Neoadjuvant treatment for gastric cancer in the West: a critical review

Improvements in surgical treatment have approximated the survival results in Western countries to those observed in Asia. However, even with optimal surgery, at least 30% of patients treated with curative intent will have recurrence. This review is focused on the neoadjuvant chemotherapy phase III trials performed in the West, highlighting their limitations and favorable results. Also, a rationale describing the reasons why this multimodality set of treatment is favored in Western countries is developed. Also, some controversies regarding perioperative chemotherapy are presented, such as the addition of radiotherapy, the association with hyperthermic intraperitoneal chemotherapy (HIPEC) and the criteria used for patient selection, in order to identify those who could have better response rates to chemotherapy.