Editorial
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World J Gastrointest Surg. Feb 27, 2012; 4(2): 27-31
Published online Feb 27, 2012. doi: 10.4240/wjgs.v4.i2.27
Neoadjuvant chemotherapy for locally advanced gastric cancer: With or without radiation
Ai-Wen Wu, Jia-Fu Ji
Ai-Wen Wu, Jia-Fu Ji, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, Beijing 100142, China
Author contributions: Wu AW and Ji JF concept, designed this editorial, and drafted, revsed and made the final approval of the published version of the manuscript.
Correspondence to: Jia-Fu Ji, MD, PhD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, Beijing 100142, China. jiafuj@hotmail.com
Telephone: +86-10-88196048 Fax: +86-10-88122437
Received: November 18, 2010
Revised: October 26, 2011
Accepted: November 10, 2011
Published online: February 27, 2012
Abstract

The role of perioperative chemotherapy for gastric cancer has been established for gastric cancers in their advanced stage. In most parts of the world, even in Japan and Korea, local recurrence of gastric cancer following curative resection remains a problem. Should radiation be added to chemotherapy to achieve better local and regional control? What is the current evidence? What are the concerns regarding neoadjuvant chemoradiation in terms of safety, efficacy and survival benefit? After a serious review of the literature, the authors conclude that it is still too early to get a definitive answer but radiation seems promising. It may bring a higher pathological response rate. Rationally, more high level clinical trials are needed to confirm the role of radiotherapy in the neoadjuvant setting or to ascertain subsets of patients who may benefit from it. It is of note that surgeons should pay attention to possible complicated circumstances following radiotherapy, maintain proper nutrition status and minimize the occurrence of postoperative complications. As few data are available in Japan and Korea, interpretation and implementation of neoadjuvant radiation or chemoradiation should be done with caution.

Keywords: Stomach; Neoplasm; Treatment; Radiation; Neoadjuvant