 The mainstay of curative treatment of gastric cancer is radical surgical dissection. Because most patients in the Western world present with advanced stages long term survival is found in about 25, with local recurrences as part of treatment failure in up to 80 of cases. Studies examining the role of more extended lymph node dissections D1 vs. D2, adjuvant radiotherapy or adjuvant chemotherapy did not result in a clinical relevant improvement of survival. In 2001 results of a South West Oncology group SWOG trial that randomized between surgery and surgery with chemoradiotherapy were published. This trial, that was hampered by suboptimal surgery less than D1 in majority of patients and radiotherapy 2D radiotherapy; 35 protocol deviations showed an absolute increase in median survival of 9 months. More recently results of the MAGIC study, which randomized between surgery and surgery plus 6 perioperative courses of ECF chemotherapy, were presented. This regimen resulted in an absolute 5-year survival benefit of 13 and in a 10 higher resectability rate. 