• Inoperable
• Radiation
• Radical
• Stomach cancer
• Symptoms

• Humans
• Stomach Neoplasms/radiotherapy
• Stomach Neoplasms/pathology
• Palliative Care/methods
• Radiotherapy Dosage

• Chinese Society of Clinical Oncology (CSCO)
• adjuvant
• chemotherapy
• diagnosis
• gastric cancer
• immunotherapy
• neoadjuvant
• radiotherapy
• surgery
• targeted therapy

• Humans
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/genetics
• Stomach Neoplasms/therapy
• Medical Oncology
• Immunotherapy
• Neoadjuvant Therapy
• China

• gastrointestinal cancer
• tumour biomarkers
• cancer therapy

• Biomarkers, Tumor/genetics
• Biomarkers, Tumor/metabolism
• ErbB Receptors/metabolism
• Humans
• Phosphatidylinositol 3-Kinases/genetics
• Phosphatidylinositol 3-Kinases/metabolism
• Signal Transduction
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/genetics
• Stomach Neoplasms/therapy
• Tumor Suppressor Protein p53

• Guangdong Basic and Applied Basic Research Foundation #2021A1515010117
• The National Key Research and Development Program of China #2018YFA0902801 The 100 Top Talents Program of Sun Yat-Sen University (ZSQYBRJH0001)
• National Natural Science Foundation of China (National Science Foundation of China)
• Guangdong Provincial Key Laboratory of Digestive Cancer Research #2021B1212040006

• gastric cancer
• gastroesophageal cancer
• neoadjuvant therapy
• neoadjuvant chemoradiation
• perioperative chemotherapy
• meta-analysis

• Adenocarcinoma/pathology
• Area Under Curve
• Chemoradiotherapy/methods
• Chemotherapy, Adjuvant/methods
• Humans
• Radium/therapeutic use
• Stomach Neoplasms/pathology
• United States

• P30 CA008748 NCI NIH HHS
• P30 CA072720 NCI NIH HHS
• R50 CA275877 NCI NIH HHS

More than 50% of gastric cancer are at least locally advanced at presentation. For such patients, a multimodal approach rather than mere surgical resection leads to better long-term prognosis. Neoadjuvant chemoradiotherapy is one of the common treatment strategies for local advanced gastric cancer. Based on the experience and evidence from esophago-gastric cancers, the incorporation of systemic and locoregional therapy has shown superior disease control and reduced local recurrence. However, the optimal chemotherapy regimen, patient selection, technical consideration and potential biomarkers are still under investigation. Furthermore, the comparison of neoadjuvant chemoradiotherapy with neoadjuvant/perioperative chemotherapy is also an important issue to be answered. In the review article, we addressed the current available evidence to provide a comprehensive understanding and the use of neoadjuvant chemoradiotherapy for locally advanced gastric cancer. Future studies and ongoing trials will be necessary to determine the best candidate and the role of newer systemic and radiation therapies in such patients. NCRT is a feasible treatment option for LAGC, with the ability to achieve favorable disease control and enable higher radical resection rates over those afforded by perioperative chemotherapy or surgery alone. Large clinical trials examining the comparative efficacy of NCRT and NCT are underway. The discrepancy between the satisfactory pCR rates associated with NCRT and the nonsignificant association between NCRT and survival warrants further exploration. Furthermore, newer therapies such as immunotherapy and adaptive radiotherapy may be implemented in con-junction with NCRT, and the development of useful biomarkers may ultimately lead to the de-velopment of personalized treatments for LAGC. These research directions may lead to the dis-covery of the optimal approach to administering NCRT to patients with LAGC. They may also aid in the determination of the optimal candidates for undergoing NCRT.

Locally advanced gastric cancer (LAGC) has a poor prognosis with surgical resection alone, and neoadjuvant treatment has been recommended to improve surgical and oncological outcomes. Although neoadjuvant chemotherapy has been established to be effective for LAGC, the role of neoadjuvant chemoradiotherapy (NCRT) remains under investigation. Clinical experience and research evidence on esophagogastric junction adenocarcinoma (e.g., cardia gastric cancers) indicate that the likelihood of achieving sustainable local control is higher through NCRT than through resection alone. Furthermore, NCRT also has an acceptable treatment-related toxicity and adverse event profile. In particular, it increases the likelihood of achieving an R0 resection and a pathological complete response (pCR). Moreover, NCRT results in higher overall and recurrence-free survival rates than surgery alone; however, evidence on the survival benefits of NCRT versus neoadjuvant chemotherapy (NCT) remains conflicting. For noncardia gastric cancer, the efficacy of NCRT has mostly been reported in retrospective studies, and several large clinical trials are ongoing. Consequently, NCRT might play a more essential role in unresectable LAGC, for which NCT alone may not be adequate to attain disease control. The continual improvements in systemic treatments, radiotherapy techniques, and emerging biomarkers can also lead to improved personalized therapy for NCRT. To elucidate the contributions of NCRT to gastric cancer treatment in the future, the efficacy, potential toxicity, predictive biomarkers, and clinical considerations for implementing NCRT in different types of LAGC were reviewed.

