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[Adjuvant therapy concepts in advanced stomach carcinoma. Future treatment not without irradiation?].

Perforation of the wall of the stomach, or positive lymph nodes appreciably worsens the prognosis of resected gastric carcinoma. In such a situation, neither adjuvant chemotherapy [12] nor optimal lymph node resection achieves a significant improvement in overall survival [5-8]. In contrast, a significant benefit of adjuvant radiochemotherapy after curative resection of advanced gastric carcinoma has been demonstrated. Thus, standardized postoperative radiochemotherapy should be applied after standardized surgery with a D1 resection. Optimal supportive treatment, that is, at least 1500 kcal/day, appropriate treatment of reflux or dumping symptoms, and supplementation for iron, vitamin B12 and calcium deficiency, is mandatory, if therapeutic success is not to be compromised [13,14].