Although the incidence of gastric cancer has been substantially declining for several
decades, it is still the sixth most common cancer and the fourth most frequent cause of
cancer death worldwide. Surgery is still the only curative option for gastric cancer.
However, most patients are unable to undergo surgery because of late stage, unresectable
disease. The prognosis for these patients is very poor. Although the Magic trial showed that
perioperative chemotherapy can increase the rate of curative surgery and significantly
improve overall survival in patients with operable gastric or lower esophageal
adenocarcinomas, no pCR events were reported in this trial. The intervention arm in PREACT
consists of pre-operative chemotherapy, pre-operative radiochemotherapy, surgery and
post-operative chemotherapy. The control arm consists of pre-operative chemotherapy, surgery,
and post-operative chemotherapy. The primary purpose of PREACT is to investigate whether the
addition of radiochemotherapy to chemotherapy is superior to chemotherapy alone in the
pre-operative setting in improving disease free survival in patients with locally advanced
gastric or esophagogastric junction adenocarcinoma.