[PubMed] [Google Scholar] 49. GAC individuals are limited and more research is needed. illness, smoking, high salt intake, and obesity. STANDARD TREATMENT FOR RESECTABLE GAC IN THE USA Resectable GAC individuals with cT1b can proceed to surgery (in the community establishing) or receive preoperative therapy (in the university or college establishing) [Table 1]. If GAC individuals directly undergo surgery treatment, postoperative chemoradiation is recommended based on the pathological stage or quality of surgery. Endoscopic resection is performed relating to Japanese guideline, but early stage (stage I) GAC is definitely rare in the USA. Table 1. Summary of NCCN guideline for resectable gastric adenocarcinoma = 0.0046], and the HR for RFS is 1.51 (95% CI 1.25C1.83; 0.001). Both overall relapse and locoregional relapse were decreased in postoperative chemoradiotherapy group[6,7]. According to these results, Cynarin postoperative chemoradition therapy became the standard treatment. It is appropriate only for those individuals who undergo suboptimal surgery and don’t received preoperative chemotherapy. INT 0116 experienced some inherent drawbacks since surgical method was not part of the protocol. Therefore, in the INT-0116 trial, D0, D1, and D2 lymph node dissections underwent in 54%, 36%, and 10% individuals, respectively. Consequently, the effectiveness of postoperative chemoradiation after D2 resection remains unclear. The Designer (Adjuvant Chemoradiation Therapy in Belly Tumor) trial in Korea compared postoperative treatment with capecitabine plus cisplatin (XP) and Cynarin XP plus radiation after curative resection with D2 lymph node dissection. This trial showed that the estimated 3-yr disease free survival rates were 78.2% in the chemoradiation group and 74.2% in XP alone group (= 0.862), suggesting the addition of radiation to adjuvant XP did not significantly reduce recurrence after D2 dissection. Additionally, the randomized phase III CRITICS-study assessed perioperative chemo = 393) and chemoradiation group (= 395), and the 5-yr survival is definitely 41.3% for chemotherapy group and 40.9% for chemoradiation group (= 0.99). These results suggest that postoperative chemoradiation is not useful if ideal or near-optimal surgery is performed. Several chemotherapy regimens before and after chemoradiation were evaluated[10C12]. For instance, Korean study evaluated 5-FU plus cisplatin (FP) before and after concurrent radiotherapy with capecitabine, and this routine was well tolerated. Epirubicin, cisplatin, and 5-FU (ECF) before and after concurrent radiotherapy was assessed, and this routine was Cynarin feasible, ITGA4 but did not improve survival[11,12]. Perioperative chemotherapy Tests evaluating perioperative chemotherapy were held in Europe and its results possess impacted NCCN Guideline as category 1 evidence. MAGIC trial showed an advantage in OS but control and experimental arms performed poorly. The NCCN recommendations have not downgraded ECF based on toxicity issues and poor effectiveness. FNCLCC/FFCD trial randomly assigned 224 individuals into the 2 organizations: 113 to surgery plus perioperative chemotherapy (2 or 3 3 preoperative and 3 or 4 4 postoperative cycles of FP) and 111 to surgery alone. Compared with the surgery only group, the perioperative chemotherapy group experienced a favorable overall survival (5-yr rate, 38% = 0.02) and significantly increased the R0 resection rate (84% = 0.04), but 75% of individuals with this trial had esophageal adenocarcinoma. Recently, MRC-OEO5 trial compared two perioperative chemotherapy routine, 2 cycles FP and 4 cycles ECF/ECX (epirubicin, cisplatin and capecitabine). This study showed no OS benefit for ECF/ECX compared with FP (3-yr rate, 42% = 0.30), suggesting that addition of epirubicin and longer duration does not provide any advantage. However, this trial mainly included individuals with lower esophageal and junctional (types I and II) adenocarcinoma, not GAC. The FLOT4 trial, which is definitely multicenter, randomized, and phase 3 trial, compared perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) and ECF/ECX[16,17]. Of 716 individuals, 360 individuals is assigned into ECF/ECX group and 356 individuals assigned into FLOT group, and FLOT improved median progression-free Cynarin survival (PFS) (30 weeks = 0.001) and median OS (50 weeks = 0.012) compared with ECF/ECX. Fifty percent of individuals in FLOT group completed the planned postoperative treatments, while 37% of individuals in ECF/ECX completed. Perioperative complications were similar across the.