Treatment of Stomach Cancer with Regional Lymph Node Involvement in Resectable Locally Advanced Disease

This protocol addresses a specific, well-defined population of gastric cancer patients in whom the disease is still amenable to surgical removal but has reached a locally advanced stage with involvement of regional lymph nodes.

Clinical scenario

Patients present with resectable locally advanced gastric cancer staged at cT2–cT3 with confirmed regional lymph node metastasis and no distant metastasis, or with cT4 disease without distant metastasis. The presence of intra-abdominal regional lymph node involvement is a defining feature of this clinical pathway.

Treatment approach

The protocol centres on a surgical strategy with systematic lymph node clearance, aiming for complete (R0) resection. An additional perioperative component has been evaluated in this population alongside surgery — the full structured approach is in the complete protocol →

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.

Neoadjuvant DOS achieved a higher rate of complete (R0) resection compared to upfront surgery (95% vs. 84%, P<0.001).

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