221.

    PubMed  Article  CAS  Google Scholar 

  43. Grau JJ, Estape J, Alcobendas F, et al.: Positive results of adjuvant mitomycin-C in resected gastric cancer: a randomised trial on 134 patients. Eur J Cancer 1993, 29A:340–342.

    PubMed  Article  CAS  Google Scholar 

  44. Controlled trial of adjuvant chemotherapy following curative resection for gastric cancer. The Gastrointestinal Tumor Study Group. Cancer 1982, 49:1116–1122.

  45. Cirera L, Balil A, Batiste-Alentorn E, et al.: Randomized clinical trial of adjuvant mitomycin plus tegafur in patients with resected stage III gastric cancer. J Clin Oncol 1999, 17:3810–3815.

    PubMed  CAS  Google Scholar 

  46. Grau JJ, Estape J, Fuster J, et al.: Randomized trial of adjuvant chemotherapy with mitomycin plus ftorafur versus mitomycin alone in resected locally advanced gastric cancer. J Clin Oncol 1998, 16:1036–1039.

    PubMed  CAS  Google Scholar 

  47. Neri B, Cini G, Andreoli F, et al.: Randomized trial of adjuvant chemotherapy versus control after curative resection for gastric cancer: 5-year follow-up. Br J Cancer 2001, 84:878–880.

    PubMed  Article  CAS  Google Scholar 

  48. Rougier P, Mahjoubi M, Lasser P, et al.: Neoadjuvant chemotherapy in locally advanced gastric carcinoma: a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum. Eur J Cancer 1994, 30A:1269–1275.

    PubMed  Article  CAS  Google Scholar 

  49. Ajani JA, Mansfield PF, Ota DM: Potentially resectable gastric carcinoma: current approaches to staging and preoperative therapy. World J Surg 1995, 19:216–220.

    PubMed  Article  CAS  Google Scholar 

  50. Crookes P, Leichman CG, Leichman L, et al.: Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report. Cancer 1997, 79:1767–1775.

    PubMed  Article  CAS  Google Scholar 

  51. Ajani JA, Mansfield PF, Lynch PM, et al.: Enhanced staging and all chemotherapy preoperatively in patients with potentially resectable gastric carcinoma. J Clin Oncol 1999, 17:2403–2411.

    PubMed  CAS  Google Scholar 

  52. Plukker JT, Mulder NH, Sleijfer DT, et al.: Chemotherapy and surgery for locally advanced cancer of the cardia and fundus: phase II study with methotrexate and 5-fluorouracil. Br J Surg 1991, 78:955–958.

    PubMed  Article  CAS  Google Scholar 

  53. Ajani JA, Mayer RJ, Ota DM, et al.: Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Natl Cancer Inst 1993, 85:1839–1844.

    PubMed  Article  CAS  Google Scholar 

  54. Geh JI, Glynne-Jones R, Kwok QS, et al.: Preoperative ECF chemotherapy in gastro-oesophageal adenocarcinoma. Clin Oncol (R Coll Radiol) 2000, 12:182–187.

    CAS  Google Scholar 

  55. Melcher AA, Mort D, Maughan TS: Epirubicin, cisplatin and continuous infusion 5-fluorouracil (ECF) as neoadjuvant chemotherapy in gastro-oesophageal cancer. Br J Cancer 1996, 74:1651–1654.

    PubMed  CAS  Google Scholar 

  56. Fink U, Schuhmacher C, Stein HJ, et al.: Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection. Br J Surg 1995, 82:1248–1252.

    PubMed  Article  CAS  Google Scholar 

  57. Ajani JA, Ota DM, Jessup JM, et al.: Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy. Cancer 1991, 68:1501–1506.

    PubMed  Article  CAS  Google Scholar 

  58. Menges M, Schmidt C, Lindemann W, et al.: Low toxic neoadjuvant cisplatin, 5-fluorouracil and folinic acid in locally advanced gastric cancer yields high R-0 resection rate. J Cancer Res Clin Oncol 2003, 129:423–429.

    PubMed  Article  CAS  Google Scholar 

  59. Yonemura Y, Sawa T, Kinoshita K, et al.: Neoadjuvant chemotherapy for high-grade advanced gastric cancer. World J Surg 1993, 17:256–262.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. GI Medical Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Mailbox 426, 77030, Houston, TX, USA

    Alexandria T. Phan MD & Jaffer A. Ajani MD

Authors
  1. Alexandria T. Phan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaffer A. Ajani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Phan, A.T., Ajani, J.A. Gastric carcinoma. Curr Oncol Rep 6, 192–198 (2004). https://doi.org/10.1007/s11912-004-0049-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-004-0049-7

Keywords

  • Gastric Cancer
  • Docetaxel
  • Clin Oncol
  • Gastric Carcinoma
  • Curative Resection