ABSTRACT
The incidence of gastric cancer in the United States is decreasing, but it remains the third most common cancer worldwide (1). Although complete surgical resection is potentially curative in early stages, locoregional recurrence remains a frustrating problem in patients presenting with more advanced stages of disease (T3-4 or N1-2). Numerous factors contribute to the overall dismal survival rates in gastric cancer, including limited public awareness of the disease in Western cultures, a lack of standardization in diagnostic and clinical algorithms, a paucity of multi-institutional prospective randomized trials to help define standards of care, and an overall aggressive underlying tumor biology. The end result is that most patients are not cured by surgery alone, with high rates of relapse that beg for advances in adjuvant therapy to improve overall the outcomes. Complicating the treatment algorithm for aggressive locoregional therapy are controversies regarding the extent of gastric and lymph-node resection (1-5). In addition to refinements in surgical standards, efforts to improve outcomes have centered on earlier detection of disease, more sophisticated staging tools, and combined modality therapies (6-10).
