Treatment of Locally Advanced Gastric Cancer with Regional Lymph Node Metastasis (cT2–cT4)

In patients with resectable locally advanced gastric cancer who present with regional lymph node involvement or cT4 staging without distant spread, the treatment approach goes beyond surgery alone. This protocol defines the evidence-based strategy for this specific clinical setting.

Clinical Scenario

This protocol applies to patients with one of the following presentations:

Resectable locally advanced gastric cancer staged cT2–cT3 with regional lymph node metastasis and no distant metastasis
cT4 gastric cancer with no distant metastasis

          Regional lymph node metastasis (intra-abdominal lymph node involvement) is the defining locoregional feature that shapes the treatment approach in this scenario.
        

Treatment Approach

Neoadjuvant chemotherapy as part of a perioperative chemotherapy strategy is a key component for eligible patients in this setting. The full protocol specifies which regimens are supported by evidence, how they are sequenced with surgery, and how to select between options.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.5230/jgc.2025.25.e11

NCT as part of perioperative chemotherapy can be considered for patients with resectable locally AGC.

The PRODIGY study in Korea investigated whether NCT with docetaxel, oxaliplatin, and S-1 (DOS) followed by surgery and adjuvant S-1 could improve outcomes compared to upfront surgery followed by adjuvant S-1 in patients with locally AGC with clinical T2/3N+ or cT4Nany disease.

The RESOLVE study compared perioperative SOX vs. upfront surgery followed by adjuvant CAPOX in patients with cT4aN+ or cT4bNany disease.

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