• chemoradiation therapy
• locally advanced gastric cancer
• neoadjuvant treatment

Clinical research found that TCM is therapeutic in treating gastric cancer. Clearing heat is the most common method, while some antirheumatic medicines are widely used in treatment as well. To explore the pharmacological mechanism, we researched the comparison between heat-clearing medicine and antirheumatic medicine in treating gastric cancer.

First, related ingredients and targets were searched, respectively, and are shown in an active ingredient-target network. Combining the relevant targets of gastric cancer, we constructed a PPI network and MCODE network. Then, GO and KEGG enrichment analyses were conducted. Molecular docking experiments were performed to verify the affinity of targets and ligands. Finally, we analyzed the tumor immune infiltration on gene expression, somatic CNA, and clinical outcome.

A total of 31 ingredients and 90 targets of heat-clearing medicine, 31 ingredients and 186 targets of antirheumatic medicine, and 12,155 targets of gastric cancer were collected. Antirheumatic medicine ranked the top in all the enrichment analyses. In the KEGG pathway, both types of medicines were related to pathways in cancer. In the KEGG map, AR, MMP2, ERBB2, and TP53 were the most crucial targets. Key targets and ligands were docked with low binding energy. Analysis of tumor immune infiltration showed that the expressions of AR and ERBB2 were correlated with the abundance of immune infiltration and made a difference in clinical outcomes.

Quercetin is an important ingredient in both heat-clearing medicine and antirheumatic medicine. AR signaling pathway exists in both types of medicines. The mechanism of the antitumor effect in antirheumatic medicine was similar to trastuzumab, a targeted drug aimed at ERBB2. Both types of medicines were significant in tumor immune infiltration. The immunology of gastric tumor deserves further research.

Gastric cancer is a prevalent cancer with a predilection for Asian ethnicity and male patients. In early and locally advanced gastric cancer, without significant comorbidities, surgery is a part of the treatment management of this cancer. However, with concurrent comorbidities, surgery may not be recommended and alternative treatment options such as palliative chemotherapy and/or radiation and definitive chemoradiation can be considered to reduce morbidity. We present three cases of gastric cancer where definitive chemoradiation with dose escalation was utilized due to underlying comorbidities and poor performance status. The treatment was generally well tolerated by patients and resulted in substantial reduction in gastric mass size in two patients with median overall survival of 10 months.

• definitive chemoradiation
• gastric cancer

• Gastric cancer
• adjuvant
• chemoradiation
• definitive
• neoadjuvant
• radiation therapy

• Adjuvant
• Chemotherapy
• Chinese Society of Clinical Oncology (CSCO)
• Diagnosis
• Gastric cancer
• Immunotherapy
• Neoadjuvant
• Radiotherapy
• Surgery
• Targeted therapy

• China
• Humans
• Medical Oncology
• Societies, Medical
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/therapy

• 5-fluorouracil
• Chemotherapy
• Cisplatin
• Docetaxel
• Epirubicin
• Gastric cancer

In patients affected by gastric cancer (GC), especially those in advanced stage, the multidisciplinary approach of treatment is fundamental to obtain a good disease control and quality of life. Although many chemotherapeutics in combination to radiotherapy are adopted in the peri- or postoperative setting, the most optimal timing, regimens and doses remains controversial. In the era of radical surgery performed with D2-lymphadenectomy, the role of radiation therapy remains to be better defined. Categories of patients, who could benefit more from an intensified local treatment rather than more toxic systemic therapy, are still under investigation. Evidence and recent updates of the randomized trials, meta-analysis and prospective trials show that the postoperative radiotherapy plays a fundamental role in reducing the loco-regional recurrence and in turn the disease-free survival in operable advanced GC patients, also after a well performed D2 surgery. Therapeutic decisions should be taken considering the individual patients, but the multimodal approach is necessary to guarantee a longer survival and a good quality of life. Ongoing randomized trials could better define the timing and the combination of radiotherapy and systemic therapy.

• Adjuvant chemoradiation
• Locally advanced
• Perioperative chemotherapy
• Gastric cancer
• Combined treatment

• 5FU, 5-fluorouracil
• 5FU-LV, 5-fluorouracil leucovorin
• Adenocarcinoma
• Adjuvant therapy
• CRT, chemoradiotherapy
• CT, chemotherapy
• Chemoradiotherapy
• DCF, Doxorubicin Cisplatin 5-fluorouracil
• ECF, Epirubicin Cisplatin 5-fluorouracil
• ECX, Epirubicin Cisplatin Capecitabin
• FOLFOX, 5-fluorouracil oxaliplatin
• FUFOL, bolus 5-fluorouracil followed by leucovorin over 15 minutes
• Gastric cancer
• IMRT
• IMRT, intensity modulated radiation therapy
• LV, leucovorin
• RT, radiation therapy
• XELOX, capecitabin oxaliplatine