Guideline Video

Guideline Resources

  • Title: Radiation Therapy for Gastric Cancer
  • Society: American Society for Radiation Oncology
  • Publish Date: November 17, 2025
  • Summary
  • Full-text

Video Transcription

Just published November 17th, 2025, the American Society for Radiation Oncology’s newest guideline on Radiation Therapy for Gastric Cancer

This guideline provides evidence-based recommendations addressing the indications for radiation therapy, or RT, for gastric cancer in a variety of clinical settings ranging from patients with resectable locoregional disease to metastatic and symptomatic disease.

There are 27 recommendations but in today’s rapid update video we’ll just be going over the first 10. So to view the full guidelines, make sure to check it out on guidelinecentral.com. 

  • For patients with cT2-4 and/or N+ resectable gastric cancer, perioperative chemotherapy is recommended.
  • For patients with cT2-4 and/or N+ resectable gastric cancer receiving perioperative chemotherapy, 5-fluorouracil or 5-FU, leucovorin, oxaliplatin and docetaxel, also known as FLOT, is recommended over ECF or ECX which is epirubicin, cisplatin and 5-FU or capecitabine.
  • For patients with cT2-4 and/or N+ resectable gastric cancer who are not candidates for perioperative chemotherapy with FLOT, ECF, or ECX, preoperative chemoradiation with concurrent 5-FU or capecitabine is recommended.
  • For patients with borderline resectable gastric cancer at-risk for R1 or R2 resection with perioperative chemotherapy alone, adding preoperative chemoradiation with concurrent 5-FU or capecitabine is conditionally recommended.
  • For patients with microsatellite stable/mismatch repair proficient, cT3-4 and/or N+ resectable gastric cancer, perioperative immunotherapy with chemotherapy is conditionally recommended.
  • For patients with microsatellite unstable/mismatch repair deficient, cT2-4 and/or N+ resectable gastric cancer, perioperative immunotherapy with or without chemotherapy is conditionally recommended.
  • For patients with pT1N2-3, pT2N+, and/or pT3-4 any N stage disease following R0 resection and D2 lymphadenectomy, postoperative chemotherapy alone is recommended.
  • For patients with pT1N2-3, pT2N+, and/or pT3-4 any N stage resected gastric cancer who are not candidates for perioperative or postoperative multiagent chemotherapy, postoperative chemoradiation is conditionally recommended.
  • For patients with pT1N2-3, pT2N+, and/or pT3-4 any N stage resected gastric cancer who have <D2 lymphadenectomy, postoperative chemoradiation with or without postoperative chemotherapy is conditionally recommended.
  • For patients with cT2-4 and/or N+ resected gastric cancer with R1-2 resection, postoperative chemoradiation  with or without postoperative chemotherapy is conditionally recommended, whether or not preoperative systemic therapy was given.

And there you have it. Make sure to check out the guideline from The American Society for Radiation Oncology and other related clinical decision support tools at guidelinecentral.com.

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