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Objective To discuss the current situation and challenge to the treatment strategy for elderly patients with advanced gastric cancer and provide reference for the exploration of ideal treatment methods. Methods Collect the clinical material of an elderly patient with advanced gastric cancer, and the relevant literatures were reviewed. Results A 79-year-old man was clinically diagnosed as adenocarcinoma on the fundus of stomach (cT4a-bN2Mx). After the third course of neo-adjuvant concurrent chemo-radiotherapy, a remarkable reduction and down-staging was achieved (cT3-4N1Mx), then followed by radical gastrectomy for gastric cancer. S1 was used alone for the postoperative chemotherapy. The patient received nutritional therapy in the full treatment course, and the physical condition was satisfactory without tumor metastasis and relapse two years and a half after the surgery. Conclusions The sequentially comprehensive therapy suggestes a treatment therapy for elderly patients with advanced gastric cancer, and deserves further verification and promotion clinically.