Chemotherapy, Targeted Therapy & Radiation Therapy
In addition to surgery, your team may recommend treatments such as chemotherapy and radiation to improve your chances of a cure as well as to help you live longer and experience fewer symptoms of stomach cancer, if the disease has spread to the outer layer of the stomach wall, lymph nodes, or nearby organs. The treatment plan may include receiving chemotherapy before surgery (called neoadjuvant therapy) to first shrink a tumor, or after surgery (called adjuvant therapy) to eliminate any remaining cancer cells.
Our doctors are skilled at selecting the most effective chemotherapy drug or combination of drugs for you. If you have advanced cancer or for various reasons cannot safely undergo surgery, we may combine chemotherapy with radiation therapy to help lengthen and improve your quality of life.
Although not common, we sometimes recommend intraperitoneal (IP) chemotherapy to treat stomach cancer. With this approach, chemotherapy drugs are placed directly into the internal lining of the abdominal area (called the peritoneal cavity) through a surgically implanted catheter. This approach enables us to deliver a high concentration of chemotherapy agents directly to the cancerous tissue, which may increase the effectiveness of treatment compared with chemotherapy given through the vein or by mouth.
Targeted Therapy and Investigational Approaches
We are evaluating the effectiveness of treating stomach cancer with targeted therapies that block specific processes involved in promoting the development and growth of tumors. We determine which targeted therapy is best for you based on the unique molecular characteristics of the tumor. These agents are given in combination with conventional chemotherapy.
For example, a large clinical trial demonstrated that giving the drug Herceptin® in combination with chemotherapy improves tumor shrinkage and survival in people with stomach cancer who have a mutation in the HER2 gene. We are also studying the long-term effectiveness of and development of resistance to therapies aimed at HER2 and other mutations, as well as new combinations of conventional chemotherapy drugs.
The hunt for stomach tumor biomarkers continues as well. These substances, found in tumor tissue or released from a tumor into the blood or other bodily fluids, hold hope for helping us to select the most effective treatments and to avoid the development of drug resistance.
Investigators are also exploring imaging techniques such as PET to identify people who have an early response to chemotherapy. Studies indicate that PET imaging can help predict long-term survival and provide information that may help doctors determine whether or not to continue the chemotherapy regimen.
Radiation therapy uses high-energy rays or particles to kill cancer cells. Doctors at Memorial Sloan Kettering often use this approach after surgery for stomach cancer (alone or in combination with chemotherapy) to destroy any remaining cancer cells. We may also recommend radiation therapy to reduce symptoms in people whose cancer cannot be operated on.
Our sophisticated technologies deliver therapeutic doses of radiation directly to tumors in and around the stomach while limiting the radiation dose to nearby healthy tissues. This approach can help to avoid side effects caused by damage to healthy tissue.
We combine advanced imaging with specialized techniques to monitor your progress during and after treatment, and to further enhance its precision and effectiveness. Through clinical trials we are also investigating new combinations of chemotherapy and radiation therapy.
Image-Guided Radiation Therapy
At Memorial Sloan Kettering we often use a technology called image-guided radiation therapy (IGRT) to treat people with stomach cancer. IGRT uses highly sophisticated computer software and three-dimensional imaging to mold high-dose radiation beams to the contours of each tumor. Using this technique, large amounts of radiation can be delivered directly to the tumor while reducing the risk of damage to other organs.
Because the stomach can shift during breathing, our radiation therapists use a technique called respiratory gating to deliver radiation only during certain points in your breathing cycle. Real-time CT scans are used during the treatment session to identify the optimal position of the tumor for giving radiation.
Our radiation therapists work closely as a team to ensure the highest level of safety during every step of your treatment. Medical physicists carefully plan each treatment and are present during each radiation procedure to ensure that the correct dose of radiation is delivered precisely where it is needed.