What would your approach be for a patient with early stage gastric cancer who declines a gastrectomy?   

I would first clarify if less invasive endoscopic or operative strategies such as endoscopic resection (EMR vs ESD) or local resection/partial gastrectomy are appropriate and feasible based on the patient and disease related factors. If not, I’d recommend definitive chemoradiation, 50-50.4 Gy ...

I agree that chemoradiation is the option for a localized gastric cancer that is not amenable to ESD (which should be reserved only for T1a lesions). However, the elephant in the room here is that we are foregoing curative surgery for unclear reasons. Assuming the patient is not medically inoperable...