Treatment of Resectable Locally Advanced Gastric Cancer with Regional Lymph Node Metastasis
This protocol addresses resectable locally advanced gastric cancer presenting with cT2–cT3 disease and confirmed regional lymph node metastasis — or cT4 disease — with no distant metastasis. A perioperative chemotherapy approach combining neoadjuvant and adjuvant treatment around surgery is the framework for this population.
Patient Population
Patients eligible for this protocol have resectable locally advanced gastric cancer with intra-abdominal regional lymph node involvement (cT2/3N+ or cT4Nany) and no evidence of distant metastasis. Neoadjuvant chemotherapy (NCT) as part of a perioperative strategy is a key consideration for this group.
Adjuvant Phase of Perioperative Management
Adjuvant chemotherapy completing the perioperative regimen is central to this protocol. The full regimen options, selection criteria, and sequencing are available in the complete structured protocol.
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.
- Adjuvant chemotherapy (S-1 or capecitabine and oxaliplatin [CAPOX]) is recommended in patients with pathological stage II or III gastric cancer.