Surgery is still the main treatment for gastric cancer, however, due to the lack of screening for gastric cancer and the lack of typical symptoms of early gastric cancer that can be easily ignored, fewer cases of gastric cancer are diagnosed in China, and progressive gastric cancer predominates. It is difficult to achieve eradication of progressive gastric cancer with only single surgical treatment, and comprehensive treatment becomes the key to increase the cure rate and survival rate and improve the quality of life.
Chemotherapy, as an important component of comprehensive treatment, is one of the most important tools in the treatment of gastric cancer today. Except for a few patients with early-stage gastric cancer and advanced gastric cancer patients with an expected survival of less than 3 months, chemotherapy is usually recommended for those who are physically able to do so.
Taking into account both the timing and the purpose of chemotherapy, gastric cancer chemotherapy can be divided into preoperative neoadjuvant chemotherapy, postoperative adjuvant chemotherapy, and palliative chemotherapy. Which patients need to receive these chemotherapies? The following will be described specifically.
Which patients need preoperative neoadjuvant chemotherapy?
Neoadjuvant chemotherapy for gastric cancer is chemotherapy given before radical surgery for gastric cancer to downstage the tumor, shrink the mass, and kill invisible metastatic cells early, thereby improving the cure rate and reducing the risk of tumor recurrence.
The 2017 edition of the Chinese Society of Clinical Oncology (COSO) guidelines for the management of primary gastric cancer recommends preoperative neoadjuvant chemotherapy for patients with progressive gastric cancer, especially those with clinical stage III or higher and positive lymph nodes.
Which patients need postoperative adjuvant chemotherapy?
Adjuvant chemotherapy for gastric cancer is chemotherapy that is administered after a patient has undergone surgery for gastric cancer. The goal of adjuvant chemotherapy is to remove tumor cells that may enter or have entered the circulation, reduce the risk of recurrence and metastasis of gastric cancer, and bring the patient to a cure if possible.
The National Comprehensive Cancer Network (NCCN) Gastric Cancer Guidelines 2017 edition and the Chinese Gastric Cancer Guidelines both recommend that postoperative adjuvant chemotherapy should be given to those with pathologically confirmed positive lymph nodes after gastric cancer surgery and those who are in the progressive stage of gastric cancer. However, the need for adjuvant chemotherapy for gastric cancer patients requires a comprehensive and professional assessment by an oncologist based on the patient’s postoperative stage (depth of primary tumor infiltration and lymph node metastasis), tumor pathological staging, age, and physical ability.
Which patients need palliative chemotherapy?
Palliative chemotherapy is chemotherapy for patients with advanced gastric cancer, the vast majority of whom cannot be cured and can only be treated with chemotherapy to prolong their survival as long as possible, reduce or alleviate discomfort and pain, and improve their quality of life as much as possible. Patients who require palliative chemotherapy usually include patients with gastric cancer who already have distant metastases at the time of initial diagnosis and patients with advanced gastric cancer who have recurrence or metastases after postoperative chemotherapy.
In conclusion, chemotherapy is one of the important tools in the comprehensive treatment of gastric cancer, and for different patients, doctors will develop a treatment plan appropriate to their specific conditions. (Contributed by Xiaoyu Guo, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)