Gastric Carcinoma Neoadjuvant and Adjuvant Therapy

1.1 Epidemiology In the last 80 years, the incidence of gastric cancer and gastric cancer-related mortality has decreased significantly. However, gastric cancer is the 4th most common cancer and the 2nd common cause of cancer associated mortality in the world (Crew, K.D. Neugut, A.I., 2006, Ferlay, J., et al., 2010, Ferlay, J., et al., 2010, Jemal, A., et al., 2010, Krejs, G.J., 2010, Malvezzi, M., et al., 2010, Sasako, M., et al., 2010, Shin, H.R., et al., 2010). Gastric cancer according to anatomic location in the stomach, proximal (cardia) and distal (noncardia) is divided into 2 groups. Although decreasing, distal located tumors are still the most common type in developing countries. While there is an increase in proximal located tumors, the distal located gastric cancers have been decreasing in western societies (Ferlay, J., et al., 2010, Krejs, G.J., 2010, Malvezzi, M., et al., 2010). More than 90% of gastric cancers are adenocarcinomas and can be either intestinal, or diffuse type (Crew, K.D. Neugut, A.I., 2006, Krejs, G.J., 2010). The incidence vary significantly throughout the world. More than half of all gastric cancers in the world are seen in eastern Asia (Sasako, M., et al., 2010). Korea and Japan had the highest incidence countries. While its incidence is 60/100.000 for men and 25/100.000 for women in Korea and Japan (Long, N., et al., 2010), it is around 5/100.000 for Australia and New Zealand (Crew, K.D. Neugut, A.I., 2006, Ferlay, J., et al., 2010, Krejs, G.J., 2010, Malvezzi, M., et al., 2010, Sasako, M., et al., 2010, Shin, H.R., et al., 2010). Often seen in whites aged 60-80, the male to female ratio is 2:1, which rises up to 5:1 for proximal tumors (Krejs, G.J., 2010). The main risk factors related to the development of gastric cancer are Helicobacter pylori infection, dietary factors, tobacco use and obesity (Crew, K.D. Neugut, A.I., 2006, Krejs, G.J., 2010, Sasako, M., et al., 2010). Having been the most important cancerrelated mortality in the United States in the 1930s for both sexes, its incidence and mortality rates have dramatically decreased over the years. For the year 2010, 21.000 new cases and 11.000 deaths from stomach cancer are estimated in the United States (Jemal, A., et al., 2010). As the 4th most common cause of cancer-related deaths, gastric cancer incidence and mortality rates among the European countries also show significant variations (Ferlay, J., et al., 2010, Krejs, G.J., 2010, Malvezzi, M., et al., 2010). The incidence of stomach cancer in men