Locoregional gastric cancer: a narrative review of multidisciplinary management

Gastric cancer is one of the most common cancers worldwide. While relatively uncommon in the United States, worldwide it is the 5^th most common cancer diagnosed. Almost half of patients present with locoregional disease. Even with advanced surgical techniques and adjuvant perioperative treatment the prognosis for patients in this cohort is still dismal. Perioperative chemotherapy and/or radiation have been used in the last several decades in an attempt to improve outcomes in locally advanced resectable gastric cancer. In this article, we will review the development of these multimodal treatment strategies over the past two to three decades. We will compare these treatment modalities and their impact on survival outcomes. We will review the evidence for perioperative chemotherapy and radiotherapy, used in isolation and in combination. We will evaluate the evidence for these various treatment strategies and discuss how this impacts the current guidelines and recommendations. While advanced locoregional gastric cancer continues to carry significant mortality, several recent studies have added to the armament of treatment options and have seen significant improvement in progression free and overall survival in this patient population. Ongoing studies into perioperative management continue to investigate alternative treatment options and best practice for locally advanced resectable gastric cancer.