Staging	Stratification	Grade I recommendations	Grade II recommendations	Grade III recommendations
Unresectable	ECOG performance score = 0–1	Concurrent chemoradiotherapy (Evidence 1A)a,c MDT should discuss the possibility of surgery after concurrent chemoradiotherapy. If complete resection can be achieved, surgery can be considered	Chemotherapy (Evidence 2B)b Radiotherapy (Evidence 2B)c MDT should discuss the possibility of surgery after chemotherapy or radiotherapy. If complete resection can be achieved, surgery can be considered	Chemotherapyb + radiotherapy or concurrent chemoradiotherapya,c MDT should discuss the possibility of surgery after sequential chemotherapy or concurrent chemoradiotherapy. If complete resection can be achieved, surgery can be considered
	ECOG performance score = 2	Best supportive care or symptomatic treatment (Evidence 1A) Bypass surgery, endoscopic treatment, stenting, and/or palliative radiotherapy are recommended if they may improve nutritional status, alleviate bleeding, pain, or obstruction	Best supportive care or symptomatic treatment + chemotherapy ± radiotherapy (Evidence 2A) After improvement of nutritional, symptomatic status and depending on the patients’ general conditions, chemotherapyb alone or in combination with radiotherapy can be considered

ECOG Eastern Cooperative Oncology Group

^aConcurrent chemoradiotherapy regimen: Chemotherapy regimen: capecitabine + paclitaxel [82] (Evidence level 1A); cisplatin + 5-FU or capecitabine or S-1 [83] (Evidence level 1A); oxaliplatin + 5-FU or capecitabine or S-1 [84] (Evidence level 2B); paclitaxel + 5-FU or capecitabine or S-1 [80] (Evidence level 2B); capecitabine [66] (Evidence level 2B); S-1 [85] (Evidence level 2B); 5-FU [86] (Evidence level 1A)

^bFor more details regarding the chemotherapeutic regimens, please refer to “late-stage metastatic gastric cancer chemotherapy regimen”

^cRadiotherapy: Three-dimensional conformal radiotherapy/intensity-modulated radiotherapy