Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Cancer: Where Are We at?

Abstract

Locally advanced gastric cancer (LAGC) has a poor prognosis with surgical resection alone, and neoadjuvant treatment has been recommended to improve surgical and oncological outcomes. Although neoadjuvant chemotherapy has been established to be effective for LAGC, the role of neoadjuvant chemoradiotherapy (NCRT) remains under investigation. Clinical experience and research evidence on esophagogastric junction adenocarcinoma (e.g., cardia gastric cancers) indicate that the likelihood of achieving sustainable local control is higher through NCRT than through resection alone. Furthermore, NCRT also has an acceptable treatment-related toxicity and adverse event profile. In particular, it increases the likelihood of achieving an R0 resection and a pathological complete response (pCR). Moreover, NCRT results in higher overall and recurrence-free survival rates than surgery alone; however, evidence on the survival benefits of NCRT versus neoadjuvant chemotherapy (NCT) remains conflicting. For noncardia gastric cancer, the efficacy of NCRT has mostly been reported in retrospective studies, and several large clinical trials are ongoing. Consequently, NCRT might play a more essential role in unresectable LAGC, for which NCT alone may not be adequate to attain disease control. The continual improvements in systemic treatments, radiotherapy techniques, and emerging biomarkers can also lead to improved personalized therapy for NCRT. To elucidate the contributions of NCRT to gastric cancer treatment in the future, the efficacy, potential toxicity, predictive biomarkers, and clinical considerations for implementing NCRT in different types of LAGC were reviewed.

Prognostic nomogram for resectable gastric cancer after preoperative chemotherapy to assist in decision-making for adjuvant chemotherapy: a retrospective study combined with external validation

“…In order to improve the prognosis of patients with GC, NACT have achieved some results [12][13][14]. NACT can improve the resection rate of surgery, control or even eliminate micrometastasis before surgery, and reduce the possibility of recurrence after surgery by lowering the stage of patients with advanced GC [15][16][17][18]. In 2006, the MAGIC study included 503 resectable GC patients, 250 of whom received NACT plus surgery, and 253 received just surgery.…”

Identification of the Mechanism of Action of the Index Components of Banxia Xiexin Decoction for Gastric Cancer through Network Pharmacology, Bioinformatics, and Molecular Docking Analysis

“…Te disease is becoming a social and economic burden for all countries, especially developing countries, including China [1][2][3]. Despite multiple therapeutic approaches such as surgical resection, chemotherapy, target therapies, and neoadjuvant chemoradiotherapy, the prognosis for patients with gastric cancer remains unsatisfactory [4,5]. Terefore, it is imperative to identify and develop new approaches to treating gastric cancer.…”

Analysis of Patient Outcomes following Curative R0 Multiorgan Resections for Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

“…The prognosis of locally advanced gastric cancer (LAGC) remains a formidable challenge in the field of oncological surgery [1,2]. Despite advancements in preoperative chemotherapy and radiation therapy, the survival rates post-surgery have shown only modest improvements over the past decades, with approximately 40% overall survival 2 of 20 in all gastric cancers, and from 0% to 15% in disseminated and LAGC [3][4][5].…”