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In summary, gastric and GEJ malignancies present a variety of challenges. Innovative combined-modality approaches will be needed to improve survival with acceptable morbidity. This treatment may include combinations of EBRT plus chemotherapy, IORT, and resection for the local component of disease, systemic or intraperitoneal chemotherapy for the abdominal component, and systemic treatment (chemotherapy, other) for the extraabdominal risks of relapse. For patients with metastatic disease, the availability of growth factors may allow more aggressive multidrug approaches.