Late Local Recurrence of Gastric Cancer After Preoperative Radiochemotherapy: Three Case Reports and Literature Review

Gastric cancer (GC) ranks as the fifth most common cancer type, contributing significantly to cancer-related mortality. This paper presents three cases of patients treated with preoperative radiochemotherapy (preopRTCT) at the National Cancer Center who experienced recurrences of GC after 15, 11 and 19 years. In all cases follow-up ended years before recurrence. Relapse was diagnosed late and treatment outcome was poor. We believe that extending the follow-up period for gastric cancer patients beyond the initial treatment is necessary especially for younger patients with large tumors. Late recurrences, often diagnosed at advanced stages, require differentiation from second primary malignancies, a process that remains diagnostically challenging. Imaging and endoscopic monitoring of asymptomatic patients may improve early detection, although cost-effectiveness concerns persist. Emphasis should be placed on modifying behavioral factors that predispose to cancer during follow-up. Identifying risk factors, molecular markers such as microRNA, and high- risk groups is essential to optimize surveillance strategies and reduce costs. Early detection could improve outcomes and offset expenses by enhancing survival and quality of life. These efforts require further research.