Gastrointestinal cancer club delhi india, Dr.Ajay K.Sachdev delhi based Dept. of Gastrointestinal Surgeon serior gastro intestinal surgeonconsultant Surgery G.I. Surgeon G I Surgery Radiotherapy,Chemotherapy, G.I Cancers Advanced Hepatobiliary, Pancreatic, Esophageal,Intestinal,Colorectal surgeries and G.I. Oncoogy cancers of abdominal organs Gastroenterology IASG CANCERS OF ABDOMINAL ORGANSEXPERIENCED G.I. SURGEON

Localized disease :-

-	Post operative Chemoradiotherapy with 5 Fu and Cisplatin.3 year OS of 50% (41% for surgery alone).
-	Perioperative Chemotherapy with ECF (Epirubiucin, Cisplatin and infusional 5FU). 5 year OS of 36 % Vs 23%.

Paclitaxel and DDP are being evaluated.
Preoperative chemotherapy - tried in resectable localized
cancer with variable results. Can be considered investigational.

Index regimen is Cisplatin and Infusional 5FU- with response rate of 20-30% and survival of 7-8 months.
Addition of Docetaxel (V325) adds 10 % to response rates with 1 month prolongation of survival. 2 year survival is 18%. Toxicity is an issue. Probably for young and fit patients.

Chemotherapy is defined as drugs that are used to kill tumor cells. The large advantage in using chemotherapy is that, since it is a medicine, is travels through the entire body. Hence, if some tumor cells have spread outside of what surgery or radiation can treat, they can potentially be killed by chemotherapy. Similar to radiation, some normal cells are damaged during treatment, resulting in side effects. The standard chemotherapy used in the treatment of gastric cancer is called 5-FU, coupled with another drug called leucovorin. This type of chemotherapy is delivered through the vein. Side effects from 5-FU and leucovorin include nausea, diarrhea, skin changes, and sores of the mouth. Although other chemotherapy drugs (Cisplatin, Oxaliplatin, Docetaxel and Epirubicin) are being investigated for the treatment of gastric cancer, 5-FU plus leucovorin remains the standard.

The standard of care is detailed as follows:

Surgery-to remove all of the cancer, as well as removal of the lymph nodes in the area of the stomach
Radiation-to the area of the upper abdomen, 5 days per week for 5 weeks. Radiation usually starts 4-6 weeks after surgery, to allow for recovery from surgery. Radiation may be delayed a few weeks if chemotherapy is started for a few weeks prior to combining the two treatments.
Chemotherapy-using 5-FU and leucovorin chemotherapy, given during the radiation and also after the radiation is completed. Sometimes chemotherapy is started for a few weeks prior to the start of radiation therapy.

In unfortunate event of disease having spread beyond stomach and adjoining glands, chemotherapy is usually the sole modality of treatment. This can provide relief of symptoms and may be able to prolong the life as well.