Clinical research of neoadjuvant chemotherapy for gastric cancer-current and future concepts

Surgery is considered the mainstay of curative therapy for locally advanced gastric cancer (GC). The necessity of complete tumor resection and adequate lymphadenectomy (D2 lymphadenectomy) has been advocated before. Due to the lack of national screening programs in Western countries, most GC cases are diagnosed in a locally advanced tumor-stage, which causes frequent recurrences and impaired survival prognosis. Based on this observation neoadjuvant treatment concepts were developed. Starting in the 1990s an increasing number of patients with locally advanced GC were subjected to a pre-, peri-, or postoperative chemotherapeutic treatment with the aim to improve prognosis after curative resection. However, treatment decisions largely depend on in which part of the world the patient lives, since in different regions of the world different regimens are preferred. This manuscript summarizes the relevant studies dealing with neoadjuvant chemotherapy concepts for GC and provides an overview on the latest developments in this area.