Two facts are worth mentioning: one, that solely local relapses are scarce in the studies that have been carried out, and secondly, that they do not differentiate between R0 D2 surgery alone and those with adjuvant radiochemotherapy treatment. On the other hand, in the INT-0116 study there is no signiﬁcant difference in locoregional relapses according to the arm of treatment. Final comments Therefore, in general, there are positive data to advise the use of adjuvant treatment in gastric cancer in N3 and T3/T4. There is no evidence that radiotherapy improves the rate of locoregional relapses in patients who undergo R0 D2 surgery. Even in Macdonald’s study, there is no signiﬁcant difference between the two arms, despite D0 surgery in 53% of cases. The optimum treatment has not been established, but as there is probably real potential beneﬁt, it seems reasonable to opt for any of the treatments that have shown positive results, bearing in mind the patient’s circumstances and the infrastructures available. For incomplete surgery (R1, R2 or D0), it seems advisable to include radiotherapy in the complementary treatment. In any case, a discussion of the pros and cons with the patient is fundamental to reach what should be a joint decision. However the development of new trials that allow a deﬁnitive standard treatment to be established is necessary. References Bajetta E, Buzzoni R, Mariani L, et al. 2002. Adjuvant chemotherapy in gastric cancer: 5-year results of a randomized study by the Italian Trial in Medical Oncology (ITMO) group. Ann oncol, 13(2):299–307 Bonenkamp JJ, Hermans J, Sakako M, et al. 1999. Extended lymph-node dissection for gastric cancer. Dutch Gastric Cancer Group. 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